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Sample records for surgical procedure simple

  1. Aesthetic Surgical Crown Lengthening Procedure.

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  2. Aesthetic Surgical Crown Lengthening Procedure

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  3. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira

    2015-01-01

    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  4. Evaluation of surgical procedures for trigeminal neuralgia.

    OpenAIRE

    Ong, K. S.; Keng, S. B.

    2003-01-01

    Trigeminal neuralgia is a type of facial pain that is difficult to treat. The pain can be excruciating and debilitating. The wide range of treatments currently used for trigeminal neuralgia is ample evidence that there is no simple answer to how it should be managed. This review will evaluate the current surgical procedures used for the treatment of trigeminal neuralgia. A critical analysis of the evidence-based studies to date was done to evaluate and compare the efficacy of the different su...

  5. Aesthetic Surgical Crown Lengthening Procedure

    OpenAIRE

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most h...

  6. SURGICAL PROCEDURES IN SUSHRUTA SAMHITA

    Directory of Open Access Journals (Sweden)

    Singh R.K

    2011-05-01

    Full Text Available The Sushruta Samhita is an Ayurvedic text, by the legendary Sushruta, foundational to Ayurvedic medicine (Indian traditional medicine, with innovative chapters mainly on surgery. There is a general impression that Sushruta Samhita is only an ancient Indian Ayurvedic text book of surgery. Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. It still retains the land mark position in the field of surgical texts. In addition to his worldwide known work of historical significance on plastic surgery, he also made similar unique contributions on numerous aspects of medicine, such as fracture and dislocations, urinary stones, skin diseases including leprosy, Pancha Karma (Purification procedures, toxicology, pediatrics, eye diseases, psychiatry, obstetrics and gynaecology, etc. A very limited conceptual work has been performed on the selected chapters of Sushruta Samhita. Therefore a review conceptual study has been carried out on the various surgical concepts of Sushruta Samhita. Outcome of this study shows, Sushruta Samhita is written in the aphorism form and the techniques described in it are eminently in line with technical abilities of the times. It is need of the hour to explore the hidden truth by decoding the versions of the texts.

  7. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  8. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  9. Augmented reality in surgical procedures

    Science.gov (United States)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, Ø.; Gersak, B.

    2008-02-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantially improved cost-effectiveness for the hospital and the society. However, the introduction of MIT has also led to new problems. The manipulation of structures within the body through small incisions reduces dexterity and tactile feedback. It requires a different approach than conventional surgical procedures, since eye-hand co-ordination is not based on direct vision, but more predominantly on image guidance via endoscopes or radiological imaging modalities. ARIS*ER is a multidisciplinary consortium developing a new generation of decision support tools for MIT by augmenting visual and sensorial feedback. We will present tools based on novel concepts in visualization, robotics and haptics providing tailored solutions for a range of clinical applications. Examples from radio-frequency ablation of liver-tumors, laparoscopic liver surgery and minimally invasive cardiac surgery will be presented. Demonstrators were developed with the aim to provide a seamless workflow for the clinical user conducting image-guided therapy.

  10. Anaesthesia for Ophthalmic Surgical Procedures | Onakpoya | East ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: Ophthalmic surgical procedures are performed under anaesthesia to enhance ... Local anaesthesia was the more commonly (92.1%) employed while general anaesthesia was ...

  11. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

    for all types of procedures except for eye wall repairs in which general anaesthesia was used for 71.4% of ... other hand, provide globe/lid akinesia, anaesthesia and varying .... dominance is reflective of cataract being the most common eye ...

  12. Surgical procedures in pinniped and cetacean species.

    Science.gov (United States)

    Higgins, Jennifer L; Hendrickson, Dean A

    2013-12-01

    Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment

  13. Characterization of aerosols produced by surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  14. Surgical Procedures in Predoctoral Periodontics Programs.

    Science.gov (United States)

    Radentz, William H.; Caffesse, Raul G.

    1991-01-01

    A survey of 58 dental school periodontics departments revealed the frequency of predoctoral dental students performing surgery, the frequency of specific procedures, the degree of participation or performance of students, incidence of preclinical surgical laboratories in the curricula, and materials and anesthesia used. A wide range in…

  15. Fundamental Ethical Issues in Unnecessary Surgical Procedures.

    Science.gov (United States)

    Tayade, Motilal Chandu; Dalvi, Shashank D

    2016-04-01

    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don't really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient's lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario.

  16. Measuring temperature rise during orthopaedic surgical procedures.

    Science.gov (United States)

    Manoogian, Sarah; Lee, Adam K; Widmaier, James C

    2016-09-01

    A reliable means for measuring temperatures generated during surgical procedures is needed to recommend best practices for inserting fixation devices and minimizing the risk of osteonecrosis. Twenty four screw tests for three surgical procedures were conducted using the four thermocouples in the bone and one thermocouple in the screw. The maximum temperature rise recorded from the thermocouple in the screw (92.7±8.9°C, 158.7±20.9°C, 204.4±35.2°C) was consistently higher than the average temperature rise recorded in the bone (31.8±9.3°C, 44.9±12.4°C, 77.3±12.7°C). The same overall trend between the temperatures that resulted from three screw insertion procedures was recorded with significant statistical analyses using either the thermocouple in the screw or the average of several in-bone thermocouples. Placing a single thermocouple in the bone was determined to have limitations in accurately comparing temperatures from different external fixation screw insertion procedures. Using the preferred measurement techniques, a standard screw with a predrilled hole was found to have the lowest maximum temperatures for the shortest duration compared to the other two insertion procedures. Future studies evaluating bone temperature increase need to use reliable temperature measurements for recommending best practices to surgeons.

  17. Veterinary Students' Recollection Methods for Surgical Procedures

    DEFF Research Database (Denmark)

    Langebaek, Rikke; Tanggaard, Lene; Berendt, Mette

    2016-01-01

    When veterinary students face their first live animal surgeries, their level of anxiety is generally high and this can affect their ability to recall the procedure they are about to undertake. Multimodal teaching methods have previously been shown to enhance learning and facilitate recall; however......, student preferences for recollection methods when translating theory into practice have not been documented. The aim of this study was to investigate veterinary students' experience with recollection of a surgical procedure they were about to perform after using multiple methods for preparation. From...... a group of 171 veterinary students enrolled in a basic surgery course, 26 students were randomly selected to participate in semi-structured interviews. Results showed that 58% of the students used a visual, dynamic method of recollection, mentally visualizing the video they had watched as part...

  18. The versatility of spandex photographic retractor for transoral surgical procedures.

    Science.gov (United States)

    Tauro, David P; Uppada, Uday Kiran

    2016-01-01

    The trend toward transoral access, be it for pathology or facial cosmetic surgery, has become increasingly popular over the last two decades with facial incisions being used more and more sporadically than otherwise. Transoral access because of its inherent limitations, retraction of the oral and perioral tissues without inducing physical or thermal injury makes it a daunting task for the operating surgeon. The use of conventional retractors in conjunction with surgical instruments can lead to inadvertent injury to the perioral tissues resulting in untoward postoperative sequelae leading to patient discomfort and delayed recovery. This article elucidates the versatility of a simple photographic retractor (spandex) as a useful adjunctive tool in the retraction and protection of the perioral tissues for almost all transoral surgical procedures.

  19. [Surgical treatment of the accessory navicular syndrome with simple excision].

    Science.gov (United States)

    Chi, Lei-Ting; Li, Cheng; Zhang, Dong; Li, Zhi; Huang, Bo; Zhang, Ting-Jiu; Yu, Ming; Wang, Ping-Xi

    2009-12-01

    To observe and evaluate the clinical effects of surgical treatment for the accessory navicular syndrome with simple excision. From November 2006 to December 2008, 23 patients (twenty-five feet) with accessory navicular syndrome received simple excision of the accessory navicular bone. The chief complains were intermittent pain of feet after running or walking. Physical examination showed local tenderness on palpation in the region of the navicular bone. X-ray or CT showed there was an accessory navicular bone. The present history ranged from 6 months to 12 years. There were 14 males and 9 females. The mean age was 14.6 years, ranging from 8 to 35 years. About 2 cm long incision was made at the tip of the medial prominence of the navicular bone. After partial dissection of the posterior tibial tendon, the accesssory navicular bone was exposed and excisied. The prominence of the tuberosity of the navicular bone was cut and shaved. The posterior tibial tenden was repaired before closing the wound. The foot was immobilized with cast or brace in inversion position and no weight-bearing for 2 weeks. Strenuous jumping or dancing must be avoided in 3 months after surgery. The patients with residual symptoms and signs received physical therapy and an arch support for shoes without flatfoot deformity. The average clinical follow-up during was 12 month (ranged, 3 to 18 months). The excellent results in 21 feet and good in 4 feet (3 feet with mild flat deformity and 1 foot with old sprain injury). The average hospital stay was 5 days and no wound infection occurred. All patients resumed the normal life and study after operation. Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for

  20. Finishing procedures in orthodontic-surgical cases.

    Science.gov (United States)

    Brunel, Jean-Michel

    2015-09-01

    To ensure optimal results, we must do our utmost to achieve targets based on order, symmetry and precision, our ultimate aim being to strive towards the desired harmony, planned contrast and exact proportions. Orthodontic-surgical treatments require specific finishing procedures, which most often call for multidisciplinary, or even transdisciplinary, collaboration. Finishing will involve the dental arches just as much as the orofacial environment. Above all, treatment of this kind demands a highly targeted approach in combination with well-defined and perfectly executed techniques. To finish a case satisfactorily, reasonable targets should be aimed for to ensure they are achieved. One must be ambitious and yet wise. A tight alliance of surgeon and orthodontist will nurture convincing and achievable projects and good, lifelong outcomes. Following the consolidation phase, roughly 4 to 6 weeks post-surgery, we can initiate the final orthodontic treatment, which, in effect, constitutes a mini-treatment in its own right. "Details make perfection, but perfection is not a detail" (Leonardo Da Vinci). "A lucid mind is the ante-chamber of intelligence" (Léo Ferré). In the order of life, every form of unity is always unique, and if each of us is unique, it is because everyone else is too. Ambition, wisdom, lucidity and efficiency will guarantee a successful result, the successful result. We must not be mere observers of our treatments, but the architect, project manager and site foreman at one and the same time. One could talk ad infinitum about finishing orthodontic-surgical cases because everything else leads up to the case-finishing and even the fullest description could never be exhaustive. Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.

  1. A simple procedure for estimating soil porosity

    Science.gov (United States)

    Emmet-Booth, Jeremy; Forristal, Dermot; Fenton, Owen; Holden, Nick

    2016-04-01

    Soil degradation from mismanagement is of international concern. Simple, accessible tools for rapidly assessing impacts of soil management are required. Soil structure is a key component of soil quality and porosity is a useful indicator of structure. We outline a version of a procedure described by Piwowarczyk et al. (2011) used to estimate porosity of samples taken during a soil quality survey of 38 sites across Ireland as part of the Government funded SQUARE (Soil Quality Assessment Research) project. This required intact core (r = 2.5 cm, H = 5cm) samples taken at 5-10 cm and 10-20 cm depth, to be covered with muslin cloth at one end and secured with a jubilee clip. Samples were saturated in sealable water tanks for ≈ 64 hours, then allowed to drain by gravity for 24 hours, at which point Field Capacity (F.C.) was assumed to have been reached, followed by oven drying with weight determined at each stage. This allowed the calculation of bulk density and the estimation of water content at saturation and following gravitational drainage, thus total and functional porosity. The assumption that F.C. was reached following 24 hours of gravitational drainage was based on the Soil Moisture Deficit model used in Ireland to predict when soils are potentially vulnerable to structural damage and used nationally as a management tool. Preliminary results indicate moderately strong, negative correlations between estimated total porosity at 5-10 cm and 10-20 cm depth (rs = -0.7, P soil quality scores of the Visual Evaluation of Soil Structure (VESS) method which was conducted at each survey site. Estimated functional porosity at 5-10 cm depth was found to moderately, negatively correlate with VESS scores (rs = - 0.5, P indicating porosity of a large quantity of samples taken at numerous sites or if done periodically, temporal changes in porosity at a field scale, indicating the impacts of soil management. Reference Piwowarczyk, A., Giuliani, G. & Holden, N.M. 2011. Can soil

  2. Development of a Cognitive Robotic System for Simple Surgical Tasks

    OpenAIRE

    Riccardo Muradore; Paolo Fiorini; Gokhan Akgun; Duygun Erol Barkana; Marcello Bonfe; Fabrizio Boriero; Andrea Caprara; Giacomo Rossi; Riccardo Dodi; Ole Jakob Elle; Federica Ferraguti; Lorenza Gasperotti; Roger Gassert; Kim Mathiassen; Dilla Handini

    2015-01-01

    ARTICLE International Journal of Advanced Robotic Systems Development of a Cognitive Robotic System for Simple Surgical Tasks Invited Feature Article Riccardo Muradore1*, Paolo Fiorini1, Gokhan Akgun2, Duygun Erol Barkana3, Marcello Bonfe4, Fabrizio Boriero1, Andrea Caprara11, Giacomo De Rossi1, Riccardo Dodi5, Ole Jakob Elle6, Federica Ferraguti7, Lorenza Gasperotti1, Roger Gassert8, Kim Mathiassen6, Dilla Handini9, Olivier Lambercy8, Lin Li10, Maarja Kruusmaa10, Aura...

  3. Historical perspectives on the evolution of surgical procedures in endodontics.

    Science.gov (United States)

    Gutmann, James L; Gutmann, Marylou S

    2010-01-01

    The historical pathway to current surgical endodontic procedures and their applications has been tortuous and tumultuous. Influenced heavily in their development by the European sector, these surgical procedures faced many challenges over the decades. Fortunately for today's practitioners, influential members of the oral surgery community, and a few staunch believers in retaining devitalized teeth, persisted in their investigation of and search for improved procedures that had predictable outcomes. Many so-called "revolutionary" or newer techniques practiced today are but a re-emergence of surgical concepts that were lost in the archives of time. With the advent of evidence-based endodontics, these procedures are now supported extensively by science and by the integration of science into materials usage, technique applications and outcomes research. However, in many respects, this story is just beginning, as the "roots" of surgical endodontics are explored.

  4. Factors affecting anxiety-fear of surgical procedures in dentistry ...

    African Journals Online (AJOL)

    Factors affecting anxiety-fear of surgical procedures in dentistry. ... the questions concerning previous dental experience, education level, and previous ... structure and gender are the significantly effective factors on dental anxiety and fear.

  5. Pneumatic tourniquet for surgical procedures of hemodialysis vascular access.

    Science.gov (United States)

    Wang, Shouwen

    2015-01-01

    Pneumatic tourniquet has been frequently utilized in various surgical specialties to facilitate surgical procedures on the extremities. However, its use for surgical procedures of hemodialysis access has been limited to some surgeons in the United States and often confined to the hospital settings under general anesthesia or regional nerve block. We have successfully employed a pneumatic tourniquet system for surgical procedures of hemodialysis access under conscious sedation and local anesthesia in an outpatient setting. Because prolonged tourniquet inflation is associated with ischemic pain and other potential complications, we have limited the continuous inflation time to pneumatic tourniquet use is well tolerated under conscious sedation and not associated with significant adverse events. These and other reported data suggest that pneumatic tourniquet can reduce procedure time, minimize required dissection, reduce vascular trauma by eliminating vascular clamps and potentially improve the outcomes of surgical procedures of hemodialysis access. These advantages may be translated into cost savings for hemodialysis access care. This review discusses practical issues of pneumatic tourniquet use and its applications in surgical procedures of hemodialysis access. © 2014 Wiley Periodicals, Inc.

  6. Mucogingival surgical procedures: a review of the literature.

    Science.gov (United States)

    Haeri, A; Serio, F G

    1999-07-01

    This article provides an in-depth review of the literature on mucogingival surgical techniques. Indications and contraindications of various surgical procedures are discussed with reference to the literature. Surgical techniques and indications for increasing the zone of keratinized tissue, such as free autogenous grafts, applications of freeze-dried skin, and dermal matrix allografts, are described. Procedures to attain root coverage, such as various autogenous grafts and guided tissue regeneration techniques, along with application of chemicals such as citric acid to improve their success, are also described.

  7. Surgical site infection rates following laparoscopic urological procedures.

    Science.gov (United States)

    George, Arvin K; Srinivasan, Arun K; Cho, Jane; Sadek, Mostafa A; Kavoussi, Louis R

    2011-04-01

    Surgical site infections have been categorized by the Centers for Medicare and Medicaid Services as "never events". The incidence of surgical site infection following laparoscopic urological surgery and its risk factors are poorly defined. We evaluated surgical site infection following urological laparoscopic surgery and identified possible factors that may influence occurrence. Patients who underwent transperitoneal laparoscopic procedures during a 4-year period by a single laparoscopic surgeon were retrospectively reviewed. Surgical site infections were identified postoperatively and defined using the Centers for Disease Control criteria. Clinical parameters, comorbidities, smoking history, preoperative urinalysis and culture results as well as operative data were analyzed. Nonparametric testing using the Mann-Whitney U test, multivariable logistic regression and Spearman's rank correlation coefficient were used for data analysis. In 556 patients undergoing urological laparoscopic procedures 14 surgical site infections (2.5%) were identified at mean postoperative day 21.5. Of the 14 surgical site infections 10 (71.4%) were located at a specimen extraction site. Operative time, procedure type and increasing body mass index were significantly associated with the occurrence of surgical site infections (p = 0.007, p = 0.019, p = 0.038, respectively), whereas history of diabetes mellitus (p = 0.071) and intraoperative transfusion (p = 0.053) were found to trend toward significance. Age, gender, positive urine culture, steroid use, procedure type and smoking history were not significantly associated with surgical site infection. Body mass index and operative time remained significant predictors of surgical site infection on multivariate logistic regression analysis. Surgical site infection is an infrequent complication following laparoscopic surgery with the majority occurring at the specimen extraction site. Infection is associated with prolonged operative time and

  8. Modeling and prediction of surgical procedure times

    NARCIS (Netherlands)

    P.S. Stepaniak (Pieter); C. Heij (Christiaan); G. de Vries (Guus)

    2009-01-01

    textabstractAccurate prediction of medical operation times is of crucial importance for cost efficient operation room planning in hospitals. This paper investigates the possible dependence of procedure times on surgeon factors like age, experience, gender, and team composition. The effect of these f

  9. Craniopharyngioma--analysis of surgical procedure.

    Science.gov (United States)

    Takahashi, T; Fujii, H; Toba, Y; Isayama, Y; Tamaki, N; Matsumoto, S

    1983-01-01

    Twenty cases of craniopharyngiomas treated surgically between 1972 and 1979 have been studed neuro-ophthalmologically. The visual fields demonstrated asymetrical bitemporal hemianopsia, occasionally homonymous hemianopsia and central scotomas. The visual function was followed up for a period of one to 8 years after the operation. Improvement and retention of the visual function were observed in 88% of cases with subtotal resection and irradiation, 45% of cases with partial resection and irradiation, and 0% of totally resected cases. Histopathologically, the dense adhesion and tumor invasion in the optic chiasm were observed in autopsy cases. From the viewpoint of operative results and autopsy findings, the subtotal excision with irradiation is advocated for the treatment of craniopharyngiomas, particularly in the adult cases.

  10. Surgical conditions and requested procedures for ruminants and ...

    African Journals Online (AJOL)

    cal conditions and requested procedures cattle, sheep, goat, dog and cat, accounted ... pattern of surgical diseases and requested procedures among ruminants and ..... or primary closure. 10 (18.18%). -. 10(7.51%). Dental caries tooth extraction. 1(1.81 ... Third eyelid prolapse .... To facilitate the healing process of traumatic.

  11. Effect of bariatric surgery on future general surgical procedures

    Directory of Open Access Journals (Sweden)

    Subhash Kini

    2011-01-01

    Full Text Available Bariatric surgery is now accepted as a safe and effective procedure for morbid obesity. The frequency of bariatric procedures is increasing with the adoption of the laparoscopic approach. The general surgeons will be facing many more of such patients presenting with common general surgical problems. Many of the general surgeons, faced with such situations, may not be aware of the changes in the gastrointestinal anatomy following bariatric procedures and management of these clinical situations will therefore present diagnostic and therapeutic challenges. We hereby present a review of management of few common general surgical problems in patients with a history of bariatric surgery.

  12. Chronic pancreatitis: A surgical disease? Role of the Frey procedure

    Institute of Scientific and Technical Information of China (English)

    Alexra; Roch; Jérome; Teyssedou; Didier; Mutter; Jacques; Marescaux; Patrick; Pessaux

    2014-01-01

    Although medical treatment and endoscopic interven-tions are primarily offered to patients with chronic pancreatitis, approximately 40% to 75% will ultimately require surgery during the course of their disease. Al-though pancreaticoduodenectomy has been considered the standard surgical procedure because of its favorable results on pain control, its high postoperative complica-tion and pancreatic exocrine or/and endocrine dysfunc-tion rates have led to a growing enthusiasm for duodenal preserving pancreatic head resection. The aim of this review is to better understand the rationale underlying of the Frey procedure in chronic pancreatitis and to ana-lyze its outcome. Because of its hybrid nature, combin-ing both resection and drainage, the Frey procedure has been conceptualized based on the pathophysiology of chronic pancreatitis. The short and long-term outcome, especially pain relief and quality of life, are better after the Frey procedure than after any other surgical proce-dure performed for chronic pancreatitis.

  13. Reported analgesic administration to rabbits undergoing experimental surgical procedures.

    Science.gov (United States)

    Coulter, Claire A; Flecknell, Paul A; Leach, Matthew C; Richardson, Claire A

    2011-02-21

    It has become widely accepted that whenever animals are used in scientific procedures, the 3Rs principle of replacement, reduction and refinement described by William Russell and Rex Burch should be adhered to. Animals should be replaced with non-sentient alternatives if possible, the number of animals used should be reduced and experimental procedures should be refined to minimise pain, suffering and distress. Administration of analgesic agents to animals undergoing surgical procedures is a refinement used to alleviate pain. In this study, a structured literature review was carried out to examine current trends in analgesic administration to rabbits undergoing experimental surgical procedures. 128 papers from 51 peer-reviewed journals were selected for inclusion in this review. Reporting administration of systemic analgesia to rabbits in peer-reviewed scientific papers increased significantly from 16% to 50% between 1995-1997 and 2005-2007 (P rabbits undergoing surgical procedures is increasing, rabbits do not always receive analgesia when they undergo experimental surgery. Other practices in rabbit perioperative care that could be improved, highlighted by this survey include: 1) changing the timing of analgesic administration by giving systemic analgesics pre- or perioperatively rather than only postoperatively, 2) using multimodal analgesia when pain is likely to be moderate to severe and 3) increasing the use of non-steroidal anti-inflammatory drugs and use of other techniques such as epidural analgesia particularly for orthopaedic procedures.

  14. Reported analgesic administration to rabbits undergoing experimental surgical procedures

    Directory of Open Access Journals (Sweden)

    Leach Matthew C

    2011-02-01

    Full Text Available Abstract Background It has become widely accepted that whenever animals are used in scientific procedures, the 3Rs principle of replacement, reduction and refinement described by William Russell and Rex Burch should be adhered to. Animals should be replaced with non-sentient alternatives if possible, the number of animals used should be reduced and experimental procedures should be refined to minimise pain, suffering and distress. Administration of analgesic agents to animals undergoing surgical procedures is a refinement used to alleviate pain. In this study, a structured literature review was carried out to examine current trends in analgesic administration to rabbits undergoing experimental surgical procedures. Results 128 papers from 51 peer-reviewed journals were selected for inclusion in this review. Reporting administration of systemic analgesia to rabbits in peer-reviewed scientific papers increased significantly from 16% to 50% between 1995-1997 and 2005-2007 (P P Conclusions Although this review provides evidence that systemic analgesic administration to rabbits undergoing surgical procedures is increasing, rabbits do not always receive analgesia when they undergo experimental surgery. Other practices in rabbit perioperative care that could be improved, highlighted by this survey include: 1 changing the timing of analgesic administration by giving systemic analgesics pre- or perioperatively rather than only postoperatively, 2 using multimodal analgesia when pain is likely to be moderate to severe and 3 increasing the use of non-steroidal anti-inflammatory drugs and use of other techniques such as epidural analgesia particularly for orthopaedic procedures.

  15. Effect of surgical procedures on prostate tumor gene expression profiles

    Institute of Scientific and Technical Information of China (English)

    Jie Li; Zhi-Hong Zhang; Chang-Jun Yin; Christian Pavlovich; Jun Luo; Robert Getzenberg; Wei Zhang

    2012-01-01

    Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALRP).Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens,which are indispensable for molecular analysis and biomarker evaluation.The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature.RNA integrity number (RIN) values were compared between total RNA samples extracted from consecutive LRP (n=11 ) and ORP (n=24) prostate specimens.Expression profiling was performed using the Agilent human whole-genome expression microarrays.Expression differences by surgical type were analyzed by Volcano plot analysis and gene ontology analysis.Quantitative reverse transcription (RT)-PCR was used for expression validation in an independent set of LRP (n=8) and ORP (n=8) samples.The LRP procedure did not compromise RNA integrity.Differential gene expression by surgery types was limited to a small subset of genes,the number of which was smaller than that expected by chance.Unexpectedly,this small subset of differentially expressed genes was enriched for those encoding transcription factors,oxygen transporters and other previously reported surgery-induced stress-response genes,and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens.The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible,supporting the suitability of LRP surgical specimens for routine molecular analysis.Blunted in vivo stress response in LRP specimens,likely mediated by CO2 insufflation but not by longer ischemia time,is manifested in the reduced expression of stress-response genes in these specimens.

  16. Surgical Procedures Needed to Eradicate Infection in Knee Septic Arthritis.

    Science.gov (United States)

    Dave, Omkar H; Patel, Karan A; Andersen, Clark R; Carmichael, Kelly D

    2016-01-01

    Septic arthritis of the knee is encountered on a regular basis by orthopedists and nonorthopedists. No established therapeutic algorithm exists for septic arthritis of the knee, and there is much variability in management. This study assessed the number of surgical procedures, arthroscopic or open, required to eradicate infection. The study was a retrospective analysis of 79 patients who were treated for septic knee arthritis from 1995 to 2011. Patients who were included in the study had native septic knee arthritis that had resolved with treatment consisting of irrigation and debridement, either open or arthroscopic. Logistic regression analysis was used to explore the relation between the interval between onset of symptoms and index surgery and the use of arthroscopy and the need for multiple procedures. Fifty-two patients met the inclusion criteria, and 53% were male, with average follow-up of 7.2 years (range, 1-16.2 years). Arthroscopic irrigation and debridement was performed in 70% of cases. On average, successful treatment required 1.3 procedures (SD, 0.6; range, 1-4 procedures). A significant relation (P=.012) was found between time from presentation to surgery and the need for multiple procedures. With arthroscopic irrigation and debridement, most patients with septic knee arthritis require only 1 surgical procedure to eradicate infection. The need for multiple procedures increases with time from onset of symptoms to surgery.

  17. How I do it: Simple and effortless approach to identify thoracodorsal nerve on axillary clearance procedure

    Science.gov (United States)

    Zin, T; Maw, M; Oo, SM; Pai, DR; Paijan, RB; Kyi, M

    2012-01-01

    Breast cancer surgery frequently involves an axillary clearance procedure for nodal metastases. Injury to the thoracodorsal nerve is one of the complications related to the axillary dissection. The thoracodorsal nerve innervates the latissimus dorsi muscle which facilitates in certain movements of the arm. Moreover, it can be used as a nerve graft in long thoracic nerve injury whether in trauma or surgery. Understanding the anatomy structures and good surgical technique in the axillary clearance procedure can identify and prevent such an injury to the thoracodorsal nerve. Here, we demonstrate a simple and effortless technique for identification of the thoracodorsal nerve during axillary surgery. PMID:22675404

  18. Surgical site infections in paediatric otolaryngology operative procedures.

    Science.gov (United States)

    Ifeacho, S N; Bajaj, Y; Jephson, C G; Albert, D M

    2012-07-01

    An assessment of the rate of surgical site infections associated with elective paediatric otolaryngology surgical procedures. Prospective data was collected for a 3-week period for all children undergoing surgery where either mucosa or skin was breached. The parents of the children were requested to complete a questionnaire at 30 days after the operation. Data was collected on 80 consecutive cases. The majority of cases were admitted on the day of the procedure. The procedures included adenotonsillectomy (24), grommets (12), cochlear implantation (6), bone-anchored hearing aid (2), submandibular gland excision (1), branchial sinus excision (1), cystic hygroma excision (3), nasal glioma excision (1), microlaryngobronchoscopy (13), tracheostomy (3) and other procedures (14). Nearly half the cases had more than one operation done at the same time. 26/80 (32.5%) patients had a temporary or permanent implant inserted at the time of operation (grommet, bone-anchored hearing aid, cochlear implant). 25/80 (31%) operative fields were classed as clean and 55/80 (68.7%) as clean contaminated operations. The duration of the operation varied from 6 min to 142 min. Hospital antibiotic protocol was adhered to in 69/80 (86.3%) cases but not in 11/80 cases. In our series, 3/80 (3.7%) patients had an infection in the postoperative period. Surgical site infections do occur at an appreciable rate in paediatric otolaryngology. With the potential for serious consequences, reduction in the risk of surgical site infections is important. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Legal sanctity of consent for surgical procedures in India

    Directory of Open Access Journals (Sweden)

    Gauri Sharma

    2012-01-01

    Full Text Available As surgeons, we are morally committed to respecting the right of self-determination of patients, thus an informed consent is necessary before any operative intervention. Many neurosurgical patients are incapable of giving consent because of impaired consciousness. Moreover, neurosurgical procedures involve high risks and often are time sensitive; therefore obtaining consent is a challenging job. Patients and their family members need immense courage, understanding, and trust before giving consent for a surgical procedure to a doctor. Lawsuits against doctors are on the rise and it is important to understand "what is consent?" in legal parlance.

  20. A Simple and Safe Procedure to Repair Rectal Prolapse Perineally Using Stapling Devices

    Directory of Open Access Journals (Sweden)

    Fumitake Hata

    2014-01-01

    Full Text Available Rectal prolapses are not life-threatening, however the bleeding and fecal incontinence associated with them significantly erode quality of life and can cause concern among patients' caregivers in nursing homes. Many procedures have been reported that repair rectal prolapses, and the procedure used depends on the severity of the prolapse; however, the treatments are yet to be established. Here we report a simple and safe procedure to repair rectal prolapse perineally using stapling devices. We performed this procedure on 5 patients within a short time. All patients were followed up for over 24 months and none had any recurrences of their rectal prolapses. No complications occurred during the operations and postoperative periods. Most patients who have prolapses are elderly and fragile, so the treatment must be easy, safe, and rapid. While rectal prolapse is not life-threatening, the goal of treatment is to alleviate its symptoms. The procedure we describe is consistent with this concept. We suggest that this procedure, which uses surgical stapling devices, might be a better option for the treatment of complete rectal prolapse. We will continue to surgically correct complete rectal prolapses and investigate the long-term outcomes of the procedure.

  1. Simple procedures for analyzing and purifying methylene green.

    Science.gov (United States)

    Glusko, C A; Previtali, C M; Chesta, C A; Montejano, H A

    2012-07-01

    Methylene green is a versatile dye that can be used in a wide range of technical applications, most of which require the dye to be pure. Because commercial lots of methylene green are known to be heterogeneous, we report a thin layer chromatographic method for checking purity. We also describe a simple and effective flash chromatographic purification procedure for subsequent purification. The identity and purity of the dye can be checked easily using UV-visible absorption spectrum measurements or by more sophisticated procedures if necessary.

  2. Nuss procedure in adult pectus excavatum: a simple artifice to reduce sternal tension.

    Science.gov (United States)

    Ravenni, Giacomo; Actis Dato, Guglielmo Mario; Zingarelli, Edoardo; Flocco, Roberto; Casabona, Riccardo

    2013-07-01

    Nowadays the Nuss operation represents the standard surgical choice for pectus excavatum repair in children and teenagers. Some concerns have been raised regarding its applicability in adults, as compared with younger patients, in view of the higher rate of complications after surgery. We describe an easy trick that has been performed on a 36-year old man with a moderate pectus excavatum after an unsatisfactory Nuss procedure. It consisted of a T-shaped partial anterior sternotomy, performed after positioning of the stainless steel bar, in order to promote a hinge mechanism of the sternum to reduce the tension over the reinforcement. This procedure was successful with well-controlled postoperative pain and great patient satisfaction. No complications were recorded at 1-year follow-up. In our opinion, this simple trick could represent a valid surgical option for pectus excavatum repair in late adolescents and adults to obviate the occurrence of major sternal tension.

  3. Manga Vectorization and Manipulation with Procedural Simple Screentone.

    Science.gov (United States)

    Yao, Chih-Yuan; Hung, Shih-Hsuan; Li, Guo-Wei; Chen, I-Yu; Adhitya, Reza; Lai, Yu-Chi

    2017-02-01

    Manga are a popular artistic form around the world, and artists use simple line drawing and screentone to create all kinds of interesting productions. Vectorization is helpful to digitally reproduce these elements for proper content and intention delivery on electronic devices. Therefore, this study aims at transforming scanned Manga to a vector representation for interactive manipulation and real-time rendering with arbitrary resolution. Our system first decomposes the patch into rough Manga elements including possible borders and shading regions using adaptive binarization and screentone detector. We classify detected screentone into simple and complex patterns: our system extracts simple screentone properties for refining screentone borders, estimating lighting, compensating missing strokes inside screentone regions, and later resolution independently rendering with our procedural shaders. Our system treats the others as complex screentone areas and vectorizes them with our proposed line tracer which aims at locating boundaries of all shading regions and polishing all shading borders with the curve-based Gaussian refiner. A user can lay down simple scribbles to cluster Manga elements intuitively for the formation of semantic components, and our system vectorizes these components into shading meshes along with embedded Bézier curves as a unified foundation for consistent manipulation including pattern manipulation, deformation, and lighting addition. Our system can real-time and resolution independently render the shading regions with our procedural shaders and drawing borders with the curve-based shader. For Manga manipulation, the proposed vector representation can be not only magnified without artifacts but also deformed easily to generate interesting results.

  4. A novel surgical procedure for bridging of massive bone defects

    Directory of Open Access Journals (Sweden)

    Springfield Dempsey S

    2005-02-01

    Full Text Available Abstract Background Bony defects arising from tumor resection or debridement after infection, non-union or trauma present a challenging problem to orthopedic surgeons, as well as patients due to compliance issues. Current treatment options are time intensive, require more than one operation and are associated with high rate of complications. For this reason, we developed a new surgical procedure to bridge a massive long bone defect. Methods To bridge the gap, an in situ periosteal sleeve is elevated circumferentially off of healthy diaphyseal bone adjacent to the bone defect. Then, the adjacent bone is osteotomized and the transport segment is moved along an intramedullary nail, out of the periosteal sleeve and into the original diaphyseal defect, where it is docked. Vascularity is maintained through retention of the soft tissue attachments to the in situ periosteal sleeve. In addition, periosteal osteogenesis can be augmented through utilization of cancellous bone graft or in situ cortical bone adherent to the periosteal sleeve. Results The proposed procedure is novel in that it exploits the osteogenic potential of the periosteum by replacing the defect arising from resection of tissue out of a pathological area with a defect in a healthy area of tissue, through transport of the adjacent bone segment. Furthermore, the proposed procedure has several advantages over the current standard of care including ease of implementation, rapid patient mobilization, and no need for specialized implants (intramedullary nails are standard inventory for surgical oncology and trauma departments or costly orthobiologics. Conclusions The proposed procedure offers a viable and potentially preferable alternative to the current standard treatment modalities, particularly in areas of the world where few surgeons are trained for procedures such as distraction osteogenesis (e.g. the Ilizarov procedure as well as areas of the world where surgeons have little access to

  5. Total bilateral hip arthroplasty in one surgical procedure

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    Popović Zoran

    2007-01-01

    Full Text Available Background/Aim. Primary coxarthrosis occurs often in older population. There is possibility of implanting both endoprothesis simultaneously in bilateral coxarthrosis which decreases hospitalization and reduces the expenses and possibility of complication that can occur during general anesthesia. The most serious indications for bilateral total hip arthroplasty in one procedure are younger patients with serious bilateral osteoarthrosis of the hips, without added diseases. Absolute contraindication is found in patients with persistent ductus arteriosus and septal defect. The aim of this study was to point out the possibility and advantages of a single-staged bilateral hip arthroplasty and introducing it in our orthopedic practice. Methods. The procedure was accomplished in 19 patients. The standard total hip arthroplasty surgical technique was performed, followed by the usual antibiotic and anticoagulant therapy. Results. Only one complication - acetabular part instability we recorded, followed by luxation that was surgically managed. Conclusion. This procedure can be performed routinely in selected population and should be reserved for major medical centers capable to provide adequate postoperative care.

  6. A simple procedure for the comparison of covariance matrices.

    Science.gov (United States)

    Garcia, Carlos

    2012-11-21

    Comparing the covariation patterns of populations or species is a basic step in the evolutionary analysis of quantitative traits. Here I propose a new, simple method to make this comparison in two population samples that is based on comparing the variance explained in each sample by the eigenvectors of its own covariance matrix with that explained by the covariance matrix eigenvectors of the other sample. The rationale of this procedure is that the matrix eigenvectors of two similar samples would explain similar amounts of variance in the two samples. I use computer simulation and morphological covariance matrices from the two morphs in a marine snail hybrid zone to show how the proposed procedure can be used to measure the contribution of the matrices orientation and shape to the overall differentiation. I show how this procedure can detect even modest differences between matrices calculated with moderately sized samples, and how it can be used as the basis for more detailed analyses of the nature of these differences. The new procedure constitutes a useful resource for the comparison of covariance matrices. It could fill the gap between procedures resulting in a single, overall measure of differentiation, and analytical methods based on multiple model comparison not providing such a measure.

  7. A simple procedure for the comparison of covariance matrices

    Science.gov (United States)

    2012-01-01

    Background Comparing the covariation patterns of populations or species is a basic step in the evolutionary analysis of quantitative traits. Here I propose a new, simple method to make this comparison in two population samples that is based on comparing the variance explained in each sample by the eigenvectors of its own covariance matrix with that explained by the covariance matrix eigenvectors of the other sample. The rationale of this procedure is that the matrix eigenvectors of two similar samples would explain similar amounts of variance in the two samples. I use computer simulation and morphological covariance matrices from the two morphs in a marine snail hybrid zone to show how the proposed procedure can be used to measure the contribution of the matrices orientation and shape to the overall differentiation. Results I show how this procedure can detect even modest differences between matrices calculated with moderately sized samples, and how it can be used as the basis for more detailed analyses of the nature of these differences. Conclusions The new procedure constitutes a useful resource for the comparison of covariance matrices. It could fill the gap between procedures resulting in a single, overall measure of differentiation, and analytical methods based on multiple model comparison not providing such a measure. PMID:23171139

  8. A simple procedure for the comparison of covariance matrices

    Directory of Open Access Journals (Sweden)

    Garcia Carlos

    2012-11-01

    Full Text Available Abstract Background Comparing the covariation patterns of populations or species is a basic step in the evolutionary analysis of quantitative traits. Here I propose a new, simple method to make this comparison in two population samples that is based on comparing the variance explained in each sample by the eigenvectors of its own covariance matrix with that explained by the covariance matrix eigenvectors of the other sample. The rationale of this procedure is that the matrix eigenvectors of two similar samples would explain similar amounts of variance in the two samples. I use computer simulation and morphological covariance matrices from the two morphs in a marine snail hybrid zone to show how the proposed procedure can be used to measure the contribution of the matrices orientation and shape to the overall differentiation. Results I show how this procedure can detect even modest differences between matrices calculated with moderately sized samples, and how it can be used as the basis for more detailed analyses of the nature of these differences. Conclusions The new procedure constitutes a useful resource for the comparison of covariance matrices. It could fill the gap between procedures resulting in a single, overall measure of differentiation, and analytical methods based on multiple model comparison not providing such a measure.

  9. [Mammary prosthesis: considerations about a choreography of the surgical procedure].

    Science.gov (United States)

    Grolleau, J-L; Gangloff, D; Garrido, I; Chavoin, J-P

    2005-10-01

    Breast augmentation offers a high rate of satisfaction but the local complications remain frequent. These are mainly capsular contracture, malpositions of implant, acute or infraclinical infections. The causes of these complications are multifactorials. The goal of this chapter is to determine the effect of the surgical technique on the result. We think that if no routine procedure can be proposed, a reflexion on the objectives of the breast augmentation and the adaptation of the surgical technique is necessary for each surgeon. We identify twelve aims and discuss them: rigorous preoperative planning, determination of the position of the implant, creation of an adapted implant pocket, as much atraumatic as possible dissection, no bacterial contamination, no foreign particles, respect of the implant, drainage or not, efficient suture, pain and discomfort control, need for contension and clear postoperative advices. These objectives being precised, we integrate them in a chronological surgical process under the form of questions. Each surgeon can then choose his answers by evaluating the arguments, which led to his choices.

  10. [Surgical crown lengthening procedures. Preparatory step for fixed prosthesis].

    Science.gov (United States)

    Parashis, A O; Tripodakis, A P

    1990-04-01

    Necessary restorative requirements for full coverage are adequate axial wall height of the preparation for retention as well as sufficient vertical width of sound tooth structure cervically for the crown margins. In cases where adequate healthy tooth structure does not exist coronally to the epithelial attachment due to various crown damages, the margins of the crown might traumatize the periodontal attachment and the periodontium will be jeopardized iatrogenically. Teeth with inadequate axial Reight of the clinical crown, subgingival caries, vertical or horizontal fractures will require surgical crown lengthening procedures before prosthetic treatment is performed. These procedures may either involve only the soft tissues or bone remodeling as well. Irrespective of the procedure, crown lengthening must be performed with the objective of at least 3 mm. of healthy tooth structure coronally to the bone. This width will permit the formation of a new dentinogingival junction and the existence of 1-2 m.m. of sound tooth structure coronally to the new attachment line for the construction of a biologically acceptable crown margin. The purpose of this article is to discuss the clinical problem and underline the importance of crown lengthening procedures as a preparatory step for prosthetic treatment in fixed partial dentures.

  11. Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Taghavi, Sharven; Jayarajan, Senthil N; Mangi, Abeel A; Hollenbach, Kathryn; Dauer, Elizabeth; Sjoholm, Lars O; Pathak, Abhijit; Santora, Thomas A; Goldberg, Amy J; Rappold, Joseph F

    2015-01-01

    As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

  12. Surgical procedure of Free Flap. Main nursing care

    Directory of Open Access Journals (Sweden)

    Manuel Molina López

    2010-05-01

    Full Text Available The free flap surgical technique is used to cover extensive skin loss areas and situations where no flap is available, or in axial zones. The great breackthrough in the field of reconstructive surgical techniques and the creation of new units where these complex techniques are used, means that the nursing staff who work in these hospital units are adquiring greater protagonism in caring for, and the subsequent success of this type of surgery in which the problems of collaboration in all the perioperative phases depend entirely on the nursing team.The collaborative nursing problems could be defined as real or potential health problems, where users need nursing staff to follow the treatment and control procedures prescribed by other professional, generally doctors, who control and are responsible for the final outcome.While planning collaborative objectives and activities it should be taken into account that the function of the nursing staff is twofold: on the one hand, the patient must be taken care of as prescribed by other professionals and, on the other hand, it should bring into play cognitive elements (knowledge and know-how and clinical judgment when executing these in controlling the patients evolution.In this article our intention is to give an interesting and comprehensive description of the free flap surgical technique, its pros and cons, and identify the principal collaborative problems which nursing will have to deal with in each one of the perioperative phases, the number and specific nature of such oblige nursing on many occasions, to update and/or acquire new skills.

  13. Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures.

    Science.gov (United States)

    Myers, Douglas J; Lipscomb, Hester J; Epling, Carol; Hunt, Debra; Richardson, William; Smith-Lovin, Lynn; Dement, John M

    2016-05-01

    To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures. A 10-year retrospective cohort study. A single large academic teaching hospital. Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010 and 2,113 reported percutaneous BBFE were analyzed. A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices. RESULTS The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture needles (0.96 [0.88-1.04]). Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

  14. Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease

    Institute of Scientific and Technical Information of China (English)

    Deha Erdogan; Otto M van Delden; Erik AJ Rauws; Olivier RC Busch; Johan S Lameris; Dirk J Gouma; Thomas M van Gulik

    2007-01-01

    AIM: To evaluate the results of the treatment of simple liver cysts (solitary and multiple) and polycystic liver disease (PLD) using percutaneous sclerotherapy and/or surgical procedures in a single tertiary referral centre.METHODS: Retrospective analysis of 54 patients referred for evaluation and possible treatment of simple liver cysts (solitary and multiple) and PLD, from January 1997 to July 2006.RESULTS: Simple liver cysts were treated in 41 pts (76%) with a mean size of 12.6 cm. The most common reason for referral was abdominal pain or discomfort (85%). Percutaneous sclerotherapy was performed as initial treatment in 30 pts, showing cyst recurrence in 6 pts (20%). Surgical treatment was initially performed in 11 pts with cyst recurrence in 3 pts (27%). PLD was treated in 13 pts (24%) with a mean size of the dominant cyst of 13 cm. Percutaneous sclerotherapy for PLD was performed in 9 pts with recurrence in 7 pts (77.8%). Surgical treatment for PLD was undertaken in 4 pts (30.8%) with recurrence in all. Eventually, 2 pts with PLD in the presence of polycystic kidney disease underwent liver- and kidney transplantation because of deterioration of liver and kidney function.CONCLUSION: The majority of patients with simple liver cysts and PLD are referred for progressive abdominal pain. As initial treatment, percutaneous sclerotherapy is appropriate. Surgical deroofing is indicated in case of cyst recurrence after percutaneous sclerotherapy. However, the results of percutaneous sclerotherapy and surgical treatment for PLD are disappointing. Partial liver resection is indicated when there is suspicion of a pre-malignant lesion.

  15. Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics

    Directory of Open Access Journals (Sweden)

    Andreas L. Ioannou

    2015-01-01

    Full Text Available Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon’s rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.

  16. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity El bypass gástrico de una anastómosis: un procedimiento simple, seguro y eficaz para tratar la obesidad mórbida

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2004-11-01

    Full Text Available The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force. Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.El Bypass Gástrico de Una Anastomosis se ha desarrollado a partir del Mini Bypass Gástrico descrito por Robert Rutledge. La modificación del procedimiento original consiste en hacer una anastomosis latero-lateral en lugar de termino-lateral como se hace en la técnica original. Este cambio intenta reducir la exposición de la mucosa gástrica a la secreción bilio-pancreática, evitando así el posible efecto carcinogénico de la exposición crónica que constituye la más importante crítica del procedimiento original. Al fijar el asa de yeyuno a la nueva bolsa gástrica unos centímetros por encima de la anastomosis gastro-yeyunal, la secreción bilio-pancreática tiene menos posibilidades de entrar en la cavidad gástrica (fuerza de gravedad. Al ser la anastomosis latero-lateral esta posibilidad se reduce aún más. Además, el asa de yeyuno refuerza la línea de grapas contra su disrupción y previene la posible dilatación de la bolsa gástrica.

  17. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.

    NARCIS (Netherlands)

    Manniën, Judith; Wille, Jan C; Snoeren, Ruud L M M; Hof, Susan van den

    2006-01-01

    OBJECTIVE: To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. DESIGN: Prospective SSI surveillance with voluntary PDS.

  18. Platelet-Rich Fibrin: An Autologous Fibrin Matrix in Surgical Procedures: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Amir Hossein Nejat

    2011-01-01

    Full Text Available Introduction: The healing process after surgery is a challenging issue for surgeons. Various materials and techniques have been developed to facilitate this process and reduce its period. Fibrin adhesives are often used in cardiothoracic and vascular surgery to seal diffuse microvascular bleeding and in general and plastic surgery to seal wound borders. This Case report and literature review will introduce the various usages of platelet-rich fibrin in different surgical procedures and the method of producing the matrix. Case Report: A 24-year old man with periorbital skin avulsion treated with PRF membrane has been reported and discussed in this paper.  Conclusion: Platelet-rich fibrin is a natural autologous fibrin matrix, which can be produced with a simple blood sample and a table centrifuge. The material has been used in a wide range of surgical procedures to shorten the healing period and reduce post-surgical complications.

  19. Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children's Hospitals.

    Science.gov (United States)

    Chan, Katherine H; Bell, Teresa; Cain, Mark; Carroll, Aaron; Benneyworth, Brian D

    2017-03-01

    Guidelines recommend surgical antibiotic prophylaxis for clean-contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children's hospitals. Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean-contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean-contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean-contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean-contaminated procedures (OR 0.86, 95% CI 0.84-0.88, p variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean-contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Hospitals that used surgical antibiotic prophylaxis appropriately for clean-contaminated procedures were likely to use surgical antibiotic prophylaxis inappropriately for clean procedures. More variation was seen in hospital level guideline compliance for clean-contaminated procedures. Copyright © 2017 American Urological

  20. A Simple Illustration for the Need of Multiple Comparison Procedures

    Science.gov (United States)

    Carter, Rickey E.

    2010-01-01

    Statistical adjustments to accommodate multiple comparisons are routinely covered in introductory statistical courses. The fundamental rationale for such adjustments, however, may not be readily understood. This article presents a simple illustration to help remedy this.

  1. Factors Affecting Anxiety-Fear of Surgical Procedures in Dentistry

    African Journals Online (AJOL)

    2017-05-16

    May 16, 2017 ... Aim: To compare dental anxiety and fear during procedures performed under local anesthesia ... of the procedure trigger psychosomatic diseases in the ... Nigerian Journal of Clinical Practice ¦ Volume 20 ¦ Issue 4 ¦ April 2017.

  2. Crohn′s disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications

    Directory of Open Access Journals (Sweden)

    B Kolar

    2011-01-01

    Full Text Available Surgical management is considered for specific indications in Crohn′s disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn′s disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

  3. Generic Graph Grammar: A Simple Grammar for Generic Procedural Modelling

    DEFF Research Database (Denmark)

    Christiansen, Asger Nyman; Bærentzen, Jakob Andreas

    2012-01-01

    in a directed cyclic graph. Furthermore, the basic productions are chosen such that Generic Graph Grammar seamlessly combines the capabilities of L-systems to imitate biological growth (to model trees, animals, etc.) and those of split grammars to design structured objects (chairs, houses, etc.). This results......Methods for procedural modelling tend to be designed either for organic objects, which are described well by skeletal structures, or for man-made objects, which are described well by surface primitives. Procedural methods, which allow for modelling of both kinds of objects, are few and usually...

  4. Perioperative challenges and surgical treatment of large simple, and infectious liver cyst - a 12-year experience.

    Directory of Open Access Journals (Sweden)

    Yuichiro Maruyama

    Full Text Available BACKGROUND: Cystic lesions of the liver consist of a heterogeneous group of disorders that can present diagnostic and therapeutic challenges. METHODS: A retrospective review of all medical records of adult patients diagnosed with large (>7 cm cystic lesions of the liver between January 2000 and December 2011, at Kurume University Hospital. Cases with polycystic disease were excluded. RESULTS: Twenty three patients were identified. The mean size was 13.9 cm (range, 7-22cm. The majority of simple cysts were found in women (females: males, 2: 21. In 19 patients, the cyst was removed surgically by wide deroofing (laparoscopically in 16 cases, combined with ethanol sclerotherapy in 13 cases. Infection of the liver cyst occurred in one patient, who later underwent central bi-segmentectomy. CONCLUSION: Simple large cysts of the liver can be successfully treated by laparoscopic deroofing and alcohol sclerotherapy. Large hepatic cyst considered to need drainage should be removed surgically to avoid possible infection.

  5. Elbow arthroscopy: setup, portal placement, and simple procedures.

    Science.gov (United States)

    Ahmad, Christopher S; Vitale, Mark A

    2011-01-01

    Elbow arthroscopy has become an accepted treatment for numerous elbow conditions, including loose bodies, lateral epicondylitis, contractures, painful osteophytes, synovitis, osteochondritis dissecans, synovial plica, and osteoarthritis. It is absolutely necessary that the treating surgeon have complete knowledge of elbow anatomy. Three options exist for patient positioning: supine, prone, and lateral decubitus. Standard arthroscopic probes, grasping forceps, punches, and motorized shavers and burrs are used in the procedure. Retractors are essential for visualizing, exposing, and protecting nerves. Specially designed capsular biters can be used to develop a plane between the capsule and the surrounding soft tissues to facilitate capsulotomy and capsulectomy. Among elbow arthroscopists, the sequence of portal placement varies; however, there is little variation in the exact location of portal placement because of neurovascular constraints. Loose body removal and extensor carpi radialis brevis release for lateral epicondylitis are common procedures suitable for the beginning arthroscopist. For beginning and advanced procedures, the surgeon's skill and competence must be at a level consistent with the procedure to avoid complications.

  6. An intensive vascular surgical skills and simulation course for vascular trainees improves procedural knowledge and self-rated procedural competence.

    Science.gov (United States)

    Robinson, William P; Doucet, Danielle R; Simons, Jessica P; Wyman, Allison; Aiello, Francesco A; Arous, Elias; Schanzer, Andres; Messina, Louis M

    2017-03-01

    Surgical skills and simulation courses are emerging to meet the demand for vascular simulation training for vascular surgical skills, but their educational effect has not yet been described. We sought to determine the effect of an intensive vascular surgical skills and simulation course on the procedural knowledge and self-rated procedural competence of vascular trainees and to assess participant feedback regarding the course. Participants underwent a 1.5-day course covering open and endovascular procedures on high-fidelity simulators and cadavers. Before and after the course, participants completed a written test that assessed procedural knowledge concerning index open vascular and endovascular procedures. Participants also assessed their own procedural competence in open and endovascular procedures on a 5-point Likert scale (1: no ability to perform, 5: performs independently). Scores before and after the course were compared among postgraduate year (PGY) 1-2 and PGY 3-7 trainees. Participants completed a survey to rate the relevance and realism of open and endovascular simulations. Fifty-eight vascular integrated residents and vascular fellows (PGY 1-7) completed the course and all assessments. After course participation, procedural knowledge scores were significantly improved among PGY 1-2 residents (50% correct before vs 59% after; P educational effect. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  7. Femoral lengthening during hip resurfacing arthroplasty: a new surgical procedure.

    Science.gov (United States)

    Vasseur, L; Ayoub, B; Mesnil, P; Pasquier, G; Migaud, H; Girard, J

    2015-04-01

    Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33-64 months). The mean surgical time was 100 min (range, 76-124 min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32 mm (range, 25-40 mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy.

  8. Comparison of simple and economical photocatalyst immobilisation procedures

    DEFF Research Database (Denmark)

    Lim, L.L.P.; Lynch, R.J.; In, Su-il

    2009-01-01

    Photocatalysis is extremely useful for the removal of organic contaminants in water. However, the conditions used for preparing and fixing the catalyst to a substrate have a great effect on its performance. The determination of a suitable immobilisation procedure for specific application becomes...... research on removal of groundwater contaminants. This work may be useful to researchers by providing the relative performance of different dip-coating alternatives tested under identical conditions....

  9. Novel surgical procedures in glaucoma: advances in penetrating glaucoma surgery.

    Science.gov (United States)

    Filippopoulos, Theodoros; Rhee, Douglas J

    2008-03-01

    Despite late modifications and enhancements, traditional penetrating glaucoma surgery is not without complications and is reserved for patients in whom pharmacologic treatment and/or laser trabeculoplasty do not suffice to control the intraocular pressure. This article critically reviews recent advances in penetrating glaucoma surgery with particular attention paid to two novel surgical approaches: ab interno trabeculectomy with the Trabectome and implantation of the Ex-PRESS shunt. Ab interno trabeculectomy (Trabectome) achieves a sustained 30% reduction in intraocular pressure by focally ablating and cauterizing the trabecular meshwork/inner wall of Schlemm's canal. It has a remarkable safety profile with respect to early hypotonous or infectious complications as it does not generate a bleb, but it can be associated with early postoperative intraocular pressure spikes that may necessitate additional glaucoma surgery. The Ex-PRESS shunt is more commonly implanted under a partial thickness scleral flap, and appears to have similar efficacy to standard trabeculectomy offering some advantages with respect to the rate of early complications related to hypotony. Penetrating glaucoma surgery will continue to evolve. As prospective randomized clinical trials become available, we will determine the exact role of these surgical techniques in the glaucoma surgical armamentarium.

  10. Technical and surgical aspects of the sphenopalatine ganglion (SPG) microstimulator insertion procedure

    DEFF Research Database (Denmark)

    Assaf, A T; Hillerup, S; Rostgaard, J

    2016-01-01

    procedure. Perioperative surgical sequelae included sensory disturbances, pain, and swelling. Follow-up procedures included placement of a second microstimulator on the opposite side (n=2), adjustment of the microstimulator lead location (n=13), re-placement after initial unsuccessful placement (n=1......), and removal (n=5). This SPG microstimulator insertion procedure has sequelae comparable to other oral cavity procedures including tooth extractions, sinus surgery, and dental implant placement. Twenty-five of 29 subjects (86%) completing a self-assessment questionnaire indicated that the surgical effects were...

  11. Bacterial population kinetics on hands during 2 consecutive surgical hand disinfection procedures.

    Science.gov (United States)

    Kampf, Günter; Ostermeyer, Christiane; Kohlmann, Thomas

    2008-06-01

    Although consecutive surgical hand disinfections is common clinical practice, the effect on the bacterial density on hands has not been studied for all commonly used hand rubs. We studied the effect of 2 consecutive applications of hand rubs on resident bacterial hand flora. A propanol-based hand rub (PBHR; Sterillium) and the reference alcohol (60% n-propanol) were tested in a Latin-square design according to EN 12791. The first application of the PBHR was always for 1.5 minutes; the second application was for 1.5, 1, or 0.5 minutes. The reference alcohol was always applied for 3 minutes. Pre-values and post-values were obtained in accordance with EN 12791. The first reference disinfection reduced the bacterial density by 2.87 log(10) (immediate efficacy) and 2.27 log(10) (after 3 hours). The PBHR yielded a similar reduction. Immediately after the second reference disinfection, bacterial density was reduced by 0.45 log(10). Application of the PBHR yielded greater reductions of 0.71 log(10) (after 0.5 minute), 0.79 log(10) (after 1 minute), and 1.12 log(10) (after 1.5 minutes). The difference between all treatments was not significant (P = .089; Friedman test). After 3 hours, bacterial density was further decreased by 1.11 log(10) (reference disinfection), 1.89 log(10) (PBHR, 1 minute), 1.67 log(10) (PBHR, 1.5 minutes), and 1.08 log(10) (PBHR, 0.5 minute). The difference between all treatments was significant (P = .005), but none of the short treatments with the PBHR was significantly less effective than the reference treatment (P > .05; Wilcoxon-Wilcox test). Overall, a simple 1.5-minute application of a well-formulated PBHR for surgical hand disinfection keeps the bacterial density as low as possible ("irreducible minimum") even in 2 consecutive surgical procedures of 3 hours.

  12. Simple procedures for imposing constraints for nonlinear least squares optimization

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho, R. [Petrobras, Rio de Janeiro (Brazil); Thompson, L.G.; Redner, R.; Reynolds, A.C. [Univ. of Tulsa, OK (United States)

    1995-12-31

    Nonlinear regression method (least squares, least absolute value, etc.) have gained acceptance as practical technology for analyzing well-test pressure data. Even for relatively simple problems, however, commonly used algorithms sometimes converge to nonfeasible parameter estimates (e.g., negative permeabilities) resulting in a failure of the method. The primary objective of this work is to present a new method for imaging the objective function across all boundaries imposed to satisfy physical constraints on the parameters. The algorithm is extremely simple and reliable. The method uses an equivalent unconstrained objective function to impose the physical constraints required in the original problem. Thus, it can be used with standard unconstrained least squares software without reprogramming and provides a viable alternative to penalty functions for imposing constraints when estimating well and reservoir parameters from pressure transient data. In this work, the authors also present two methods of implementing the penalty function approach for imposing parameter constraints in a general unconstrained least squares algorithm. Based on their experience, the new imaging method always converges to a feasible solution in less time than the penalty function methods.

  13. U.S. survey of surgical capabilities and experience with surgical procedures in patients with congenital haemophilia with inhibitors.

    Science.gov (United States)

    Shapiro, A; Cooper, D L

    2012-05-01

    General guidelines exist for the use of recombinant activated factor VII (rFVIIa) to maintain haemostasis during surgery in congenital haemophilia A and B patients with high responding inhibitors (CHwI). Individual surgical plans are required and based upon historical therapy response, adverse events and anticipated procedure. Surgical interventions are feasible, yet it remains unclear how many US hemophilia treatment centres (HTCs) perform procedures in this fragile population. To better understand the US HTC surgical experience in CHwI patients and the number/types of procedures performed, a 21-question survey was sent to 133 US HTCs, with follow-up for response clarification and to non-responders. 98/133 HTCs (74%) responded, with 87 currently treating CHwI patients. In the last decade, 76/85 HTCs performed 994 surgeries on CHwI patients. Sites were experienced in the following procedures: central line insertion/removal (73 HTCs), dental (58), orthopaedic (52), abdominal (23), cardiovascular (14) and otolaryngologic (11). Experience with orthopaedic surgeries included synovectomies - arthroscopic (23 HTCs), radioisotopic (22), and open (7); joint replacement (18); fracture repair (14); and arthrodesis (8). Treatment modalities included rFVIIa bolus (83 HTCs) or continuous infusions (9), plasma-derived activated prothrombin complex concentrate (pd-aPCC) (55), antifibrinolytics (51), topical haemostatic agents (29), factor VIII (16) and fibrin sealants (14). Protocols for bypassing agents were used by 31/92 (33%) HTCs. Most US HTCs surveyed care for CHwI patients (74%) and have experience in minor surgery; fewer HTCs reported complex orthopaedic surgical experience. Identification of best practices and surgical barriers is required to guide future initiatives to support these patients.

  14. Economic considerations of antifungal prophylaxis in patients undergoing surgical procedures

    Directory of Open Access Journals (Sweden)

    Maria Adriana Cataldo

    2011-01-01

    Full Text Available Maria Adriana Cataldo, Nicola PetrosilloSecond Infectious Diseases Division, National Institute for Infectious Diseases, “Lazzaro Spallanzani”, Rome, ItalyAbstract: Fungi are a frequent cause of nosocomial infections, with an incidence that has increased significantly in recent years, especially among critically ill patients who require intensive care unit (ICU admission. Among ICU patients, postsurgical patients have a higher risk of Candida infections in the bloodstream. In consideration of the high incidence of fungal infections in these patients, their strong impact on mortality rate, and of the difficulties in Candida diagnosis, some experts suggest the use of antifungal prophylaxis in critically ill surgical patients. A clinical benefit from this strategy has been demonstrated, but the economic impact of the use of antifungal prophylaxis in surgical patients has not been systematically evaluated, and its cost–benefit ratio has not been defined. Whereas the costs associated with treating fungal infections are very high, the cost of antifungal drugs varies from affordable (ie, the older azoles to expensive (ie, echinocandins, polyenes, and the newer azoles. Adverse drug-related effects and the possibly increased incidence of fluconazole resistance and of isolates other than Candida albicans must also be taken into account. From the published studies of antifungal prophylaxis in surgical patients, a likely economic benefit of this strategy could be inferred, but its usefulness and cost–benefits should be evaluated in light of local data, because the available evidence does not permit general recommendations.Keywords: antifungal prophylaxis, cost-effectiveness, economics, surgery, fungal infection 

  15. Simple procedure for phase-space measurement and entanglement validation

    Science.gov (United States)

    Rundle, R. P.; Mills, P. W.; Tilma, Todd; Samson, J. H.; Everitt, M. J.

    2017-08-01

    It has recently been shown that it is possible to represent the complete quantum state of any system as a phase-space quasiprobability distribution (Wigner function) [Phys. Rev. Lett. 117, 180401 (2016), 10.1103/PhysRevLett.117.180401]. Such functions take the form of expectation values of an observable that has a direct analogy to displaced parity operators. In this work we give a procedure for the measurement of the Wigner function that should be applicable to any quantum system. We have applied our procedure to IBM's Quantum Experience five-qubit quantum processor to demonstrate that we can measure and generate the Wigner functions of two different Bell states as well as the five-qubit Greenberger-Horne-Zeilinger state. Because Wigner functions for spin systems are not unique, we define, compare, and contrast two distinct examples. We show how the use of these Wigner functions leads to an optimal method for quantum state analysis especially in the situation where specific characteristic features are of particular interest (such as for spin Schrödinger cat states). Furthermore we show that this analysis leads to straightforward, and potentially very efficient, entanglement test and state characterization methods.

  16. The Maze procedure: surgical therapy for refractory atrial fibrillation.

    Science.gov (United States)

    McCarthy, P M; Castle, L W; Trohman, R G; Simmons, T W; Maloney, J D; Klein, A L; White, R D; Cox, J L

    1993-01-01

    Although atrial fibrillation is well tolerated by most patients, in some patients the consequences may be severe. The Maze procedure is a new open-heart operation that creates a carefully designed maze of incisions in the atrial myocardium; this maze then acts as an electrical conduit to channel atrial impulses from the sinoatrial node to the atrioventricular node. The Maze procedure has been shown to restore sinus rhythm and atrial systole (thus reducing the risk of thromboembolism), improve hemodynamics, alleviate palpitations, and eliminate the need for antiarrhythmic and anticoagulant drugs. We describe our first patient to undergo this operation.

  17. Surgical Treatment of Canine Glaucoma: Filtering and End-Stage Glaucoma Procedures.

    Science.gov (United States)

    Maggio, Federica; Bras, Dineli

    2015-11-01

    Canine glaucoma is a common cause of vision loss associated with raised intraocular pressure, and leads to damage of the retina and optic nerve head. In most cases, medical treatment alone cannot provide long-term management of intraocular pressure control and preservation of vision. Surgical intervention is usually recommended to either decrease aqueous humor production, or increase its outflow. Among the current available procedures, filtering techniques are aimed at increasing aqueous humor outflow. Proper surgical timing and a combination of cyclodestructive and filtering procedures have been recently suggested to improve the long-term success of surgical treatment in dogs. Bleb fibrosis and surgical failure are still common occurrences in filtration surgery with relapse of glaucoma and vision loss. End stage procedures, such as enucleation, evisceration with intrascleral prosthesis, and chemical ablation of the ciliary bodies are then recommended to address chronic discomfort in buphthalmic and blind eyes.

  18. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

    DEFF Research Database (Denmark)

    Bøtker, M T; Vang, M L; Grøfte, T;

    2014-01-01

    with focused ultrasonography in patients undergoing urgent surgical procedures. Methods We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology...... was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. Results A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society....... Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. Conclusion Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical...

  19. A simple procedure for correcting loading effects of aethalometer data.

    Science.gov (United States)

    Virkkula, Aki; Mäkelä, Timo; Hillamo, Risto; Yli-Tuomi, Tarja; Hirsikko, Anne; Hämeri, Kaarle; Koponen, Ismo K

    2007-10-01

    A simple method for correcting for the loading effects of aethalometer data is presented. The formula BC(CORRECTED) = (1 + k x ATN) x BC(NONCORRECTED), where ATN is the attenuation and BC is black carbon, was used for correcting aethalometer data obtained from measurements at three different sites: a subway station in Helsinki, an urban background measurement station in Helsinki, and a rural station in Hyytiälä in central Finland. The BC data were compared with simultaneously measured aerosol volume concentrations (V). After the correction algorithm, the BC-to-V ratio remained relatively stable between consequent filter spots, which can be regarded as indirect evidence that the correction algorithm works. The k value calculated from the outdoor sites had a clear seasonal cycle that could be explained by darker aerosol in winter than in summer. When the contribution of BC to the total aerosol volume was high, the k factor was high and vice versa. In winter, the k values at all wavelengths were very close to that obtained from the subway station data. In summer, the k value was wavelength dependent and often negative. When the k value is negative, the noncorrected BC concentrations overestimated the true concentrations.

  20. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

  1. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures

    NARCIS (Netherlands)

    Kinnersley, P.; Phillips, K.; Savage, K.; Kelly, M.J.; Farrell, E.; Morgan, B.; Whistance, R.; Lewis, V.; Mann, M.K.; Stephens, B.L.; Blazeby, J.; Elwyn, G.; Edwards, A.G.

    2013-01-01

    BACKGROUND: Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken. However, it is a complex process which requires patients be provided with information which they can understand and retain, opportunity to consider their optio

  2. Surgical procedure logging with use of a hand-held computer.

    Science.gov (United States)

    Fischer, Sandra; Lapinsky, Stephen E; Weshler, Jason; Howard, Frazer; Rotstein, Lorne E; Cohen, Zane; Stewart, Thomas E

    2002-10-01

    To evaluate the feasibility of incorporating hand-held computing technology in a surgical residency program, by means of hand-held devices for surgical procedure logging linked through the Internet to a central database. Division of General Surgery, University of Toronto. A survey of general surgery residents. The 69 residents in the general surgery training program received hand-held computers with preinstalled medical programs and a program designed for surgical procedure logging. Procedural data were uploaded via the Internet to a central database. Survey data were collected regarding previous computer use as well as previous procedure logging methods. Utilization of the procedure logging system. After a 5-month pilot period, 38% of surgical residents were using the procedure-logging program successfully and on a regular basis. Program use was higher among more junior trainees. Analysis of the database provided valuable information on individual trainees, hospital programs and supervising surgeons, data that would assist in program development. Hand-held devices can be implemented in a large division of general surgery to provide a reference database and a procedure-logging platform. However, user acceptance is not uniform and continued training and support are necessary to increase acceptance. The procedure database provides important information for optimizing trainees' educational experience.

  3. Impact of robotic assistance on precision of vitreoretinal surgical procedures.

    Directory of Open Access Journals (Sweden)

    Yasuo Noda

    Full Text Available PURPOSE: To elucidate the merits of robotic application for vitreoretinal maneuver in comparison to conventional manual performance using an in-vitro eye model constructed for the present study. METHODS: Capability to accurately approach the target on the fundus, to stabilize the manipulator tip just above the fundus, and to perceive the contact of the manipulator tip with the fundus were tested. The accuracies were compared between the robotic and manual control, as well as between ophthalmologists and engineering students. RESULTS: In case of manual control, ophthalmologists were superior to engineering students in all the 3 test procedures. Robotic assistance significantly improved accuracy of all the test procedures performed by engineering students. For the ophthalmologists including a specialist of vitreoretinal surgery, robotic assistance enhanced the accuracy in the stabilization of manipulator tip (from 90.9 µm to 14.9 µm, P = 0.0006 and the perception of contact with the fundus (from 20.0 mN to 7.84 mN, P = 0.046, while robotic assistance did not improve pointing accuracy. CONCLUSIONS: It was confirmed that telerobotic assistance has a potential to significantly improve precision in vitreoretinal procedures in both experienced and inexperienced hands.

  4. A Case of Microstomia Subsequent to Toxic Epidermal Necrolysis Surgically Treated by Simple Technique

    Directory of Open Access Journals (Sweden)

    Takanobu Mashiko, MD

    2013-06-01

    Full Text Available Summary: Toxic epidermal necrolysis (TEN is a rare but severe adverse dermatitis that is an autoimmune reaction to drugs such as nonsteroidal anti-inflammatory drugs. TEN most severely affects the mucous membranes including the mouth and could develop into microstomia; however, microstomia in relation to TEN has rarely been reported in the literature. We describe an adult female patient who developed microstomia due to scar contracture of the bilateral oral commissures subsequent to TEN and was successfully treated by a simple surgical technique consisting solely of transverse incision of the commissure and longitudinal closure.

  5. Variability in noncardiac surgical procedures in children with congenital heart disease.

    Science.gov (United States)

    Sulkowski, Jason P; Cooper, Jennifer N; McConnell, Patrick I; Pasquali, Sara K; Shah, Samir S; Minneci, Peter C; Deans, Katherine J

    2014-11-01

    The purpose of this study was to examine the volume and variability of noncardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004 and 2012 were included. Frequencies of noncardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a noncardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. 8857 patients underwent congenital heart surgery during the first year of life, 3621 (41%) of whom had 13,894 noncardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4432; 31.9%) or otolaryngology (4002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having noncardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1-3), children in the high-risk group (categories 4-6) were more likely to have general, dental, orthopedic, and thoracic procedures. Children with CHD requiring cardiac surgery frequently also undergo noncardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Patients' perceptions of palliative surgical procedures: a qualitative analysis.

    Science.gov (United States)

    Hamilton, Trevor D; Selby, Debbie; Tsang, Melanie E; Kim, Audrey; Wright, Frances C

    2017-08-01

    Patients with incurable malignancies can require surgical intervention. We prospectively evaluated patients treated with palliative surgery to qualitatively assess peri-operative outcomes. Eligible patients were assessed at a tertiary care cancer center. Demographic information and peri-operative morbidity and mortality were collected. Semi-structured qualitative interviews were obtained pre-operatively and post-operatively (1 month). Qualitative evaluation was performed using content analysis and an inductive approach. Twenty-eight patients were approached and 20 consented to interview. Data saturation was achieved after 14 patients. Median patient age was 58% and 56% were female. Peri-operative morbidity and mortality were 44% and 22%, respectively. "No other option" was seen as a dominant pre-operative theme (14 of 18). Other pre-operative themes included a "poor understanding of prognosis and the role of surgery in overall treatment plan". Post-operative themes included a "perceived benefit from surgery" and "satisfaction with decision-making", notwithstanding significant complications. Improved understanding of prognosis and the role of surgery were described post-operatively. Despite limited options and a poor understanding of prognosis, many patients perceived benefit from palliative surgery. However, peri-operative mortality was substantial. A robust and thorough patient-centered discussion about individual goals for surgery should be undertaken by surgeon, patient and family prior to embarking on a palliative operation.

  7. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure.

    Science.gov (United States)

    Ganji, Kiran Kumar; Patil, Veena Ashok; John, Jiji

    2012-01-01

    Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student "t" Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group) and 1.95 mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

  8. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

    Directory of Open Access Journals (Sweden)

    Kiran Kumar Ganji

    2012-01-01

    Full Text Available Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20 patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening and adjacent sites: Plaque and Gingival Indices (PI & (GI, Position of Gingival Margin from reference Stent (PGMRS, Probing depth (PD, and Biologic Width (BW. Statistical Analysis Used. Student “t” Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group and 1.95 mm (Ostectomy procedure B2 Group and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

  9. Do surgical gloves protect staff during electrosurgical procedures?

    Science.gov (United States)

    Tucker, R D; Ferguson, S

    1991-11-01

    Fifteen pair of commercially available gloves were tested under conditions that occur during radio frequency electrosurgery to determine their potential to cause burns or shocks. Two pair of gloves showed a hydration effect that produced sufficiently low direct current resistance, 1500 and 5000 ohms, to be a potential shock or burn hazard. All intact gloves passed in excess of 0.75 A of radio frequency current by capacitive coupling. Eleven pair of gloves displayed dielectric breakdown of the latex or neoprene at voltages between 2200 and 2600 volts; the remaining gloves ranged from 5800 to 7000 volts. Under specific conditions all gloves tested have the potential to cause burns or shocks to the surgeon during electrosurgical procedures. To avoid burns, shocks, or glove perforation, surgeons should be aware of situations that put them at high risk.

  10. A Rapid Selection Procedure for Simple Commercial Implementation of omega-Transaminase Reactions

    DEFF Research Database (Denmark)

    Gundersen Deslauriers, Maria; Tufvesson, Pär; Rackham, Emma J.

    2016-01-01

    A stepwise selection procedure is presented to quickly evaluate whether a given omega-transaminase reaction is suitable for a so-called "simple" scale-up for fast industrial implementation. Here "simple" is defined as a system without the need for extensive process development or specialized...

  11. Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement.

    Science.gov (United States)

    Ejiofor, Julius I; Neely, Robert C; Yammine, Maroun; McGurk, Siobhan; Kaneko, Tsuyoshi; Leacche, Marzia; Cohn, Lawrence H; Shekar, Prem S

    2017-05-01

    Isolated tricuspid valve (ITV) operations are infrequent and the decision to operate is controversial. We report a series of ITV operations to outline the current disease status requiring this uncommon procedure with an emphasis on the results of tricuspid valve repair (TVr) versus replacement (TVR). Using our prospective cardiac surgery database, 57 patients who underwent ITV operations between 01/02-03/14 were identified. Median follow up time was 3.5 years [interquartile range (IQR), 0.8-6.7 years]. Fifty-seven patients underwent ITV surgery with a mean age of 54.4±14.9 yrs and 61% were women. Baseline characteristics were similar between patients who underwent TVr (n=18) or TVR (n=39). The etiologies of TV dysfunction were: ITV endocarditis 14/57 (25%), persistent TV regurgitation after left-sided valve surgery in 12/57 (21%), traumatic biopsies and iatrogenic injury from pacing leads in 11/57 (19%), orthotopic heart transplant 9/57 (16%), carcinoid syndrome 3/57 (5%), congenital 2/57 (5%) and idiopathic 5/57 (9%). Overall, 32/57 (56%) patients had prior heart surgery; of which 10/32 (31%) were TV procedures. Bioprosthetic prostheses were used in 34/39 (87%) patients. Of those who had repair, 11/18 (61%) had ring annuloplasty, 3/18 (17%) bicuspidization, and 3/18 (17%) De Vega annuloplasty and one had vegetectomy. Operative mortality was 5.1% (n=2) and 16.7% (n=3) for TVR and TVr groups, respectively (P=0.32), with an overall mortality rate of 8.6%. Postoperative complications included new onset renal failure in 6/39 (15%) of TVr and 2/18 (11%) of TVR (P=0.71) and there were no strokes. Overall survival rates and degree of residual RV dysfunction were similar for the two groups (both P=0.3). Five-year survival was 77% and 84% for TVr and TVR respectively (P=0.52). There was no difference in rates of recurrent tricuspid regurgitation for TVr and TVR (35.7% vs. 23.5%, respectively, P=0.4). ITV surgery is associated with improved but still relatively high

  12. [Web-based education: learning surgical procedures step-by-step with 3D visualization].

    Science.gov (United States)

    van der Velde, Susanne; Maljers, Jaap; Wiggers, Theo

    2014-01-01

    There is a need for more uniform, structured education focused on surgical procedures. We offer a standardized, step-by-step, web-based procedural training method with which surgeons can train more interns efficiently. The basis of this learning method is formed by 3D films in which surgical procedures are performed in clearly defined steps and the anatomic structures behind the surgical operating planes are further dissected. This basis is supported by online modules in which, aside from the operation, preparation and postoperative care are also addressed. Registrars can test their knowledge with exams. Trainers can see what the registrars studied, how they scored and how they progressed with their clinical skills. With the online portfolio we offer building blocks for certification and accreditation. With this clearly structured research method of constant quality, registrars are less dependent on the local trainer. In addition, through better preparation, the operation capacity can be used more efficiently for the training.

  13. Prevalence of Neoplastic Diseases in Pet Birds Referred for Surgical Procedures

    Directory of Open Access Journals (Sweden)

    Patrícia F. Castro

    2016-01-01

    Full Text Available Neoplastic disease is common in pet birds, particularly in psittacines, and treatment should be primarily aimed at tumor eradication. Nineteen cases of pet birds submitted to diagnostic and/or therapeutic surgical procedures due to neoplastic disease characterized by the presence of visible masses were retrospectively analyzed; affected species, types of neoplasms and respective locations, and outcomes of surgical procedures were determined. All birds undergoing surgery belonged to the order Psittaciformes; the Blue-fronted parrot (Amazona aestiva was the prevalent species. Lipoma was the most frequent neoplasm in the sample studied. Most neoplasms affected the integumentary system, particularly the pericloacal area. Tumor resection was the most common surgical procedure performed, with high resolution and low recurrence rates.

  14. Locally advanced rectal cancer: a cooperative surgical approach to a complex surgical procedure.

    LENUS (Irish Health Repository)

    Owens, P

    2015-01-01

    Single stage en bloc abdominoperineal resection and sacrectomy, with a myocutaneous flap closure is a relatively uncommon procedure. Our case study of a 77 year old man with a locally invasive rectal adenocarcinoma highlights the complex intraoperative management of such a patient.

  15. The evolution of surgical procedures in the management of duodenal and gastric ulcers.

    Science.gov (United States)

    Ajao, O G; Ugwu, B T

    2013-01-01

    Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant.

  16. Fat Grafting to the Breast, a Simple Procedure for a Very Complex Reconstruction.

    Science.gov (United States)

    Claro, Francisco; Pereira, Fernando Linhares; Pinto-Neto, Aarão M

    2016-01-01

    Usually, complicated reconstructions demand complex procedures. However, we report an unpublished situation where lipofilling was the only effective procedure for breast reconstruction, once 4 previous procedures, including 2 microvascular free flaps, had failed. The reported case describes a woman without subcutaneous tissue in the left breast topography, with radiation sequelae resulting in a fibrotic, hyperchromic, unexpandable skin that was tethered to her costal bone and pleura. The 4 previous attempts of breast reconstruction resulted in unavailable nearby recipient vessels, and this situation appointed breast lipofilling as the most feasible procedure. This report shows the power of breast lipofilling, a simple procedure that can be used even for the more complex reconstructions.

  17. Towards robotic heart surgery: introduction of autonomous procedures into an experimental surgical telemanipulator system.

    Science.gov (United States)

    Bauernschmitt, R; Schirmbeck, E U; Knoll, A; Mayer, H; Nagy, I; Wessel, N; Wildhirt, S M; Lange, R

    2005-09-01

    The introduction of telemanipulator systems into cardiac surgery enabled the heart surgeon to perform minimally invasive procedures with high precision and stereoscopic view. For further improvement and especially for inclusion of autonomous action sequences, implementation of force-feedback is necessary. The aim of our study was to provide a robotic scenario giving the surgeon an impression very similar to open procedures (high immersion) and to enable autonomous surgical knot tying with delicate suture material. In this experimental set-up the feasibility of autonomous surgical knot tying is demonstrated for the first time using stereoscopic view and force feedback. Copyright 2005 John Wiley & Sons, Ltd.

  18. Cost-effectiveness analyses of elective orthopaedic surgical procedures in patients with inflammatory arthropathies

    DEFF Research Database (Denmark)

    Osnes-Ringen, H.; Kvamme, M. K.; Sønbø Kristiansen, Ivar

    2011-01-01

    (SD 13) years, 77% female] with inflammatory arthropathies underwent orthopaedic surgical treatment and responded to mail surveys at baseline and during follow-up (3, 6, 9, and 12 months). Questionnaires included the quality-of-life EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) utility scores...... 800 for non-replacement surgical procedures measured by EQ-5D (SF-6D: EUR 67 500). Conclusions: Elective orthopaedic surgery in patients with inflammatory arthropathies was cost-effective when measured with EQ-5D, and some procedures were also cost-effective when SF-6D was used in the economic...

  19. Otologic surgical procedures in an ear, nose and throat department in Subotica from 1987 to 2001

    Directory of Open Access Journals (Sweden)

    Sente Marko

    2004-01-01

    Full Text Available Introduction This paper deals with otologic surgical procedures performed in a an Ear, Nose and Throat Depertment during a 15-year period. The authors compared the number of otologic surgical procedures with the number of laryngomicroscopies and procedures performed in Waldeyer's ring. RESULTS From January 1, 1987 to December 31, 2001, 1184 patients underwent the following surgical procedures in total endotracheal anesthesia: 285 paracenteses, 473 ventilation tubes insertions, 175 antrotomies or mastoidectomies, 194 tympanoplasties, 34 radical mastoidectomies, 4 facial nerve decompressions, 5 exostoses or osteoma of the external auditory canal operations and 14 stapedectomies. DISCUsSION Otologic surgical procedures are presented in table 1. In Yugoslav literature Topolac reports approximately 700 tympanoplasties in a 10-year period (1968-1978. Radonjić and associates report 2272 ear operations in the period 1975-1985. Distribution of operations is presented in table 2, whereas in table 3 we can see that the number of operated ears is much greater than the number of operated patients. CONCLUSION We think that the number of operations is not bigger, because we operate only in critical cases. Our human and technical resources should provide advanced ear microsurgery, but only with financial and organizational support.

  20. Impact of Residents on Surgical Outcomes in High-Complexity Procedures.

    Science.gov (United States)

    Ferraris, Victor A; Harris, Jennifer W; Martin, Jeremiah T; Saha, Sibu P; Endean, Eric D

    2016-04-01

    There are different views on the effects of resident involvement on surgical outcomes. We hypothesized that resident participation in surgical care does not appreciably alter outcomes. We analyzed an American College of Surgeons NSQIP subset of inpatients having procedures with high complexity, including 4 surgical specialties (general surgery, cardiothoracic surgery, neurosurgery, and vascular surgery) with the highest mean work relative value units. We evaluated surgical outcomes in patients having procedures performed by the attending surgeon alone, or by the attending surgeon with assistance from at least one surgical resident (PGY1 to PGY≥6). Outcomes measures included operative mortality, composite morbidity, and failure to rescue (FTR). Propensity-score matching minimized the effects of nonrandom assignment of residents to procedures. In 266,411 patients, unmatched comparisons showed significantly higher operative mortality and composite morbidity rates, but decreased FTR, in operations performed with resident involvement. After propensity-score matching, there were small but significant resident-related increases in composite morbidity, but significant improvement in FTR. Senior-level resident involvement translated into improved outcomes, especially in cardiothoracic surgery procedures where >63.6% of procedures had PGY≥6 resident involvement. Resident involvement attenuated the significant worsening of operative mortality and FTR associated with multiple serious complications in individual patients. Measures of resource use increased modestly with resident involvement. We found substantial improvement in FTR with resident involvement, both in unmatched and propensity-matched comparisons. Senior-level resident participation seemed to attenuate, and even improve, surgical outcomes, despite slightly increased resource use. These results provide some reassurance about teaching paradigms. Copyright © 2016 American College of Surgeons. Published by

  1. Reliability of a CT reconstruction for preoperative surgical planning in the arthroscopic Latarjet procedure.

    Science.gov (United States)

    Hardy, Alexandre; Loriaut, Philippe; Granger, Benjamin; Neffati, Ahmed; Massein, Audrey; Casabianca, Laurent; Pascal-Moussellard, Hugues; Gerometta, Antoine

    2016-10-12

    The arthroscopic Latarjet procedure has provided reliable results in the treatment of anterior shoulder instability. However, this procedure remains technically challenging and is related to several complications. The morphology of the coracoid and the glenoid are inconsistent. Inadequate coracoid and glenoid preparing may lead to mismatching between their surfaces. Inadequate screws lengthening and orientation are a major concern. Too long screws can lead to suprascapular nerve injuries or hardware irritation, whereas too short screws can lead to nonunions, fibrous unions or migration of the bone block. The purpose of the study was to investigate the application of virtual surgical planning and digital technology in preoperative assessment and planning of the Latarjet procedure. Twelve patients planned for an arthroscopic Latarjet had a CT scan evaluation with multi-two-dimensional reconstruction performed before surgery. Interobserver and intraobserver reliability were evaluated. The shape of the anterior rim of the glenoid and the undersurface of the coracoid were classified. Coracoid height was measured, respectively, at 5 mm (C1) and 10 mm (C2) from the tip of the coracoid process, corresponding to the drilling zone. Measurements of the glenoid width were then taken in the axial view at 25 % (G1) and 50 % (G2) of the glenoid height with various α angles (5°, 10°, 15°, 20°, 25°, 30°) 7 mm from the anterior glenoid rim. Shapes of the undersurface of the coracoid and the anterior rim of the glenoid were noted during the surgical procedure. Post-operative measurements included the α angle. Concerning coracoid height measurements, there was an almost perfect to substantial intra- and inter-reliability, with values ranging from ICC = 0.75-0.97. For the shape of the coracoid, concordances were, respectively, perfect (ICC = 1) and almost perfect (0.87 [0.33; 1]) for the intra- and interobserver reliabilities. Concerning the glenoid, concordance was

  2. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years.

    Science.gov (United States)

    Takase, Katsumi; Yamamoto, Kengo

    2013-10-01

    Generally, surgical treatment is recommended for Rockwood type 5 traumatic acromioclavicular joint dislocations. Since 1980, the authors have performed the modified Dewar procedure, the modified Cadenat procedure, and anatomical reconstruction of the coracoclavicular ligaments for this injury. The goal of this study was to determine the ideal surgical procedure for acromioclavicular joint dislocations by comparing these 3 procedures. The modified Dewar procedure was performed on 55 patients (Dewar group), the modified Cadenat procedure was performed on 73 patients (Cadenat group), and anatomical reconstruction of the coracoclavicular ligaments was performed on 11 patients (reconstruction group). According to the UCLA scoring system, therapeutic results averaged 27.3 points in the Dewar group, 28.2 in the Cadenat group, and 28.4 in the reconstruction group. The incidence of residual subluxation or dislocation in the acromioclavicular joint was evaluated at final radiographic follow-up. Subluxation occurred in 21 patients in the Dewar group, 18 in the Cadenat group, and 3 in the reconstruction group. Dislocation occurred in 3 patients in the Dewar group. Osteoarthritic changes in the acromioclavicular joint occurred in 20 patients in the Dewar group, 9 in the Cadenat group, and 1 in the reconstruction group. The modified Cadenat procedure can provide satisfactory therapeutic results and avoid postoperative failure or loss of reduction compared with the modified Dewar procedure. However, the modified Cadenat procedure does not anatomically restore the coracoclavicular ligaments. Anatomic restoration of both coracoclavicular ligaments can best restore acromioclavicular joint function. Copyright 2013, SLACK Incorporated.

  3. Guidelines on the facilities required for minor surgical procedures and minimal access interventions.

    LENUS (Irish Health Repository)

    Humphreys, H

    2012-02-01

    There have been many changes in healthcare provision in recent years, including the delivery of some surgical services in primary care or in day surgery centres, which were previously provided by acute hospitals. Developments in the fields of interventional radiology and cardiology have further expanded the range and complexity of procedures undertaken in these settings. In the face of these changes there is a need to define from an infection prevention and control perspective the basic physical requirements for facilities in which such surgical procedures may be carried out. Under the auspices of the Healthcare Infection Society, we have developed the following recommendations for those designing new facilities or upgrading existing facilities. These draw upon best practice, available evidence, other guidelines where appropriate, and expert consensus to provide sensible and feasible advice. An attempt is also made to define minimal access interventions and minor surgical procedures. For minimal access interventions, including interventional radiology, new facilities should be mechanically ventilated to achieve 15 air changes per hour but natural ventilation is satisfactory for minor procedures. All procedures should involve a checklist and operators should be appropriately trained. There is also a need for prospective surveillance to accurately determine the post-procedure infection rate. Finally, there is a requirement for appropriate applied research to develop the evidence base required to support subsequent iterations of this guidance.

  4. Partial fingertip necrosis following a digital surgical procedure in a patient with primary Raynaud's phenomenon.

    Science.gov (United States)

    Uygur, Safak; Tuncer, Serhan

    2014-12-01

    Raynaud's phenomenon is a common clinical disorder consisting of recurrent, long-lasting and episodic vasospasm of the fingers and toes often associated with exposure to cold. In this article, we present a case of partial fingertip necrosis following digital surgical procedure in a patient with primary Raynaud's phenomenon.

  5. Surgical treatment of gingival recessions using Emdogain gel : Clinical procedure and case reports

    NARCIS (Netherlands)

    Abbas, F; Wennstrom, J; Van der Weijden, F; Schneiders, T; Van der Velden, U

    2003-01-01

    This article describes the clinical procedure and outcome of surgical treatment of gingival recessions with the adjunctive use of Emdogain gel, an enamel matrix derivative bioactive material for periodontal reconstructive surgery. Six cases with gingival recession on maxillary canines are presented

  6. Retention of laparoscopic procedural skills acquired on a virtual-reality surgical trainer

    DEFF Research Database (Denmark)

    Nielsen, Mathilde Maagaard; Sørensen, J L; Oestergaard, Jeanett

    2011-01-01

    BACKGROUND: Virtual-reality (VR) simulator training has been shown to improve surgical performance in laparoscopic procedures in the operating room. We have, in a randomised controlled trial, demonstrated transferability to real operations. The validity of the LapSim virtual-reality simulator...

  7. Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

    Science.gov (United States)

    Levy, I Martin; Pryor, Karen W; McKeon, Theresa R

    2016-04-01

    A surgical procedure is a complex behavior that can be constructed from foundation or component behaviors. Both the component and the composite behaviors built from them are much more likely to recur if it they are reinforced (operant learning). Behaviors in humans have been successfully reinforced using the acoustic stimulus from a mechanical clicker, where the clicker serves as a conditioned reinforcer that communicates in a way that is language- and judgment-free; however, to our knowledge, the use of operant-learning principles has not been formally evaluated for acquisition of surgical skills. Two surgical tasks were taught and compared using two teaching strategies: (1) an operant learning methodology using a conditioned, acoustic reinforcer (a clicker) for positive reinforcement; and (2) a more classical approach using demonstration alone. Our goal was to determine whether a group that is taught a surgical skill using an operant learning procedure would more precisely perform that skill than a group that is taught by demonstration alone. Two specific behaviors, "tying the locking, sliding knot" and "making a low-angle drill hole," were taught to the 2014 Postgraduate Year (PGY)-1 class and first- and second-year medical students, using an operant learning procedure incorporating precise scripts along with acoustic feedback. The control groups, composed of PGY-1 and -2 nonorthopaedic surgical residents and first- and second-year medical students, were taught using demonstration alone. The precision and speed of each behavior was recorded for each individual by a single experienced surgeon, skilled in operant learning. The groups were then compared. The operant learning group achieved better precision tying the locking, sliding knot than did the control group. Twelve of the 12 test group learners tied the knot and precisely performed all six component steps, whereas only four of the 12 control group learners tied the knot and correctly performed all six

  8. Patient-reported outcome measures after routine periodontal and implant surgical procedures.

    Science.gov (United States)

    Tan, Wah Ching; Krishnaswamy, Gita; Ong, Marianne M A; Lang, Niklaus P

    2014-06-01

    To compare patient-reported outcome measures (PROMs) after different dental surgical procedures over a 1-week post-surgical period and in relation to duration of the surgery, and periosteal releasing incisions. To evaluate the prevalence of post-surgical complications. Four hundred and sixty-eight healthy dental patients requiring surgeries, such as crown lengthening (CL), open flap debridement (OFD) and implant installation (IMP) in the National Dental Centre, Singapore (2009-2011), were consecutively recruited. PROMs on bleeding, swelling, pain and bruising were obtained using Visual Analogue Scales (VAS) on days 0, 3, 5 and 7 post-operatively. On the day of surgery, the IMP procedure gave the lowest median VAS for all four PROM parameters. After a week, OFD still had a significantly higher VAS for swelling, pain and bruising. Patients who underwent procedures lasting more than 60 min. had higher VAS for all parameters except bleeding. After considering other important confounders, type of surgery procedure was no longer associated with the VAS score for any of the parameters. Time after surgery, male gender and shorter surgery duration reduced post-operative VAS for one or more of the parameters. Longer surgeon experience helps reduce VAS scores only for bleeding. Prevalence for tenderness to palpation was 11.6%, 8.9% and 12.2% for IMP, CL and OFD, respectively, 1-week post-operatively. Swelling and suppuration occurred rarely. The median VAS scores for all PROM parameters were generally low and reduced to near zero over a week following all three surgical procedures tested. Time after surgery and shorter surgery duration were associated with lower VAS scores in all the PROM parameters in this cohort of patients. Surgery type was not associated significantly with VAS after adjustment with other important confounders. Low prevalences of post-surgical complications were reported. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques.

    Science.gov (United States)

    Alzahrani, Tariq

    2017-01-01

    Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.

  10. Pain relief following thoracic surgical procedures: A literature review of the uncommon techniques

    Directory of Open Access Journals (Sweden)

    Tariq Alzahrani

    2017-01-01

    Full Text Available Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.

  11. The Sauvé-Kapandji procedure: indications and tips for surgical success.

    Science.gov (United States)

    Lluch, Alberto

    2010-11-01

    Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, with the main disadvantage of loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji procedure. This procedure is not void of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these can be prevented if a careful surgical technique is used. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. EVALUATION OF OUTCOME OF VARIOUS SURGICAL PROCEDURES FOR UPPER EYELID PTOSIS

    Directory of Open Access Journals (Sweden)

    Nagaraju

    2015-02-01

    Full Text Available INTRODUCTION: There are various procedures available for ptosis correction. Successful outcome not only depends on correct technique but also choosing appropriate procedure for each patient. Selection of procedure is based on available levator function and also other factors like etiology, severity, Bell’s phenomenon etc. If such varied procedure s are performed in a group of patients based on standard criteria and results are evaluated systematically we can determine what works best for a given patient . AIM : Evaluation of outcome of various surgical procedures for upper eyelid ptosis . METHODOLOGY : 25 eyelids of 20 patients who presented to a tertiary centre in south India with complaint of drooping of upper lid were considered. All subjects underwent complete ocular examination corrected visual acuity and detailed ptosis evaluation with particular emphasis on measurement of levator muscle function, MRD1 (margin reflex distance - 1, palpebral fissure width in different gazes and margin crease distance. The effect of various factors like MRD1, MCD, levator function were assessed, the amount of correction required and appropriate surgical procedure was chosen. Surgical procedure of Levator resection, frontalis sling operation, anterior levator aponeurosis advancement, o r other ptosis correction procedures under appropriate anaesthesia were performed. Post - operative evaluation in terms of visual acuity, MRD, Interpalpebral fissure height, lid symmetry, lagophthalmos and complications (if any was done. RESULTS : Levator muscle resection was done in 28% of eyelids, frontal sling surgery in 60% of eyelids, Levator muscle plication in 8% eyelids and levator muscle disinsertion with frontal sling surgery in 4% eyes. Undercorrection was seen in about 44% of eyelids in varying degrees. 56% of the eyes had optimal correction. Symmetric correction was achieved in 76% of eyelids. CONCLUSION: The influence of various preoperative factors on the

  13. Nuss procedure in adult pectus excavatum: a simple artifice to reduce sternal tension

    OpenAIRE

    Ravenni, Giacomo; Actis Dato, Guglielmo Mario; Zingarelli, Edoardo; Flocco, Roberto; Casabona, Riccardo

    2013-01-01

    Nowadays the Nuss operation represents the standard surgical choice for pectus excavatum repair in children and teenagers. Some concerns have been raised regarding its applicability in adults, as compared with younger patients, in view of the higher rate of complications after surgery. We describe an easy trick that has been performed on a 36-year old man with a moderate pectus excavatum after an unsatisfactory Nuss procedure. It consisted of a T-shaped partial anterior sternotomy, performed ...

  14. Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?

    LENUS (Irish Health Repository)

    Laing, Tereze A

    2012-02-01

    BACKGROUND: The surgical management of pressure ulcers traditionally involved staged procedures, with initial debridement of necrotic or infected material followed by reconstruction at a later date when the wound was deemed viable and free of gross infection. However, over the past decade, it has been suggested that a single-stage procedure, combining initial debridement and definitive reconstruction, may provide advantages over staged surgery. We present our experience with the staged approach and review the current evidence for both methods. SUBJECTS AND SETTINGS: : We reviewed medical records of all patients referred to our service for pressure ulcer management between October 2001 and October 2007. The National Rehabilitation Hospital is the national center in Ireland for primary rehabilitation of adults and children suffering from spinal and brain injury, serving patients locally and from around the country. METHODS: All subjects who were managed surgically underwent a 2-stage procedure, with initial debridement and subsequent reconstruction. The main outcome measures were length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing. RESULTS: Forty-one of 108 patients with 58 pressure ulcers were managed surgically. All patients underwent initial surgical debridement and 20 patients underwent subsequent pressure ulcer reconstruction. Postreconstructive complications occurred in 5 patients (20%). The mean time to complete ulcer healing was 17.4 weeks. Partial flap necrosis occurred in 3 patients, but there were no episodes of flap failure. CONCLUSIONS: We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.

  15. Surgical Procedures of the Distal Limb for Treatment of Sepsis in Cattle.

    Science.gov (United States)

    Anderson, David E; Desrochers, André; van Amstel, Sarel R

    2017-07-01

    With a thorough knowledge of the anatomy of the foot, and basic surgical instruments, digit surgery can be performed in field situations. Sepsis of the distal interphalangeal and proximal interphalangeal joints should be treated surgically because conservative treatment is often ineffective. Most of the diseases described in this article are chronic and often the animals have been suffering for some time. Perioperative analgesia is important to alleviate the pain of those animals. All those procedures should be performed under local or regional anesthesia. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Isolating the Effects of Training Using Simple Regression Analysis: An Example of the Procedure.

    Science.gov (United States)

    Waugh, C. Keith

    This paper provides a case example of simple regression analysis, a forecasting procedure used to isolate the effects of training from an identified extraneous variable. This case example focuses on results of a three-day sales training program to improve bank loan officers' knowledge, skill-level, and attitude regarding solicitation and sale of…

  17. Hospital procedure volume should not be used as a measure of surgical quality.

    Science.gov (United States)

    LaPar, Damien J; Kron, Irving L; Jones, David R; Stukenborg, George J; Kozower, Benjamin D

    2012-10-01

    The Agency for Healthcare Research and Quality and the Leapfrog Group use hospital procedure volume as a quality measure for pancreatic resection (PR), abdominal aortic aneurysm (AAA) repair, esophageal resection (ER), and coronary artery bypass grafting (CABG). However, controversy exists regarding the strength and validity of the evidence for the volume-outcome association. The purpose of this study was to reevaluate the volume-outcome relationship for these procedures. Discharge data for 261,412 patients were extracted from the 2008 Nationwide Inpatient Sample. The relationship between hospital procedure volume and mortality was rigorously assessed using hierarchical general linear modeling with restricted cubic splines, adjusted for patient demographics, comorbid disease, and elective procedure status. Unadjusted mortality rates were PR (4.7%), AAA (12.7%), ER (5.8%), and CABG (2.2%), and the majority of operations were elective. Hospital procedure volume was not a statistically significant predictor of in-hospital mortality for any of the 4 procedures. Strong predictors of mortality included age, elective procedure status, renal failure, and malnutrition (P procedure volume is not a significant predictor of mortality for the performance of pancreatectomy, AAA repair, esophagectomy, or CABG. Procedure volume by itself should not be used as a proxy measure for surgical quality. Patient mortality risk is primarily attributable to patient-level characteristics such as age and comorbidity.

  18. A computationally simple central monitoring procedure, effectively applied to empirical trial data with known fraud.

    Science.gov (United States)

    van den Bor, Rutger M; Vaessen, Petrus W J; Oosterman, Bas J; Zuithoff, Nicolaas P A; Grobbee, Diederick E; Roes, Kit C B

    2017-07-01

    Central monitoring of multicenter clinical trials becomes an ever more feasible quality assurance tool, in particular for the detection of data fabrication. More widespread application, across both industry sponsored as well as academic clinical trials, requires central monitoring methodologies that are both effective and relatively simple in implementation. We describe a computationally simple fraud detection procedure intended to be applied repeatedly and (semi-)automatically to accumulating baseline data and to detect data fabrication in multicenter trials as early as possible. The procedure is based on anticipated characteristics of fabricated data. It consists of seven analyses, each of which flags approximately 10% of the centers. Centers that are flagged three or more times are considered "potentially fraudulent" and require additional investigation. The procedure is illustrated using empirical trial data with known fraud. In the illustration data, the fraudulent center is detected in most repeated applications to the accumulating trial data, while keeping the proportion of false-positive results at sufficiently low levels. The proposed procedure is computationally simple and appears to be effective in detecting center-level data fabrication. However, assessment of the procedure on independent trial data sets with known data fabrication is required. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. FIRST METATARSOPHALANGEAL JOINT OSTEOARTHRITIS: PERCUTANEOUS SURGERY, CHOICE OF A SURGICAL PROCEDURE, CLINICAL AND RADIOGRAPHIC CLASSIFICATION

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    S. Yu. Berezhnoy

    2017-01-01

    Full Text Available Introduction. Hallux rigidus is observed in approximately 2.5% of the adult population. Until now neither a unified classification of hallux rigidus appears to exist nor any clear principles to choose the surgical method. The variety of clinical and radiological signs explains the difficulties in establishing a comprehensive classification system and in selection of the criteria for surgical procedure. There are few published reports about hallux rigidus percutaneous surgical treatment. Existing papers are dedicated to a limited number of percutaneous techniques.The purpose of this study was to evaluate the efficacy of percutaneous techniques for surgical treatment of the first metatarsophalangeal joint osteoarthritis; to specify factors determining the choice of procedure; to develop a grading system of the hallux rigidus severity which will help in selection of surgery. Materials and methods. Based on 156 surgeries (107 patients the author demonstrated the possibilities of percutaneous techniques in the surgical treatment of hallux rigidus of different stages as well as provided a brief description of used surgical techniques.Results. The mean age of patients was 48.8 years (ranged from 18 to 73. The mean follow-up was 7 months (ranged from 3 to 54. At the specified time the treatment outcomes of 103 patients (150 feet were analyzed. Mean hospital stay was 0.78 days (ranged from 0 to 1. No infectious or wound-healing problems were observed. Overall, the patients were completely satisfied with the outcomes of 89 surgical treatment, qualified satisfaction was reported with patients in respect of outcomes of 57 surgeries. Four unsatisfactory outcomes were observed. The role of the relatively long first metatarsal in the development of hallux rigidus was confirmed. Conclusion. Percutaneous techniques provide successful treatment for all stages of hallux rigidus. The choice of a specific surgical technique may be challenging and requires

  20. [Accommodation and presbyopia : part 2: surgical procedures for the correction of presbyopia].

    Science.gov (United States)

    Baumeister, M; Kohnen, T

    2008-11-01

    There are two basic approaches for the surgical correction of presbyopia: increasing depth of focus (e.g. by means of multifocal laser abrasion of the cornea), Or restoring accommodation in the sense of a dynamic change in ocular refraction (accommodative intraocular lenses, scleral expansion). Pseudoaccommodative procedures are able to achieve satisfactory near vision, albeit at the price of lower performance in the intermediate range and decreased image quality. The restoration of accommodation remains problematic, partly because the mechanism of accommodation and the development of presbyopia are still not fully understood. Some surgical procedures are based on concepts, the validity of which is not confirmed or which even contradict experimental evidence. Thus, it is necessary to assess the results and presumed mechanisms critically and objectively.

  1. [Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011].

    Science.gov (United States)

    Vergara, Francesca; Freitas Ramírez, Adriana; Gispert, Rosa; Coll, José J; Saltó, Esteve; Trilla, Antoni

    2015-01-01

    To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

    OpenAIRE

    2012-01-01

    Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. ...

  3. The Perception of Aversiveness of Surgical Procedure Pictures Is Modulated by Personal/Occupational Relevance.

    Science.gov (United States)

    Paes, Juliana; de Oliveira, Leticia; Pereira, Mirtes Garcia; David, Isabel; Souza, Gabriela Guerra Leal; Sobral, Ana Paula; Machado-Pinheiro, Walter; Mocaiber, Izabela

    2016-01-01

    It is well established that emotions are organized around two motivational systems: the defensive and the appetitive. Individual differences are relevant factors in emotional reactions, making them more flexible and less stereotyped. There is evidence that health professionals have lower emotional reactivity when viewing scenes of situations involving pain. The objective of this study was to investigate whether the rating of pictures of surgical procedure depends on their personal/occupational relevance. Fifty-two female Nursing (health discipline) and forty-eight Social Work (social science discipline) students participated in the experiment, which consisted of the presentation of 105 images of different categories (e.g., neutral, food), including 25 images of surgical procedure. Volunteers judged each picture according to its valence (pleasantness) and arousal using the Self-Assessment Manikin scale (dimensional approach). Additionally, the participants chose the word that best described what they felt while viewing each image (discrete emotion perspective). The average valence score for surgical procedure pictures for the Nursing group (M = 4.57; SD = 1.02) was higher than the score for the Social Work group (M = 3.31; SD = 1.05), indicating that Nursing students classified those images as less unpleasant than the Social Work students did. Additionally, the majority of Nursing students (65.4%) chose "neutral" as the word that best described what they felt while viewing the pictures. In the Social Work group, disgust (54.2%) was the emotion that was most frequently chosen. The evaluation of emotional stimuli differed according to the groups' personal/occupational relevance: Nursing students judged pictures of surgical procedure as less unpleasant than the Social Work students did, possibly reflecting an emotional regulation skill or some type of habituation that is critically relevant to their future professional work.

  4. Phaeochromocytoma Crisis: Two Cases of Undiagnosed Phaeochromocytoma Presenting after Elective Nonrelated Surgical Procedures

    Directory of Open Access Journals (Sweden)

    P. C. Johnston

    2013-01-01

    Full Text Available Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case.

  5. Hypnosis as a Valuable Tool for Surgical Procedures in the Oral and Maxillofacial Area.

    Science.gov (United States)

    Montenegro, Gil; Alves, Luiza; Zaninotto, Ana Luiza; Falcão, Denise Pinheiro; de Amorim, Rivadávio Fernandes Batista

    2017-04-01

    Hypnosis is a valuable tool in the management of patients who undergo surgical procedures in the maxillofacial complex, particularly in reducing and eliminating pain during surgery and aiding patients who have dental fear and are allergic to anesthesia. This case report demonstrates the efficacy of hypnosis in mitigating anxiety, bleeding, and pain during dental surgery without anesthesia during implant placement of tooth 14, the upper left first molar.

  6. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

    OpenAIRE

    Kiran Kumar Ganji; Veena Ashok Patil; Jiji John

    2012-01-01

    Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans...

  7. Pediatric fasting times before surgical and radiologic procedures: benchmarking institutional practices against national standards.

    Science.gov (United States)

    Williams, Catherine; Johnson, Pat A; Guzzetta, Cathie E; Guzzetta, Philip C; Cohen, Ira Todd; Sill, Anne M; Vezina, Gilbert; Cain, Sherry; Harris, Christine; Murray, Jodi

    2014-01-01

    Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients. Findings demonstrate that pediatric patients experienced prolonged fasting before procedures and that the majority of NPO orders were non-compliant with national guidelines. We have developed strategies to reduce fasting times and ensure compliance with recommended national fasting standards.

  8. Comparative evaluation of two different vestibuloplasty surgical procedures in cleft patients: a pilot study.

    Science.gov (United States)

    de Almeida, Ana Lúcia Pompéia Fraga; Pedro, Patrícia Franco; Kogawa, Evelyn Mikaela; Pereira, Tatiana; de Barros Carrilho, Guilherme Paes; Aiello, Carlos Alberto; Freitas, Patrícia Zambonato

    2005-07-01

    Patients with a cleft lip or palate often present alterations in the labial aspect of the ridge, resulting in a shallow vestibule. This study compares the results of two different surgical procedures on deepening of the labial sulcus. Ten patients with a cleft lip and palate were separated into two groups and underwent different vestibuloplasty procedures. An experimental group used a removable retention splint. Preoperative and 4-month postoperative sulcus heights were measured and analyzed statistically. No statistically significant differences could be detected between groups. The results indicated that to reach consistent results, a larger number of patients must be submitted to this evaluation.

  9. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat

    Directory of Open Access Journals (Sweden)

    Lewis KM

    2015-12-01

    Full Text Available Kevin Michael Lewis,1 Carl Erik Kuntze,2 Heinz Gulle3 1Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA; 2Medical Affairs, Baxter Healthcare SA, Zurich, Switzerland; 3Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria Abstract: The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG. NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. Keywords: HEMOPATCH, hemostasis, surgical hemostasis, sealing, surgical sealant

  10. Investigations into the efficacy of different procedures for surgical hand disinfection between consecutive operations.

    Science.gov (United States)

    Rehork, B; Rüden, H

    1991-10-01

    In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min.

  11. USE OF DEXMEDETOMIDINE INFUSION WITH SUBANAESTHETIC DOSE OF KETAMINE FOR MINOR SURGICAL PROCEDURES: A STUDY

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    Laishram Chandralekha Singha

    2016-07-01

    Full Text Available BACKGROUND Dexmedetomidine, an α2 agonist is an approved drug for sedation and co-analgesia, but may cause hypotension and bradycardia. Ketamine, which provides profound analgesia and dissociative anaesthesia when used with dexmedetomidine may counteract the adverse haemodynamic effects as both have opposing actions on the cardiovascular system apart from providing satisfactory sedation and analgesia during minor surgical procedures. OBJECTIVE To study the sedoanalgesic efficacy and haemodynamic changes of dexmedetomidine infusion along with subanaesthetic dose of ketamine for minor surgical procedures. MATERIALS AND METHODS After Institutional Ethical Committee approval and informed patient consent, 30 ASA physical status I and II patients of age between 20-50 years planned for split skin grafting were selected and included in the study, which was done over a period of four months. The patients were given continuous infusion of loading dose of dexmedetomidine of 1 µg/kg over 10 minutes. Ketamine 0.8 mg/kg IV was given one minute before the start of the procedure and subsequently maintained with dexmedetomidine infusion @ 0.5 µg/kg/hr. Pain and sedation score, haemodynamic changes, requirement of additional dose of ketamine, and occurrence of emergence delirium were observed. RESULTS The sedation level during the procedure and the pain score in the immediate postoperative period were satisfactory. 28 patients did not have any discomfort whereas 2 patients required additional 0.8 mg/kg of IV ketamine. Hypotension occurred in 3 patients and bradycardia in 2 patients. There was nausea in 2 patients whereas emergence delirium or respiratory depression was not seen in any of the patients. CONCLUSION Dexmedetomidine infusion with subanaesthetic dose of ketamine can be used satisfactorily for minor surgical procedures.

  12. Evaluation of the Prevalence of Different Treatment Failure Modes after Crown Lengthening Surgical Procedures

    Directory of Open Access Journals (Sweden)

    Amirreza Babaloo

    2016-07-01

    Full Text Available Introduction: Preservation of the health of periodontium is very important for the long-term success of restored teeth and a balance should always be created between the patients’ esthetic requirements and the periodontal health. Failures of crown lengthening procedures are classified into early and late failures. The aim of this study was to evaluate the prevalence of early failures of crown leathering surgical procedures. Materials and methods: In this descriptive/cross-sectional study, 96 patients were selected from those referring to the Department of Periodontitis, Tabriz Faculty of Dentistry, who required crown lengthening procedures. The particulars of these patients were recorded in special forms and the reasons for the failure of surgical procedures were separately determined at 2- and 6-week intervals. In addition, the frequencies of the reasons for failures were determined in percentages and absolute frequencies. Data were analyzed with descriptive statistics (frequencies and percentages using SPSS 21. Statistical significance was set at P<0.05. Results: Evaluation of patients 6 weeks after surgery showed a failure rate of 14.5% for crown lengthening procedures in patients referring to the Department of Periodontics, Tabriz Faculty of Dentistry. The most common reasons for such early failures in the 6th week, in descending order, were a lack of sufficient keratinized gingiva around in tooth in question, fracture of the tooth structure after surgery, inadequate surgery (not creating a proper distance between the healthy margin and the crest and the coronal returning of the gingival tissue on the tooth. A lack of sufficient keratinized gingiva around the tooth was the most frequent reason for the early failure of crown lengthening procedure at both study intervals. Conclusion: It can be concluded from the results of the present study that during the 6th postoperative week the crown lengthening procedures exhibited a 14.5% failure rate

  13. Central venous catheterization: comparison between interventional radiological procedure and blind surgical reocedure

    Energy Technology Data Exchange (ETDEWEB)

    Song, Won Gyu; Jin, Gong Yong; Han, Young Min; Yu, He Chul [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2002-11-01

    To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) day, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 of interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiology and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedure complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind

  14. FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY

    Science.gov (United States)

    ZORRON, Ricardo; GALVÃO-NETO, Manoel Passos; CAMPOS, Josemberg; BRANCO, Alcides José; SAMPAIO, José; JUNGHANS, Tido; BOTHE, Claudia; BENZING, Christian; KRENZIEN, Felix

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. Objective: The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Methods: Institutional experience and systematic review from the literature on revisional bariatric surgery. Results: Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Conclusion: Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex

  15. [Arterial and portal venous complications after HPB surgical procedures: Interdisciplinary management].

    Science.gov (United States)

    Arend, J; Schütte, K; Peglow, S; Däberitz, T; Popp, F; Benedix, F; Pech, M; Wolff, S; Bruns, C

    2015-06-01

    The surgical treatment of hepatopancreatobiliary (HPB) diseases requires complex operative procedures. Within the last decades the morbidity (36-50 %) and mortality (surgery shows an increased rate of complications. Postoperative bleeding has a major effect on the outcome and the incidence is 6.7 % after pancreatic surgery and 3.2 % after hepatobiliary surgery. The major causes of early postoperative hemorrhage are related to technical difficulties in surgery whereas late onset postoperative hemorrhage is linked to anastomosis insufficiency, formation of fistulae or abscesses due to vascular arrosion or formation of pseudoaneurysms. In many cases, delayed hemorrhage is preceded by a self-limiting sentinel bleeding. The treatment is dependent on the point in time, location and severity of the hemorrhage. The majority of early postoperative hemorrhages require surgical treatment. Late onset hemorrhage in hemodynamically stable patients is preferably treated by radiological interventions. After interventional hemostatic therapy 8.2 % of patients require secondary procedures. In the case of hemodynamic instability or development of sepsis, a relaparotomy is necessary. The treatment concept includes surgical or interventional remediation of the underlying cause of the hemorrhage. Other causes of postoperative morbidity and mortality are arterial and portal venous stenosis and thrombosis. Following liver resection, thrombosis of the portal vein occurs in 8.5-9.1 % and in 11.6 % following pancreatic resection with vascular involvement. Interventional surgical procedures or conservative treatment are suitable therapeutic options depending on the time of diagnosis and clinical symptoms. The risk of morbidity and mortality after HPB surgery can be reduced only in close interdisciplinary cooperation, which is particularly true for vascular complications.

  16. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.

    Science.gov (United States)

    Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

    2011-04-01

    Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m(2). All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n= 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m(2) (P<0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. © 2011 International Hepato-Pancreato-Biliary Association.

  17. Android application for determining surgical variables in brain-tumor resection procedures.

    Science.gov (United States)

    Vijayan, Rohan C; Thompson, Reid C; Chambless, Lola B; Morone, Peter J; He, Le; Clements, Logan W; Griesenauer, Rebekah H; Kang, Hakmook; Miga, Michael I

    2017-01-01

    The fidelity of image-guided neurosurgical procedures is often compromised due to the mechanical deformations that occur during surgery. In recent work, a framework was developed to predict the extent of this brain shift in brain-tumor resection procedures. The approach uses preoperatively determined surgical variables to predict brain shift and then subsequently corrects the patient's preoperative image volume to more closely match the intraoperative state of the patient's brain. However, a clinical workflow difficulty with the execution of this framework is the preoperative acquisition of surgical variables. To simplify and expedite this process, an Android, Java-based application was developed for tablets to provide neurosurgeons with the ability to manipulate three-dimensional models of the patient's neuroanatomy and determine an expected head orientation, craniotomy size and location, and trajectory to be taken into the tumor. These variables can then be exported for use as inputs to the biomechanical model associated with the correction framework. A multisurgeon, multicase mock trial was conducted to compare the accuracy of the virtual plan to that of a mock physical surgery. It was concluded that the Android application was an accurate, efficient, and timely method for planning surgical variables.

  18. [A new concept in digestive surgery: the computer assisted surgical procedure, from virtual reality to telemanipulation].

    Science.gov (United States)

    Marescaux, J; Clément, J M; Nord, M; Russier, Y; Tassetti, V; Mutter, D; Cotin, S; Ayache, N

    1997-11-01

    Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reason is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which has to include five requirements: visual fidelity, interactivity, physical properties, physiological properties, sensory input and output. In this report we will describe how to get a realistic 3D model of the liver from bi-dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction.

  19. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

    Science.gov (United States)

    da Silva, Katia Regina; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; de Carvalho, Eduardo Infante Januzzi; Fiorelli, Alfredo Inácio; Martinelli Filho, Martino; Costa, Roberto

    2016-01-01

    Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. PMID:27579544

  20. Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.

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    Raymond, Elizabeth G; Grossman, Daniel; Weaver, Mark A; Toti, Stephanie; Winikoff, Beverly

    2014-11-01

    The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities. We calculated the abortion-related mortality rate during 2000-2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving. The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.

    Science.gov (United States)

    Fu, Teresa; Corrigan, Nicole J; Quinn, Charles T; Rogers, Zora R; Buchanan, George R

    2005-07-01

    Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications. Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered. Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.

  2. The radius surgical system - a new device for complex minimally invasive procedures in urology?

    Science.gov (United States)

    Frede, Thomas; Hammady, Ahmed; Klein, Jan; Teber, Dogu; Inaki, Noriyuki; Waseda, Masahiro; Buess, Gerhard; Rassweiler, Jens

    2007-04-01

    Complex laparoscopic procedures in urology are technically demanding with an extended learning curve. Robotic systems add significant cost to laparoscopic procedures. We therefore evaluated the use of the Radius Surgical System (RSS), a mechanical manipulator, for complex laparoscopic cases in urology. The RSS (Tuebingen Scientific) consists of two hand-guided surgical manipulators and provides a deflectable and rotatable tip allowing six degrees of freedom. We evaluated the system by using a series of standardized models in the pelvitrainer. We analyzed the effectiveness of the system and the learning curve. We then evaluated the system in the clinical setting during laparoscopic radical prostatectomy. Surgeons with experience on the RSS were compared to surgeons without previous experience on the system. We identified a learning curve in those participants without experience on the system only when performing complete anastomoses in the pelvitrainer. However, this learning curve included less than 10 anastomoses. The first clinical experiences during laparoscopic extraperitoneal radical prostatectomy (n=10) are promising. All anastomoses were patent on routine (X-ray) examination 8 days after surgery. The RSS system is easy to use and we identified a very short learning curve. We now optimize the system for use in urology. This device may facilitate complex laparoscopic procedures without the use of costly robotic systems and should be further evaluated in the experimental and clinical setting.

  3. Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.

    Science.gov (United States)

    Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B

    2017-08-01

    Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.

    Science.gov (United States)

    Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O

    2017-06-01

    Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases

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    Dário Vianna Birolini

    Full Text Available Objective: this study aims to explore the experience of Brazilian surgeons on Unintentionally Retained Foreign Bodies (RFB after surgical procedures. Methods: A questionnaire was sent to surgeons by electronic mail, between March and July 2012. The questions analyzed their experience with foreign bodies (FB, foreign bodies' types, clinical manifestations, diagnoses, risk factors and legal implications. Results: in the 2872 eligible questionnaires, 43% of the surgeons asserted that they had already left FB and 73% had removed FB in one or more occasions, totalizing 4547. Of these foreign bodies, 90% were textiles, 78% were discovered in the first year and 14% remained asymptomatic. Among doctors with less than five years after graduation, 36% had already left a FB. The most frequently surgical procedures mentioned were the elective (57% and routine (85% ones. Emergency (26%, lack of counting (25% and inadequate conditions of work contributed (12.5% to the occurrence. In 46% of the cases patients were alerted about the FB, and 26% of them sued the doctors or the institution. Conclusions: challenging medical situations, omission of security protocols and inadequate work conditions contributed to RFB. However, RFB occurs mostly in routine procedures such as cesarean or cholecystectomy, and at the beginning of the professional career, highlighting, particularly in poorest countries, the need for primary prevention. Textiles predominated causing clinical repercussions and they were diagnosed in the first postoperative months. Surgeons were sued in 11.3% of the RFB cases.

  6. Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

    Directory of Open Access Journals (Sweden)

    Anna Maria Fleury

    2011-01-01

    Full Text Available INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically. Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20% for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively. The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%. CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

  7. The increasing number of surgical procedures for female genital fistula in England: analysis of Hospital Episode Statistics (HES) data.

    Science.gov (United States)

    Ismail, S I M F

    2015-01-01

    The aim of this study was to describe the number and trend of surgical procedures for female genital fistula in England. An online search of Hospital Episode Statistics (HES) data was carried out. Data were available for the 4-year period from 2002-03 until 2005-06. The total number of surgical procedures carried out for female genital fistula steadily increased by 28.7% from 616 in 2002-03 to 793 in 2005-06. The number of surgical procedures performed for rectovaginal fistula exceeded the total number of surgical procedures carried out for vesicovaginal and urethrovaginal fistula in each year of the study period. This pattern needs to be monitored and investigated further.

  8. Medical versus surgical termination of early pregnancy: satisfaction with care, emotional impact and acceptability of the procedure

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    Prasanna L. Akkenapally

    2016-09-01

    Conclusions: Satisfaction with both the methods of medical and surgical abortion is high. Acceptability of the procedure next time was more with surgical abortion. MTOP had higher emotional impact. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3158-3166

  9. Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

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    Roberta Maia de Castro Romanelli

    Full Text Available Background Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. Objective To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. Methods This case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. Results During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days. In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03 and use of non-invasive ventilation was a protective factor (p = 0.048. Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004, duration of non-invasive ventilation (p = 0.04, and parenteral nutrition duration (p = 0.003. In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041. Conclusions Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates

  10. Patient safety in dermatologic surgery: Part I. Safety related to surgical procedures.

    Science.gov (United States)

    Hansen, Timothy J; Lolis, Margarita; Goldberg, David J; MacFarlane, Deborah F

    2015-07-01

    Surgical procedures involve unique elements related to patient safety. One must be aware of potential complications and safety issues within the practice of dermatologic surgery. Developing a high level of competence in skin surgery will address some safety issues, while implementing protocols and redundancies provides systems-based correction for other safety issues. We provide an in-depth review of patient safety in dermatologic surgery. In particular, we highlight the most common safety issues and methods for reducing error. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

    Science.gov (United States)

    Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E

    2017-03-01

    OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas

  12. EVALUATION OF NEW SURGICAL PROCEDURE ‘LIFT’ (LIGATION OF INTERSPHINCTERIC FISTULOUS TRACT IN THE MANAGEMENT OF A SUBSET OF PATIENTS WITH FISTULA–INANO

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    Anand

    2016-05-01

    Full Text Available BACKGROUND Fistula-in-ano is a common surgical condition managed in general surgical department, treated with various surgical methods with many efforts to avoid injury to anal sphincter and improve the outcomes in terms of fistula healing and prevent recurrences. AIM To evaluate the results of LIFT procedure in selective fistula patients to know its effectiveness in the management of fistulain-ano. METHODS 12 patients who underwent this procedure were evaluated. This prospective study was conducted over a period of one year after careful selection of patients with transsphincteric fistula with fixed inclusion and exclusion criteria. RESULTS Out of 12 patients, 10 patients were male and 2 were female. The mean age was 38.6 years. Of these, 9 patients were healed completely without any complications. One patient developed abscess which was drained later. One patient required additional procedure in the form of simple fistulotomy. One patient developed transient flatus incontinence which subsided later. One patient developed recurrence in 6 months. CONCLUSION This analysis indicates that the LIFT procedure is primarily effective for transsphincteric fistula patients with an overall fistula closure of 91.66% with low impact of sphincter damage and recurrence rate of 8.33%.

  13. Continuously variable rating: a new, simple and logical procedure to evaluate original scientific publications

    Directory of Open Access Journals (Sweden)

    Mauricio Rocha e Silva

    2011-01-01

    Full Text Available OBJECTIVE: Impact Factors (IF are widely used surrogates to evaluate single articles, in spite of known shortcomings imposed by cite distribution skewness. We quantify this asymmetry and propose a simple computer-based procedure for evaluating individual articles. METHOD: (a Analysis of symmetry. Journals clustered around nine Impact Factor points were selected from the medical ‘‘Subject Categories’’ in Journal Citation Reports 2010. Citable items published in 2008 were retrieved and ranked by granted citations over the Jan/2008 - Jun/2011 period. Frequency distribution of cites, normalized cumulative cites and absolute cites/decile were determined for each journal cluster. (b Positive Predictive Value. Three arbitrarily established evaluation classes were generated: LOW (1.33.9. Positive Predictive Value for journal clusters within each class range was estimated. (c Continuously Variable Rating. An alternative evaluation procedure is proposed to allow the rating of individually published articles in comparison to all articles published in the same journal within the same year of publication. The general guiding lines for the construction of a totally dedicated software program are delineated. RESULTS AND CONCLUSIONS: Skewness followed the Pareto Distribution for (1simple computer based procedure capable of accurately providing a valid rating for each article within the journal and time frame in which it was published.

  14. Microbial sealants do not decrease surgical site infection for clean-contaminated colorectal procedures.

    Science.gov (United States)

    Doorly, M; Choi, J; Floyd, A; Senagore, A

    2015-05-01

    Surgical site infections (SSI) are costly complications that may cause significant morbidity and increase the cost of care, particularly in colorectal surgery. Microbial sealants (MS) are a new class of wound barriers aimed at decreasing SSI; however, there is only evidence of benefit in clean class 1 procedures. Based on its success in class 1 procedures, we hypothesized that a microbial sealant could reduce the rate of SSI by half for clean-contaminated colorectal procedures (class 2). This was a single institution, multihospital, prospective, randomized study approved by the institutional review board. The primary objective was to determine the rate of SSI when microbial sealant (InteguSeal© Kimberly-Clark) is used compared to control (no microbial sealant). Data collected included: open versus laparoscopy, age, body mass index (BMI), diabetes and morbidity [American Society of Anesthesiologists (ASA) class], hospital readmission, reoperation and wound dehiscence. Enrolled subjects received the same preoperative mechanical bowel preparation with oral antibiotics, operative skin preparation (Chloraprep), Surgical Care Improvement Project guidelines implementation), and postoperative care glycemic control for diabetics. A total of 100 subjects were recruited over 15 months (MS-50; no MS-50). The overall incidence of SSI was 12 %, 14 % (7/50) in the MS versus 10 % (5/50) in the no MS group (p = 0.545). SSI incidence with and without microbial sealant was not significantly different in either the open or the laparoscopic subgroup. Laparoscopy decreased absolute risk of SSI by 16 %. Secondary data (age, BMI, diabetes, ASA) and tertiary data (readmission, reoperation, wound dehiscence) were positively correlated with SSI. Microbial sealant as employed in this study did not appear to offer any benefit in a class 2 (clean contaminated) operative procedure when perioperative care is standardized. The relative benefit of laparoscopy was also confirmed but unaffected by

  15. Lingual frenectomy: a comparison between the conventional surgical and laser procedure.

    Science.gov (United States)

    De Santis, D; Gerosa, R; Graziani, P F; Zanotti, G; Rossini, N; Castellani, R; Bissolotti, G; Chiarini, L; Nocini, P F; Bertossi, D

    2013-08-01

    Aim: Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum that may contribute to feeding, speech and mechanical problems. The purpose of this study is to compare the advantages of laser vis-à-vis conventional frenectomy in both intra- and post-surgical phases. Methods: This study took into consideration two patients, who were respectively 9 and 10-year-old. The first one underwent a common surgical procedure. A Nd:Yap laser device with a micropulsed wavelength of 1340 nm and power of 8 watts was used for the second. The postsurgical discomfort and healing characteristics were evaluated. Results: The results indicated that the Nd:Yap laser has the following advantages when compared to the conventional frenectomy: 1) soft tissue cutting was efficient, with no bleeding, giving a clear operative field; 2) there was no need to use sutures; 3) the surgery was less time-consuming; 4) there was no postsurgical infection and no need for analgesics or antibiotics; 5) wound contraction and scarring were decreased or eliminated; 6) despite the initial slowness of the healing process, the complete and final recovery was faster. Conclusion: Considering the above elements, it is possible to assert that the laser frenectomy has a series of unquestionable advantages if compared to the conventional surgical technique.

  16. A simple protocol for the management of deep sternal surgical site infection: a retrospective study of twenty-five cases.

    Science.gov (United States)

    Shih, Yu-Jen; Chang, Shun-Cheng; Wang, Chih-Hsin; Dai, Niann-Tzyy; Chen, Shyi-Gen; Chen, Tim-Mo; Tzeng, Yuan-Sheng

    2014-12-01

    Deep sternal incisional surgical site infection is a serious and potentially life-threatening complication after open heart surgery. Although a rare post-operative complication, the rates of post-operative morbidity and mortality are greater in patients who develop a deep sternal incisional surgical site infection than in those who do not. We evaluated retrospectively the results of patients who developed a deep sternal incisional surgical site infection who were treated with either a pectoralis major flap or delayed primary closure after previous negative-pressure wound therapy (NWPT). From July 2007 to July 2012, 25 patients had a deep sternal incisional surgical site infection after open heart surgery in the Departments of Plastic Surgery and Cardiac Surgery of the Tri-Service General Hospital Medical Center. Sternal refixation was not performed in our patients. In 15 patients, a unilateral or bilateral pectoralis major advancement flap with a myocutaneous or muscle flap was used. In seven patients, delayed primary closure was performed after NPWT. One patient received a rectus abdominis myocutaneous flap and another received a free anterior lateral thigh flap. One patient died after developing nosocomial pneumonia with severe sepsis after debridement. In our series, no patient required sternal re-fixation. Our findings suggest that delayed primary closure and use of a unilateral or bilateral pectoralis major flap following NPWT for a deep sternal incisional surgical site infection are simple and quick methods for managing such difficult surgical incisions even if the deep sternal surgical site infection is located in the lower one-third of the sternum.

  17. Simple and Efficient Procedure for Synthesis of N'-Arylamidines Using Trimethylaluminum

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    Korbad, Balaji L.; Lee, Sanghyeup [Catholic Univ., of Daegu, Daegu (Korea, Republic of)

    2013-04-15

    In conclusion, we have developed simple and efficient procedure for the synthesis of N'-arylamidines using tri-methylaluminum, nitriles and aryl amines under mild condition. Aliphatic, aromatic nitriles were reacted well with a variety of aromatic amine to afford corresponding amidines in good to high yields. Amidines are an important class of compounds that have wide range of application in the fields of catalyst design, material science, medicinal chemistry and also shown the promising anti-inflammatory and analgesic activity. They are valuable synthons for synthesis of various heterocyclic compounds. In addition, recent studies have demonstrated their capacity to fix carbon dioxide.

  18. Anxiety and pain in children undergoing elective surgical procedures: a systematic review.

    Science.gov (United States)

    Jia Shermin, Chieng Ying; Sally, Chan Wai-Chi; Hong-Gu, He

    2012-01-01

    Anxiety and pain are two significant problems experienced by children undergoing elective surgical procedures, which may lead to suboptimal postoperative outcomes. Previous studies have shown a correlation between perioperative anxiety and pain in children. This review aimed to present the best available evidence on the correlation between perioperative anxiety and pain in children undergoing elective surgical procedures, and to determine the relationship between children's demographics, their anxiety and pain level in the perioperative period. Participants were children aged between five to 18 years old who were scheduled for an elective surgical procedure in the hospital setting.No specific intervention was of interest. So long as the primary studies examined correlation of children's anxiety and pain in the perioperative period, they were considered for inclusion.This review focused on children's preoperative level of anxiety; children's postoperative level of anxiety; children's postoperative pain intensity; and/or children's postoperative behavioural changes.This review included quantitative research studies, such as randomised-controlled trials, cohort studies, and descriptive studies which addressed the correlation between perioperative anxiety and perioperative pain in children undergoing elective surgical procedures. A three-step search strategy was utilised in this review. The following databases were searched for articles published in English from the inception date of databases to December 2010: CINAHL, PubMed, Scopus, PsycINFO, Mednar, Trip Database, ProQuest Dissertations and Theses, Scirus ETD and Web of Science. Papers selected for retrieval were assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal tools from Joanna Briggs Institute. There were no disagreements between the two reviewers, so the third reviewer was not required. Data were extracted using the

  19. A simple rapid procedure for obtaining axenic cultures from monoxenic cultures of myxomycete plasmodia.

    Science.gov (United States)

    Balaji, S; Sujatha, A; Kalyanasundaram, I

    1999-10-01

    Axenic culture of myxomycete plasmodia has been attempted from time to time by various authors, but with very little success. From over 500 known species of myxomycetes, fewer than 20 species have been reported in axenic culture to date, including axenic myxamoebal cultures. In these cultures, the plasmodia required either complex media, or a killed bacterial supplement for growth. Furthermore, the time required for attaining the axenic state varied from several months to years. In the present study, a simple, rapid procedure has been developed to render monoxenic plasmodial cultures axenic. This procedure is based on our discovery that plasmodia have certain unusual substrate preferences that are inhibitory to the associated bacteria using Physarella oblonga as a model. The presence or absence of the bacteria could be ascertained through incubation in four different bacteriological media and by the use of a differential staining technique.

  20. A simple approximative procedure for taking into account low cycle fatigue loads

    Energy Technology Data Exchange (ETDEWEB)

    Larsen, G.; Thomsen, K.

    1996-09-01

    In this paper a simple approximative algorithm for taking into account low cycle fatigue loads is presented. Traditionally, the fatigue life consumption of a wind turbine is estimated by considering a number of (independent) load cases and performing a rainflow counting analysis on each of those. These results are then subsequently synthesized into a total load spectrum by performing a weighed sum of the number of individual load case ranges. The fatigue life consumption is thus obtained by applying the Palmgren-Miner rule on the total load spectrum. However, due to the assumption of isolated basic load cases, the above procedure fail to represent the low-frequency contributions related to the transition between those load cases. The procedure to be described in the following aims at taking the fatigue contribution, related to the transitions between the defined load cases, into account in an approximative manner. (au)

  1. Safety and efficacy of immediate postoperative feeding and bowel stimulation to prevent ileus after major gynecologic surgical procedures.

    Science.gov (United States)

    Fanning, James; Hojat, Rod

    2011-08-01

    Postoperative ileus is a major complication of abdominal surgical procedures To evaluate the incidence of ileus and gastrointestinal morbidity in patients who received immediate postoperative feeding and bowel stimulation after undergoing major gynecologic surgical procedures. During a 5-year period, the authors tracked demographic, surgical outcome, and follow-up information for 707 patients who underwent major gynecologic operations. All patients received the same postoperative orders, including immediate feeding of a diet of choice and bowel stimulation with 30 mL of magnesium hydroxide (milk of magnesia) twice daily until bowel movements occurred. Of 707 patients, 6 (<1%) had postoperative ileus. No patients experienced postoperative bowel obstruction and 2 patients (0.3%) had postoperative intestinal leak. No serious adverse effects associated with bowel stimulation were reported. Immediate postoperative feeding and bowel stimulation is a safe and effective approach to preventing ileus in patients who undergo major gynecologic surgical procedures.

  2. A combination of three minimally invasive surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity.

    Science.gov (United States)

    Yura, Shinya; Kato, Takumi; Ooi, Kazuhiro; Izumiyama, Yuri

    2008-08-01

    We describe a combination of 3 surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity and quality. In these situations, we have performed 3 minimally invasive, safe, and reliable surgical procedures: buccal bone graft with bone harvested from the mandibular molar region, submucous vestibuloplasty using artificial dermis, and bone-added osteotome sinus floor elevation under endoscopic control. These modified procedures can be performed in the office setting under outpatient local anesthesia and may minimize patient discomfort and reduce postoperative complications.

  3. A simple procedure for rehybridization of nuclei analyzed previously by fish

    Directory of Open Access Journals (Sweden)

    Andréa Borduchi Carvalho-Salles

    1999-06-01

    Full Text Available We present a simple procedure for interphase fluorescence in situ rehybridization (FISH. This procedure was used to evaluate fresh prostate tumor from needle biopsy specimens. Digoxigenin-labeled DNA probes were hybridized onto nuclei which had been previously investigated by FISH using biotin-labeled DNA probes. This method makes it possible to reanalyze the same nuclei with different centromeric DNA probes and is useful in cases where a limited number of slides are available.O presente trabalho descreve um procedimento simples para reibridização in situ fluorescente em núcleos interfásicos de amostras frescas de tumores de próstata obtidas a partir de biopsias aspirativas. Sondas -centroméricas marcadas com digoxigenina foram hibridizadas em núcleos anteriormente avaliados com diferentes sondas marcadas com biotina. Esse método permitiu a análise da mesma célula com diferentes seqüências de DNA centroméricas, especialmente em casos com um número limitado de lâminas disponíveis.

  4. Screening fetal losses for monosomy X with a simple PCR-based procedure

    Directory of Open Access Journals (Sweden)

    Pereira Rinaldo W.

    2000-01-01

    Full Text Available To screen for monosomy X in spontaneous fetal losses we explored a simple molecular strategy based on loss of heterozygosity at highly polymorphic X-linked loci. We developed a multiplex fluorescent procedure that allows the simultaneous amplification of five dinucleotide repeat polymorphisms in a large low-recombination region in the long arm of the X chromosome. Analysis was performed by computer-assisted laser densitometry. We did not find any instances of homozygosity at all five loci in 30 normal females tested, nor among 37 women whose typing data were retrieved from the Fondation Jean Dausset - CEPH genotype database. In addition, all cases of monosomy X previously diagnosed by conventional cytogenetics presented the anticipated loss of heterozygosity at all loci. We studied 19 spontaneously aborted female fetuses and we found four samples homozygous for the five loci (21%, in good agreement with the expected rate of monosomy X in first trimester spontaneous abortions. We conclude that the loci have high diversity and high efficiency in PCR-amplification and that our multiplex procedure constitutes a simple and useful molecular screening test for monosomy X in abortions and stillbirths.

  5. A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals.

    Science.gov (United States)

    Henke, Peter K; Kubus, Jim; Englesbe, Michael J; Harbaugh, Calista; Campbell, Darrell A

    2010-10-01

    Regional surgical quality improvement consortiums are becoming more common. Herein we have reported the effectiveness of a statewide consortium focusing on open vascular operative procedures. The statewide Michigan Surgical Quality Consortium was established in 2005 with 16 hospitals that report cases of vascular open operative intervention, in a sampling manner consistent with the private sector National Surgical Quality Improvement Program. Data are abstracted by onsite trained nurses using defined and validated pre-, peri-, and postoperative variables with 30-day follow-up. Outpatient and emergent cases were excluded. We compared outcomes over the course of the consortium (era I, April 2005-March 2007; era II, April 2007-March 2008) via univariate and multivariate techniques. Era I (n = 2,453) and era II (n = 3,409) cases were similar in age (mean, 68 years), gender (61% male), relative value units (mean, 21), and distribution of Current Procedural Terminology codes. Duration of stay and operative time decreased by 15% and 11%, respectively, when comparing era I with era II (P cardiac or renal, complications. When evaluating both eras, modifiable variables (able to be altered by the surgeon) for morbidity included increased length of operation (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.003-1.005; P < .0001), hypertension (OR, 1.46; 95% CI, 1.03-2.1; P = .03), and blood transfusion (OR, 2.8; 95% CI, 2.04-3.88; P < .0001). However, anemic patients (11%; hematocrit <30) who were transfused were less likely to suffer morbidity (OR, 56; 95% CI, 0.47-0.67; P < .0001) than those transfused who were not anemic. The absolute 2% reduction in complications led to a $172 cost savings for the payers per patient in era II compared with era I. A statewide quality-of-care consortium with timely feedback of data was associated with decreased morbidity over a relatively short follow-up period in vascular patients. Focusing on best processes in real-world practice

  6. J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

    Science.gov (United States)

    Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

    2014-11-01

    Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

  7. Surgical site infections after lower extremity revascularization procedures involving groin incisions.

    Science.gov (United States)

    Kuy, SreyRam; Dua, Anahita; Desai, Sapan; Dua, Arshish; Patel, Bhavin; Tondravi, Nader; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian D; Lee, Cheong J; Kuy, SreyReath; Subbarayan, Rishi; Rossi, Peter J

    2014-01-01

    We sought to evaluate the incidence, epidemiology, and factors associated with surgical site infections (SSIs) after lower extremity revascularization procedures involving groin incisions and determine outcomes based on SSI status. This is a single-institution, retrospective cohort study of 106 patients who underwent lower extremity revascularization procedures involving femoral artery exposure through a groin incision at a tertiary referral hospital. The primary outcome was occurrence of SSI at the groin wound. The duration of hospital stay, reoperation within 30 days, discharge disposition, and 30-day mortality were also evaluated. Independent variables included patient demographics and operative variables (i.e., procedure type, transfusion requirements, preoperative antibiotics, intraoperative vasopressors, and operative duration). Statistical analysis included chi-squared tests, t-tests, and multivariable regression analysis. Of the 106 patients who underwent a lower extremity revascularization procedure with a groin incision for femoral artery exposure, 62% were male, and the mean age was 62 years. Comorbidities included hypertension (93%), dyslipidemia (65%), statin use (63%), active smoker (50%), diabetes (24%), and chronic obstructive pulmonary disease (23%). All patients received preoperative antibiotics, 50% required intraoperative pressors, 21% received a blood transfusion, and the mean operative time was 296 min. The overall duration of stay was 10.7 days, the 30-day reoperation rate was 18%, and the 30-day mortality rate was 12%. Overall, 22% developed a seroma or hematoma, and 31% developed a SSI. Patients who developed an SSI compared with those who did not were more likely to have a postoperative seroma or hematoma (55% vs 5%) and to receive a blood transfusion (33% vs 15%), but less likely to be treated with a statin (47% vs 69%) or carry a diagnosis of dyslipidemia (50% vs 72%), respectively, all P surgical site complications after lower

  8. The effect of aromatherapy on postoperative nausea in women undergoing surgical procedures.

    Science.gov (United States)

    Ferruggiari, Luisa; Ragione, Barbara; Rich, Ellen R; Lock, Kathleen

    2012-08-01

    Postoperative nausea and vomiting (PONV) is a common source of patient discomfort and decreased satisfaction. Aromatherapy has been identified as a complementary modality for the prevention and management of PONV. The purpose of this study was to assess the effect of aromatherapy on the severity of postoperative nausea (PON) in women undergoing surgical procedures in the postanesthesia care unit. Women complaining of PON received traditional antiemetics, inhalation of peppermint oil, or saline vapor. A visual analog scale was used to rate nausea at the first complaint; at 5 minutes after intervention; and, if nausea persisted, at 10 minutes after intervention. At both 5 and 10 minutes, statistical analysis showed no significant differences between intervention and nausea rating. Obtaining eligible subjects was challenging. Although many women consented, most received intraoperative antiemetics and did not report nausea postoperatively.

  9. COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI).Methods. The clinical data of 95 USI cases or accompany USI treated by surgical procedures (Kelly operation 63 cases, Colposuspension 32 cases) was analysed retrospectively in our department.Results.The cure rates during three months after operation were 92.9% in Colposuspension group and 68.9% in Kelly operation group (P0.05). Abnormal senses rates of sexual intercouse was 3.7% in Cloposuspension and 7.3% in Kelly operation group. The length of retaining Folly catheter after Colposuspension was more than Kelly operation.Conclusion.The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

  10. COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

    Institute of Scientific and Technical Information of China (English)

    朱兰; 朗景和; 刘珠凤; 黄荣丽

    2000-01-01

    Objective. To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI). Methods. The clinical data of 95 USI cases or aecompeny USI treated by surgical procedures (Kelly operation 63 cases, Colpesuspemion 32 cases) was analysed retrospectively in our deparlment. Results. The cure rates during three months after operation were 92.9% in Colpesuspension group and 68.9% in Kelly operation group (P 0.05). Abnormal senses rates of sexual intercouse was 3.7 % in Clopesuspension and 7.3 % in Kelly operation group. The length of retaining Folly catheter after Colpesuspension was more than Kelly operation. Conclusion. The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

  11. Implantation of temperature loggers in 100 Danish dairy calves: Surgical procedure and follow-up

    DEFF Research Database (Denmark)

    Alban, L.; Chriel, M.; Tegtmeier, C.;

    1999-01-01

    One hundred Danish dairy calves had temperature loggers implanted subcutaneously on the neck. Post-operatively, the calves were given a single antibiotic treatment, and tissue reactions were assessed on 6 post-operative visits. After approximately 5 months, the loggers were removed and material...... submitted for histologic examination. This paper presents 1) the surgical procedure, 2) the prevalence of tissue reaction at the post-operative visits, 3) the degree of implant recovery, 4) the results of histopathologic examinations, 5) an evaluation of age at implantation or veterinary practitioner...... because of presence of an abcess. No migration of the temperature loggers were observed. The results of a repeated measures analysis and the histopathological findings indicate that contamination during the surgery resulted in inflammation and abcess formation. It is recommended that in the presence...

  12. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

    Directory of Open Access Journals (Sweden)

    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  13. A brief overview of bariatric surgical procedures currently being used to treat the obese patient.

    Science.gov (United States)

    Hydock, Claudia Marie

    2005-01-01

    Obesity has reached an overwhelming high in the United States as well as other developing countries around the world. Alone, approximately 60 million Americans are characterized as obese, and 10 million of them are considered morbidly obese. Many have tried and failed not only to lose the excess weight through fad diets, medically supervised diets, exercise programs, and athletic club memberships, but also to maintain a healthy weight. As a result, weight gain and loss has become a way of life, an unhealthy way of life. This often results in a weight gain of a greater number of pounds than where they started. As a result, many patients and their physicians are looking to weight loss surgery as a permanent solution to the problem of yo-yo dieting. Along with the surgical alterations to the digestive system, nutrition counseling with portion control and regular exercise are part of a comprehensive program for successful long-term weight maintenance. It is the intent of this article to provide the reader with the basic understanding of the normal anatomy of the digestive tract. Then, each surgical procedure will be discussed, enabling the reader to visualize the changes in the digestion and absorption of food. It is these changes in absorption of vitamins and minerals, fats and carbohydrates, and proteins that lead to the various medical complications seen in patients after bariatric surgery.

  14. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

    Science.gov (United States)

    2015-01-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  15. Comparison of intraoperative blood loss between four different surgical procedures in the treatment of bimaxillary protrusion.

    Science.gov (United States)

    Tseng, Yu-Chuan; Ting, Chun-Chan; Kao, Yu-Hsun; Chen, Chun-Ming

    2017-01-01

    This study was aimed at investigating the correlation between intraoperative blood loss and operation-related factors in the treatment of bimaxillary protrusion with four different procedures. Ninety-four patients were separated into the following four surgical groups: group 1: anterior subapical osteotomy of the maxilla (ASO Mx) + bilateral parasymphyseal osteotomy of the mandible (BPsO Md) + genioplasty (GeP); group 2: ASO Mx + BPsO Md; group 3: ASO Mx + ASO Md + GeP; and group 4: ASO Mx + ASO Md. Patient- and operation-related factors (age, intraoperative blood loss, operation time, and preoperative and postoperative blood parameters) were compared among the four groups. The mean operation time and intraoperative blood loss were 438.7 minutes and 369.9 mL in group 1; 432.5 minutes and 356.5 mL in group 2; 393.3 minutes and 387.3 mL in group 3; and 353.5 minutes and 289.5 mL in group 4. Intergroup differences in intraoperative blood loss were not significant. A significant correlation between intraoperative blood loss and operation time was found in group 4 but not in the other groups. No significant differences in blood loss were found among the four different surgical procedures in the treatment of bimaxillary protrusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Surgical procedures for a rat model of partial orthotopic liver transplantation with hepatic arterial reconstruction.

    Science.gov (United States)

    Nagai, Kazuyuki; Yagi, Shintaro; Uemoto, Shinji; Tolba, Rene H

    2013-03-07

    Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as studies on graft preservation and ischemia-reperfusion injury, immunological responses, hemodynamics, and small-for-size syndrome. The rat OLT is among the most difficult animal models in experimental surgery and demands advanced microsurgical skills that take a long time to learn. Consequently, the use of this model has been limited. Since the reliability and reproducibility of results are key components of the experiments in which such complex animal models are used, it is essential for surgeons who are involved in rat OLT to be trained in well-standardized and sophisticated procedures for this model. While various techniques and modifications of OLT in rats have been reported since the first model was described by Lee et al. in 1973, the elimination of the hepatic arterial reconstruction and the introduction of the cuff anastomosis technique by Kamada et al. were a major advancement in this model, because they simplified the reconstruction procedures to a great degree. In the model by Kamada et al., the hepatic rearterialization was also eliminated. Since rats could survive without hepatic arterial flow after liver transplantation, there was considerable controversy over the value of hepatic arterialization. However, the physiological superiority of the arterialized model has been increasingly acknowledged, especially in terms of preserving the bile duct system and the liver integrity. In this article, we present detailed surgical procedures for a rat model of OLT with hepatic arterial reconstruction using a 50% partial graft after ex vivo liver resection. The reconstruction procedures for each vessel and the bile duct are performed by the following methods: a 7-0 polypropylene continuous suture for the supra- and infrahepatic vena cava; a cuff technique for the portal vein; and a stent technique for the

  17. The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association.

    Science.gov (United States)

    Minhas, Shobhit V; Kester, Benjamin S; Larkin, Kevin E; Hsu, Wellington K

    2016-04-01

    Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes' careers. To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance. Cohort study; Level of evidence, 3. Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries. A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m(2) (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures. NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures. © 2016 The Author(s).

  18. Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

    Science.gov (United States)

    Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

    2015-03-01

    Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  19. A simple and efficient Agrobacterium-mediated procedure for transformation of tomato.

    Science.gov (United States)

    Sharma, Manoj K; Solanke, Amolkumar U; Jani, Dewal; Singh, Yogendra; Sharma, Arun K

    2009-09-01

    We describe a highly efficient and reproducible Agrobacterium-mediated transformation protocol applicable to several varieties of tomato (Solanum lycopersicum, earlier known as Lycopersicum esculentum). Conditions such as co-cultivation period, bacterial concentration, concentration of benzyl amino purine (BAP), zeatin and indole acetic acid (IAA) were optimized. Co-cultivation of explants with a bacterial concentration of 108 cells/ml for three days on 2 mg/l BAP, followed by regeneration on a medium containing 1 mg/ml zeatin resulted in a transformation frequency of 41.4%. Transformation of tomato plants was confirmed by Southern blot analysis and beta-glucuronidase (GUS) assay. The protocol developed showed very high efficiency of transformation for tomato varieties Pusa Ruby, Arka Vikas and Sioux. The optimized transformation procedure is simple, efficient and does not require tobacco, Petunia, tomato suspension feeder layer or acetosyringone.

  20. A simple and efficient Agrobacterium-mediated procedure for transformation of tomato

    Indian Academy of Sciences (India)

    Manoj K Sharma; Amolkumar U Solanke; Dewal Jani; Yogendra Singh; Arun K Sharma

    2009-09-01

    We describe a highly efficient and reproducible Agrobacterium-mediated transformation protocol applicable to several varieties of tomato (Solanum lycopersicum, earlier known as Lycopersicum esculentum). Conditions such as co-cultivation period, bacterial concentration, concentration of benzyl amino purine (BAP), zeatin and indole acetic acid (IAA) were optimized. Co-cultivation of explants with a bacterial concentration of 108 cells/ml for three days on 2 mg/l BAP, followed by regeneration on a medium containing 1 mg/ml zeatin resulted in a transformation frequency of 41.4%. Transformation of tomato plants was confirmed by Southern blot analysis and -glucuronidase (GUS) assay. The protocol developed showed very high efficiency of transformation for tomato varieties Pusa Ruby, Arka Vikas and Sioux. The optimized transformation procedure is simple, efficient and does not require tobacco, Petunia, tomato suspension feeder layer or acetosyringone.

  1. Perspective: authentic patient perspectives in simulations for procedural and surgical skills.

    Science.gov (United States)

    Nestel, Debra; Kneebone, Roger

    2010-05-01

    In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

  2. [Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures].

    Science.gov (United States)

    San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente

    2014-10-01

    Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  3. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Raspe, Heiner

    2005-11-01

    as an intermediate therapeutical option between conservative and operative management of small lumbar disc herniations or protrusions causing sciatica. Two RCT comparing transforaminal endoscopic procedures with microdiscectomy in patients with sciatica and small non-sequestered disc herniations show comparable short and medium term overall success rates. Concerning speed of recovery and return to work a trend towards more favourable results for the endoscopic procedures is noted. It is doubtful though, whether these results from the eleven and five years old studies are still valid for the more advanced procedures used today. The only RCT comparing the results of automated percutaneous lumbar discectomy to those of microdiscectomy showed clearly superior results of microdiscectomy. Furthermore, success rates of automated percutaneous lumbar discectomy reported in the RCT (29% differ extremely from success rates reported in case series (between 56% and 92%. The literature search retrieves no controlled trials to assess efficacy and/or effectiveness of laser-discectomy, percutaneous manual discectomy or endoscopic procedures using a posterior approach in comparison to the standard procedures. Results from recent case series permit no assessment of efficacy, especially not in comparison to standard procedures. Due to highly selected patients, modi-fications of operative procedures, highly specialised surgical units and poorly standardised outcome assessment results of case series are highly variable, their generalisability is low. The results of the five economical analyses are, due to conceptual and methodological problems, of no value for decision-making in the context of the German health care system. Discussion: Aside from low methodological study quality three conceptual problems complicate the interpretation of results. 1. Continuous further development of technologies leads to a diversity of procedures in use which prohibits generalisation of study results

  4. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Science.gov (United States)

    Lühmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner

    2005-01-01

    option between conservative and operative management of small lumbar disc herniations or protrusions causing sciatica. Two RCT comparing transforaminal endoscopic procedures with microdiscectomy in patients with sciatica and small non-sequestered disc herniations show comparable short and medium term overall success rates. Concerning speed of recovery and return to work a trend towards more favourable results for the endoscopic procedures is noted. It is doubtful though, whether these results from the eleven and five years old studies are still valid for the more advanced procedures used today. The only RCT comparing the results of automated percutaneous lumbar discectomy to those of microdiscectomy showed clearly superior results of microdiscectomy. Furthermore, success rates of automated percutaneous lumbar discectomy reported in the RCT (29%) differ extremely from success rates reported in case series (between 56% and 92%). The literature search retrieves no controlled trials to assess efficacy and/or effectiveness of laser-discectomy, percutaneous manual discectomy or endoscopic procedures using a posterior approach in comparison to the standard procedures. Results from recent case series permit no assessment of efficacy, especially not in comparison to standard procedures. Due to highly selected patients, modi-fications of operative procedures, highly specialised surgical units and poorly standardised outcome assessment results of case series are highly variable, their generalisability is low. The results of the five economical analyses are, due to conceptual and methodological problems, of no value for decision-making in the context of the German health care system. Discussion Aside from low methodological study quality three conceptual problems complicate the interpretation of results. Continuous further development of technologies leads to a diversity of procedures in use which prohibits generalisation of study results. However, diversity is noted not only for

  5. Simple procedure for automatic detection of unstable alleles in the myotonic dystrophy and Huntington's disease loci.

    Science.gov (United States)

    Falk, M; Vojtísková, M; Lukás, Z; Kroupová, I; Froster, U

    2006-01-01

    Human neurodegenerative and neuromuscular disorders are associated with a class of gene mutations represented by expansion of trinucleotide repeats. DNA testing is important for the diagnosis of these diseases because clinical discrimination is complicated by their late onset and frequently overlapping symptomatology. However, detection of pathologic alleles expanded up to several thousand trinucleotides poses a challenge for the introduction of rapid, fully automatic, and simple DNA diagnostic procedures. Here we propose a simple two-step polymerase chain reaction (PCR) protocol for rapid molecular diagnostics of myotonic dystrophy, Huntington's disease, and possibly also other triplet expansion diseases. Standard PCR amplification with target repeat flanking primers is used for the detection of alleles of up to 100 repeats; next, triplet-primed PCR is applied for detection of larger expansions. Automated capillary electrophoresis of amplicons allows rapid discrimination between normal, premutated and expanded (CTG/CAG)(n) alleles. Using the suggested protocol, the expanded allele was successfully detected in all test DNA samples with known genotypes. Our experience demonstrates that the suggested two-step PCR protocol provides high sensitivity, specificity, and reproducibility; is significantly less time-consuming; is easier to perform; and provides a better basis for automation than previous methods requiring Southern analysis. Therefore, it can be used for confirmation of uncertain clinical diagnoses, for prenatal testing in at-risk families, and, generally in research on these diseases.

  6. Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment: A systematic review

    Science.gov (United States)

    Fernández-Ferrer, Laura; Montiel-Company, José-María; Candel-Martí, Eugenia; Almerich-Silla, José-Manuel; Peñarrocha-Diago, Miguel

    2016-01-01

    Background One of the main aims of orthodontists is to reduce the treatment time as much as possible, particularly in view of the rise in demand for orthodontic treatment among adult patients. The objective of this systematic review was to examine the effectiveness of corticotomy as a surgical procedure that accelerates orthodontic tooth movement, together with its possible adverse effects. Material and Methods A systematic review of articles in 4 databases, Pubmed, Cochrane, Scopus and Embase, complemented by a manual search, identified 772 articles. The duplicates were eliminated and a critical reading of titles and abstracts led to the rejection of articles that did not meet the objectives of the review, leaving 69. After reading the full text of these articles, 49 were excluded because they did not meet the inclusion criteria. On applying the CONSORT criteria as a quality filter, a further 4 were eliminated due to low quality. Finally, 16 articles (4 systematic reviews and 12 controlled trials) were reviewed. Results All the studies agree that corticotomy prior to orthodontic treatment accelerates dental movement, reducing the treatment time. With regard to side-effects, no periodontal damage was found, although this was only studied in the short term. Conclusions The evidence regarding the results of corticotomy is limited, given the small number of quality clinical studies available. Before this procedure is included as a routine practice in dental surgeries, studies of higher methodological quality are required, studying a greater number of individuals and examining the possible long-term adverse effects and the cost/benefit of the procedure. Key words:Corticotomy, orthodontics, adults, accelerated tooth movement, osteotomy. PMID:27475698

  7. Non-photorealistic rendering of virtual implant models for computer-assisted fluoroscopy-based surgical procedures

    Science.gov (United States)

    Zheng, Guoyan

    2007-03-01

    Surgical navigation systems visualize the positions and orientations of surgical instruments and implants as graphical overlays onto a medical image of the operated anatomy on a computer monitor. The orthopaedic surgical navigation systems could be categorized according to the image modalities that are used for the visualization of surgical action. In the so-called CT-based systems or 'surgeon-defined anatomy' based systems, where a 3D volume or surface representation of the operated anatomy could be constructed from the preoperatively acquired tomographic data or through intraoperatively digitized anatomy landmarks, a photorealistic rendering of the surgical action has been identified to greatly improve usability of these navigation systems. However, this may not hold true when the virtual representation of surgical instruments and implants is superimposed onto 2D projection images in a fluoroscopy-based navigation system due to the so-called image occlusion problem. Image occlusion occurs when the field of view of the fluoroscopic image is occupied by the virtual representation of surgical implants or instruments. In these situations, the surgeon may miss part of the image details, even if transparency and/or wire-frame rendering is used. In this paper, we propose to use non-photorealistic rendering to overcome this difficulty. Laboratory testing results on foamed plastic bones during various computer-assisted fluoroscopybased surgical procedures including total hip arthroplasty and long bone fracture reduction and osteosynthesis are shown.

  8. [Epicardial cartography and surgical treatment by simple ventriculotomy of certain resistant re-entry ventricular tachycardias].

    Science.gov (United States)

    Fontaine, G; Guiraudon, G; Frank, R; Gerbaux, A; Cousteau, J P; Barrillon, A; Gay, J; Cabrol, C; Facquet, J

    1975-02-01

    Intraventricular reentry has been prooved by pre-operative electrophysiological studies in two patients without coronary artery disease and resistant ventricular tachycardia. A simple ventriculotomy oriented by epicardial mapping during tachycardia was successfull with a background of 9 and 14 months respectively. In addition, delayed epicardial potentials put into evidence an intraventricular reentry in human myocardium. This new method holds promises for the treatment of some resistant ventricular tachycardia.

  9. Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures.

    Directory of Open Access Journals (Sweden)

    Luigi Maria Cavallo

    Full Text Available We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany in various neuroendoscopic procedures.A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a endoscopic endonasal transsphenoidal; b frontal transcortical intraventricular; c supraorbital.We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0-70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest.The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have identified optimized visibility

  10. Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures

    Science.gov (United States)

    Cavallo, Luigi Maria; Di Somma, Alberto; Solari, Domenico; de Divitiis, Oreste; Bracale, Umberto Marcello; Cappabianca, Paolo

    2016-01-01

    Purpose We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) in various neuroendoscopic procedures. Methods A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a) endoscopic endonasal transsphenoidal; b) frontal transcortical intraventricular; c) supraorbital. Results We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0–70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest. Conclusions The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have

  11. A standard operating procedure for the surgical implantation of transmitters in juvenile salmonids

    Science.gov (United States)

    Liedtke, T.L.; Beeman, J.W.; Gee, L.P.

    2012-01-01

    Biotelemetry is a useful tool to monitor the movements of animals and is widely applied in fisheries research. Radio or acoustic technology can be used, depending on the study design and the environmental conditions in the study area. A broad definition of telemetry also includes the use of Passive Integrated Transponder (PIT) tags, either separately or with a radio or acoustic transmitter. To use telemetry, fish must be equipped with a transmitter. Although there are several attachment procedures available, surgical implantation of transmitters in the abdominal cavity is recognized as the best technique for long-term telemetry studies in general (Stasko and Pincock, 1977; Winter, 1996; Jepsen, 2003), and specifically for juvenile salmonids, Oncorhynchus spp. (Adams and others, 1998a, 1998b; Martinelli and others, 1998; Hall and others, 2009). Studies that use telemetry assume that the processes by which the animals are captured, handled, and tagged, as well as the act of carrying the transmitter, will have minimal effect on their behavior and performance. This assumption, commonly stated as a lack of transmitter effects, must be valid if telemetry studies are to describe accurately the movements and behavior of an entire population of interest, rather than the subset of that population that carries transmitters. This document describes a standard operating procedure (SOP) for surgical implantation of radio or acoustic transmitters in juvenile salmonids. The procedures were developed from a broad base of published information, laboratory experiments, and practical experience in tagging thousands of fish for numerous studies of juvenile salmon movements near Columbia River and Snake River hydroelectric dams. Staff from the Western Fisheries Research Center's Columbia River Research Laboratory (CRRL) frequently have used telemetry studies to evaluate new structures or operations at hydroelectric dams in the Columbia River Basin, and these evaluations typically

  12. [Choice of surgical procedure in operations for chronic pancreatitis--personal experience].

    Science.gov (United States)

    Sváb, J; Pesková, M; Fried, M; Gürlich, R; Krska, Z; Bortlík, M; Lukás, M; Horejs, J

    2002-01-01

    The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of

  13. Positional changes of the masseter and medial pterygoid muscles after surgical mandibular advancement procedures: an MRI study

    NARCIS (Netherlands)

    Dicker, G.J.; Koolstra, J.H.; Castelijns, J.A.; van Schijndel, R.A.; Tuinzing, D.B.

    2012-01-01

    This study evaluated whether surgical mandibular advancement procedures induced a change in the direction and the moment arms of the masseter (MAS) and medial pterygoid (MPM) muscles. Sixteen adults participated in this study. The sample was divided in two groups: Group I (n = 8) with a mandibular

  14. Factors Surgical Team Members Perceive Influence Choices of Wearing or Not Wearing Personal Protective Equipment during Operative/Invasive Procedures

    Science.gov (United States)

    Cuming, Richard G.

    2009-01-01

    Exposure to certain bloodborne pathogens can prematurely end a person's life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail…

  15. Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy.

    Science.gov (United States)

    Hammad, Tariq A; Alastal, Yaseen; Khan, Muhammad Ali; Hammad, Mohammad; Alaradi, Osama; Nigam, Ankesh; Sodeman, Thomas C; Nawras, Ali

    2015-10-01

    We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

  16. Factors Surgical Team Members Perceive Influence Choices of Wearing or Not Wearing Personal Protective Equipment during Operative/Invasive Procedures

    Science.gov (United States)

    Cuming, Richard G.

    2009-01-01

    Exposure to certain bloodborne pathogens can prematurely end a person's life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail…

  17. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Science.gov (United States)

    2010-10-01

    ... ASC surgical procedures performed in hospitals on an outpatient basis. 413.118 Section 413.118 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs §...

  18. Surgical Assisting

    Science.gov (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  19. FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY.

    Science.gov (United States)

    Zorron, Ricardo; Galvão-Neto, Manoel Passos; Campos, Josemberg; Branco, Alcides José; Sampaio, José; Junghans, Tido; Bothe, Claudia; Benzing, Christian; Krenzien, Felix

    Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Institutional experience and systematic review from the literature on revisional bariatric surgery. Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex surgical revisional procedures are evolving to less

  20. Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis.

    Science.gov (United States)

    Huang, Shou-Guo; Chen, Bo; Lv, Dong; Zhang, Yong; Nie, Feng-Feng; Li, Wei; Lv, Yao; Zhao, Huan-Li; Liu, Hong-Mei

    2017-01-01

    Purpose Using a network meta-analysis approach, our study aims to develop a ranking of the six surgical procedures, that is, Plate, titanium elastic nail (TEN), tension band wire (TBW), hook plate (HP), reconstruction plate (RP) and Knowles pin, by comparing the post-surgery constant shoulder scores in patients with clavicular fracture (CF). Methods A comprehensive search of electronic scientific literature databases was performed to retrieve publications investigating surgical procedures in CF, with the stringent eligible criteria, and clinical experimental studies of high quality and relevance to our area of interest were selected for network meta-analysis. Statistical analyses were conducted using Stata 12.0. Results A total of 19 studies met our inclusion criteria were eventually enrolled into our network meta-analysis, representing 1164 patients who had undergone surgical procedures for CF (TEN group = 240; Plate group = 164; TBW group  =  180; RP group  =  168; HP group  =  245; Knowles pin group  =  167). The network meta-analysis results revealed that RP significantly improved constant shoulder score in patients with CF when compared with TEN, and the post-operative constant shoulder scores in patients with CF after Plate, TBW, HP, Knowles pin and TEN were similar with no statistically significant differences. The treatment relative ranking of predictive probabilities of constant shoulder scores in patients with CF after surgery revealed the surface under the cumulative ranking curves (SUCRA) value is the highest in RP. Conclusion The current network meta-analysis suggests that RP may be the optimum surgical treatment among six inventions for patients with CF, and it can improve the shoulder score of patients with CF. Implications for Rehabilitation RP improves shoulder joint function after surgical procedure. RP achieves stability with minimal complications after surgery. RP may be the optimum surgical treatment for

  1. Surgical Uprighting Is a Successful Procedure for Management of Impacted Mandibular Second Molars.

    Science.gov (United States)

    Padwa, Bonnie L; Dang, Rushil R; Resnick, Cory M

    2017-08-01

    increase in this distance postoperatively was greater for the treatment group than for the control group (P < .001). Pulpal obliteration (n = 6; 31.5%), periapical radiolucency (n = 2; 10.5%), and root resorption (n = 1; 5.3%) were seen on postoperative radiographs. There were 2 failures (10.5%). Surgical uprighting of mandibular second molars is a useful procedure with a low failure rate. Insufficient space for eruption is the likely primary etiology for impaction. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Surgical Procedures of the Elbow: A Nationwide Cross-Sectional Observational Study in the United States

    Directory of Open Access Journals (Sweden)

    Ahmet Kinaci

    2015-01-01

    Full Text Available Background:  Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States.   Methods:  We used the National Hospital Discharge Survey (NHDS and the National Survey of Ambulatory Surgery (NSAS data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US.  Results:  An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular. Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries.  Conclusions:  Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture are some of the most variably utilized and debated.

  3. Are Preoperative Routine Laboratory Tests Necessary in Minor and Moderate Surgical Procedures?

    Directory of Open Access Journals (Sweden)

    Abit Toker

    2008-01-01

    Full Text Available Preoperative routine tests are commonly used to evaluate patients who will have planned elective surgical procedure. In this study, we aimed to identify the preoperative tests required for ASA I-II patients, over 40 years old, who will undergo elective minor and moderate surgeries. Totally 140 patients were included in the study. They were separated into 2 groups equally [Group I (40-59 years and Group II (≥60 years] according to their ages. The patients’ preoperative tests; including chest radiography, electrocardiography, hemoglobin, white blood cell, platelets, glucose, sodium, potassium, aspartate transaminase, alanine transaminase, ürea and creatinine were evaluated together with history and physical examination. After routine monitoring, balance anaesthesia was performed. The patients were followed during the peroperative and postoperative 24 hours for any problems occurred. In Group I; excluding ürea in both male and female patients and haemoglobin in only female patients; preoperative tests had no effect on the management of the asymptomatic patients. In Group II; electrocardiography, chest radiography, ürea, glucose and hemoglobin tests effected the management of the patients in the preoperative and postoperative period. In conclusion, preoperative tests could be ordered according to history and physical examination of the patients.

  4. Bilateral symmetry in vision and influence of ocular surgical procedures on binocular vision: A topical review.

    Science.gov (United States)

    Arba Mosquera, Samuel; Verma, Shwetabh

    2016-01-01

    We analyze the role of bilateral symmetry in enhancing binocular visual ability in human eyes, and further explore how efficiently bilateral symmetry is preserved in different ocular surgical procedures. The inclusion criterion for this review was strict relevance to the clinical questions under research. Enantiomorphism has been reported in lower order aberrations, higher order aberrations and cone directionality. When contrast differs in the two eyes, binocular acuity is better than monocular acuity of the eye that receives higher contrast. Anisometropia has an uncommon occurrence in large populations. Anisometropia seen in infancy and childhood is transitory and of little consequence for the visual acuity. Binocular summation of contrast signals declines with age, independent of inter-ocular differences. The symmetric associations between the right and left eye could be explained by the symmetry in pupil offset and visual axis which is always nasal in both eyes. Binocular summation mitigates poor visual performance under low luminance conditions and strong inter-ocular disparity detrimentally affects binocular summation. Considerable symmetry of response exists in fellow eyes of patients undergoing myopic PRK and LASIK, however the method to determine whether or not symmetry is maintained consist of comparing individual terms in a variety of ad hoc ways both before and after the refractive surgery, ignoring the fact that retinal image quality for any individual is based on the sum of all terms. The analysis of bilateral symmetry should be related to the patients' binocular vision status. The role of aberrations in monocular and binocular vision needs further investigation.

  5. A case of floppy epiglottis in adult: a simple surgical remedy.

    Science.gov (United States)

    Kanemaru, Shin-ichi; Kojima, Hisayoshi; Fukushima, Hideyuki; Tamaki, Hisanobu; Tamura, Yoshihiro; Yamashita, Masaru; Umeda, Hiroo; Ito, Juichi

    2007-09-01

    A new operative technique for the treatment of floppy epiglottis is introduced in this report. Though its diagnosis is not so difficult by close observations using a flexible fiberscope, it is likely to be treated as an asthma attack or a paradoxical vocal cord movement. In previous reports of upper airway obstruction caused by adult floppy epiglottis: epiglottis prolapse during inspiration, the cause of this condition has been divided broadly into two categories: idiopathic cases and secondary cases. Partial or total epiglottectomy has been usually reported for the treatment of the relief of airway obstruction caused by a floppy epiglottis. It is very difficult to decide adequately how much volume of epiglottis to cut without postoperative sequelae. A V-shaped partial epiglottidectomy is described for its treatment. This technique is very easy, simple, and effective.

  6. A simple procedure for selection and sizing of indirect passive solar heating systems

    Energy Technology Data Exchange (ETDEWEB)

    Bansal, N.K. (Indian Inst. of Tech., New Delhi (India). Centre of Energy Studies); Thomas, P.C. (Tata Energy Research Inst., Bombay (India))

    1991-01-01

    Equivalent solar-air temperatures have been defined for four indirect gain passive solar heating concepts, namely, mass wall, water wall, Trombe wall and solarium. Steady state thermal efficiencies have also been defined as a measure of the ability of each system to deliver heat into the living space. Design curves have been developed which relate the average instantaneous solar radiation incident on the passive element to thermal efficiency for different values of ambient temperature. These curves are useful in selection of an appropriate passive heating concept for a particular location. It is inferred that a solarium is most effective at very low levels of incident radiation and low ambient temperature. Water walls and Trombe walls are most efficient at higher levels of incident radiation. A simple procedure has been developed for a first approximation of sizing the selected system using these design curves and a minimum of meteorological information, namely, monthly average of daily global solar radiation, monthly average maximum and minimum ambient temperatures. (author).

  7. Acylation of Chiral Alcohols: A Simple Procedure for Chiral GC Analysis

    Directory of Open Access Journals (Sweden)

    Mireia Oromí-Farrús

    2012-01-01

    Full Text Available The use of iodine as a catalyst and either acetic or trifluoroacetic acid as a derivatizing reagent for determining the enantiomeric composition of acyclic and cyclic aliphatic chiral alcohols was investigated. Optimal conditions were selected according to the molar ratio of alcohol to acid, the reaction time, and the reaction temperature. Afterwards, chiral stability of chiral carbons was studied. Although no isomerization was observed when acetic acid was used, partial isomerization was detected with the trifluoroacetic acid. A series of chiral alcohols of a widely varying structural type were then derivatized with acetic acid using the optimal conditions. The resolution of the enantiomeric esters and the free chiral alcohols was measured using a capillary gas chromatograph equipped with a CP Chirasil-DEX CB column. The best resolutions were obtained with 2-pentyl acetates (α=3.00 and 2-hexyl acetates (α=1.95. This method provides a very simple and efficient experimental workup procedure for analyzing chiral alcohols by chiral-phase GC.

  8. Surgical Site Infections Rates in More Than 13,000 Surgical Procedures in Three Cities in Peru: Findings of the International Nosocomial Infection Control Consortium.

    Science.gov (United States)

    Ramírez-Wong, Fernando M; Atencio-Espinoza, Teodora; Rosenthal, Victor D; Ramirez, Eliza; Torres-Zegarra, Socorro L; Díaz Tavera, Zoila Rosa; Sarmiento López, Favio; Silva Astete, Nazario; Campos Guevara, Francisco; Bazan Mendoza, Carlos; Valencia Ramírez, Augusto; Soto Pastrana, Javier

    2015-10-01

    Surgical site infections (SSIs) are a threat to patient safety. However, there are not available data on SSI rates stratified by surgical procedure (SP) in Peru. From January 2005 to December 2010, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in four hospitals in three cities of Peru. Data were recorded from hospitalized patients using the U.S. Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) methods and definitions for SSI. Surgical procedures (SPs) were classified into 4 types, according to ICD-9 criteria. We recorded 352 SSIs, associated to 13,904 SPs (2.5%; CI, 2.3-2.8) SSI rates per type of SP were the following for this study's Peruvian hospitals, compared with rates of the INICC and CDC-NHSN reports, respectively: 2.9% for appendix surgery (vs. 2.9% vs. 1.4%); 2.8% for gallbladder surgery (vs. 2.5% vs. 0.6%); 2.2% for cesarean section (vs. 0.7% vs. 1.8%); 2.8% for vaginal hysterectomy (vs. 2.0% vs. 0.9%). Our SSIs rates were higher in all of the four analyzed types of SPs compared with CDC-NHSN, whereas compared with INICC, most rates were similar. This study represents an important advance in the knowledge of SSI epidemiology in Peru that will allow us to introduce targeted interventions.

  9. [Tension-free procedures in the surgical treatment of groin hernias].

    Science.gov (United States)

    Milić, Dragan J; Pejić, Miljko A

    2003-01-01

    Hernia repair is one of the most common surgical procedures performed in the United States, with 700,000 operations performed each year. Improvements in surgical technique, together with the development of new prosthetic materials and a better understanding of how to use them, have significantly improved outcomes for many patients. These improvements have occurred most notably in centers specializing in hernia surgery, with some institutions reporting failure rates of less than 1%. In contrast, failure rates for general surgeons, who perform most hernia repairs, remain significantly higher. This has important socioeconomic implications, adding an estimated $28 billion or more to the cost of treating the condition, based on calculations utilizing conservative estimates of failure rates and the average cost of a hernia repair. Success of groin hernia repair is measured primarily by the permanence of the operation, fewest complications, minimal costs, and earliest return to normal activities. This success depends largely on the surgeon's understanding of the anatomy and physiology of the surgical area as well as a knowledge of how to use most effectively the currently available techniques and materials. The most important advance in hernia surgery has been the development of tension-free repairs. In 1958, Usher described a hernia repair using Marlex mesh. The benefit of that repair he described as being "tension-eliminating" or what we now call "tension-free". Usher opened the posterior wall and sutured a swatch of Marlex mesh to the undersurface of the medial margin of the defect and to the shelving edge of the inguinal ligament. He created tails from the mesh that encircled the spermatic cord and secured them to the inguinal ligament. Every type of tension-free repair requires a mesh, whether it is done through an open anterior, open posterior, or laparoscopic route. The most common prosthetic open repairs done today are the Lichtenstein onlay patch repair, the Per

  10. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications.

    Science.gov (United States)

    Keiner, Doerthe; Gaab, Michael R; Backhaus, Vanessa; Piek, Juergen; Oertel, Joachim

    2010-12-01

    Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.

  11. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry.

    Science.gov (United States)

    Silva, Katia Regina da; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; Carvalho, Eduardo Infante Januzzi de; Fiorelli, Alfredo Inácio; Martinelli, Martino; Costa, Roberto

    2016-09-01

    Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III--IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. Complicações após procedimentos cirúrgicos em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) são um

  12. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

    Science.gov (United States)

    Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J; Anderson, Deverick J; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Weber, David J; Lewis, Sarah S

    2015-12-01

    To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. Retrospective cohort study A total of 43 community hospitals located in the southeastern United States. Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; P<.01). Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.

  13. Settlements around pumping wells: Analysis of influential factors and a simple calculation procedure

    Science.gov (United States)

    Pujades, Estanislao; De Simone, Silvia; Carrera, Jesus; Vázquez-Suñé, Enric; Jurado, Anna

    2017-05-01

    Estimated and measured settlements caused by pumping rarely agree. Several reasons could explain this mismatch, including the influence of layering, the mechanical parameters used in the predictions, or the relationship between settlements and drawdown. We analyze the influence of the above issues by investigating the mechanical response of pumped elastic porous media under different conditions. A radially symmetric conceptual model is considered and several hydro-mechanical simulations are performed varying the boundary conditions, the size of the modeled domain and the presence or not of an overlying layer. The simplicity of the considered problem allows us to compare our results with existing analytical solutions, to identify the role of each variable on pumping settlements and to generalize the results. The most relevant results are as follows: (1) settlements are proportional to drawdown only outside a circle of radius equal to 0.7 times the thickness of the pumped porous medium; inside, they are virtually constant, which leads to two simple procedures for computing pumping settlements. (2) Poorly conductive layers located above (or below) a pumped porous medium (with higher hydraulic conductivity) reduce and smooth settlements. (3) Boundary constraints affect the local specific storage coefficient and the displacements occurred. (4) The specific storage coefficient evaluated by interpreting pumping tests with the Cooper and Jacob method (1946) leads to overestimation of the actual Young's Modulus of the soil. The main conclusion is that settlements are less differential than expected near pumping wells. Still, they must always be evaluated acknowledging the nature of layering, the boundary constraints and carefully selecting the mechanical parameters of the soil.

  14. THE INFLUENCE OF THE CHOSEN SOCIO-DEMOGRAPHIC FACTORS ON THE QUALITY OF LIFE IN WOMEN AFTER GYNAECOLOGICAL SURGICAL PROCEDURES

    Directory of Open Access Journals (Sweden)

    Beata Karakiewicz

    2010-09-01

    Full Text Available Background: The aim of this study was to assess how the chosen socio-demographic factors effect the quality of life in the patients after gynaecological surgical procedures. Materials and Methods: Research was conducted in 2007 among 250 women operated in the Department of Reproduction and Gynaecology, the Pomeranian Medical University in Szczecin. In this survey-based study, we used a standardized quality of life questionnaire, the Women’s Health Questionnaire (WHQ, developed by Dr Myra Hunter at London University. Results: The most numerous patients were those with sleep disorders (38,8%, 37,6% of the surveyed complained of troublesome menstrual symptoms, 26,8% of respondents had disturbing somatic symptoms, short memory and problems with concentration. The lowest percentage of women (12,4% felt anxiety and fear associated with the past gynaecological surgical procedure. Conclusions: 1. General satisfaction and good disposition is declared by the majority of patients after gynaecological surgical procedures. 2. Age, education, having a partner, place of residence, and the number of children are the factors which have significant effect on the quality of life in women after gynaecological procedures.

  15. Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

    Directory of Open Access Journals (Sweden)

    Alessandro Del Rosso

    2013-06-01

    Full Text Available Introduction: Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS and transurethral resection of the prostate (TURP is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH treatment. Materials and Methods: 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS, maximum uri- nary flow rate (Qmax, postvoid residual urine (PVR and prostate specific antigen (PSA. Results: Overall 60 procedures were performed, 18 PlasmaKinetic (PK-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL, and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. Conclusion: Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure.

  16. Assessing the performance characteristics and clinical forces in simulated shape memory bone staple surgical procedure: The significance of SMA material model.

    Science.gov (United States)

    Saleeb, A F; Dhakal, B; Owusu-Danquah, J S

    2015-07-01

    This work is focused on the detailed computer simulation of the key stages involved in a shape memory alloy (SMA) osteosynthesis bone stapling procedure. To this end, a recently developed three-dimensional constitutive SMA material model was characterized from test data of three simple uniaxial-isothermal-tension experiments for powder metallurgically processed nickel-rich NiTi (PM/NiTi-P) material. The calibrated model was subsequently used under the complex, thermomechanical loading conditions involved in the surgical procedure using the body-temperature-activated PM/NiTi-P bone staple. Our aim here is to assess the immediate and post-surgical performance characteristics of the stapling operation using the material model. From this study: (1) it was found that adequate compressive forces were developed by the PM/NiTi-P bone staple, with the tendency of this force to even increase under sustained thermal loading due to the intrinsic "inverse relaxation phenomena" in the SMA material, (2) the simulation results correlated well with those from experimental measurements, (3) the body-temperature-activated PM/NiTi-P staple was proved to be clinically viable, providing a stable clamping force needed for speedy coaptation of the fractured bones, and (4) these realistic assessments crucially depend on the use of suitable and comprehensive SMA material models. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Rapid and simple clean-up and derivatizaton procedure for the gas chromatographic determination of acidic drugs in plasma

    NARCIS (Netherlands)

    Roseboom, H.; Hulshoff, A.

    1979-01-01

    A rapid and simple clean-up and derivatization procedure that can be generally applied to the gas chromatographie (GC) determination of acidic drugs of various chemical and therapeutic classes is described. The drugs are extracted from acidified plasma with chloroform containing 5% of isopropanol, w

  18. Smart surgical needle actuated by shape memory alloys for percutaneous procedures

    Science.gov (United States)

    Konh, Bardia

    Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle's body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility

  19. [Importance of displacement ventilation for operations and small surgical procedures from the infection preventive point of view].

    Science.gov (United States)

    Kramer, A; Külpmann, R; Wille, F; Christiansen, B; Exner, M; Kohlmann, T; Heidecke, C D; Lippert, H; Oldhafer, K; Schilling, M; Below, H; Harnoss, J C; Assadian, O

    2010-02-01

    Surgical teams need to breathe air that is conducive to their health. An adequate exchange of air ensures oxygen supply, the ventilation of humidity, smells, toxic substances, especially narcotic gases and surgical smoke, pathogens and particles. With regard to the infection risk, DIN 1946 / 4 -differentiates between operation theaters with the highest demand for clean air (operation room class I a), operation theatres with a high demand (operation room class I b) and rooms within the operation theatres without special requirements, meaning that the microbial load in the air is close to or equal to that of normal in-room air quality (room class II). For an operation room class I a, ventilation that displaces the used air is necessary, while a regular ventilation is sufficient for operation room class I b. Because of ambiguous -results in previous studies, the necessity to define a -class I a for operation rooms is being questioned. Therefore, this review focuses on the analysis of the existing publications with respect to this -question. The result of this analysis indicates that so far there is only one surgical procedure, the -implantation of hip endoprosthetics, for which a preventive effect on SSI of a class I a ventilation (displacement of the used air) is documented. One recent study, reviewed critically here, -showed opposite results, but lacks methodological clarity. Thus, it is concluded that evidence for the requirement of operation room classes can only be derived from risk assessment (infection risk by surgical intervention, extent of possible damages), but not from epidemiological studies. Risk assessment must be based on the following criteria: size and depth of the operation field, -duration of the procedure, vascular perfusion of the wound, implantation of alloplastic material and general risk of the patient for an infection. From an infection preventive point of view, no class I a "displacement ventilation" is necessary for small surgical

  20. [Evaluation of efficacy of selected antiseptics for hands disinfection before surgical procedures].

    Science.gov (United States)

    Leksowski, K; Jasiński, A; Marszałek, A

    2001-08-01

    The most important in surgical hands washing and disinfections is long-term and effective reduction of bacteria number. The aim of this study was to compare the efficiency of some antiseptic fluids used for surgical hands disinfection's (AHD 2000, Biotensid, Manopronto and Medi-Scrub PVP Iodine). 62 doctors and surgical nurses were examined. The material for the bacteriological examination was collected before and after hands disinfection's. The bacterial flora reduction have been presented as a percent and a logarithmic reduction ratio. All estimated antiseptic fluids were very potent and provided prolonged efficiency when the operation team complied with orders of hands washing.

  1. Creating an animation-enhanced video library of hepato-pancreato-biliary and transplantation surgical procedures.

    Science.gov (United States)

    Fung, Albert; Kelly, Paul; Tait, Gordon; Greig, Paul D; McGilvray, Ian D

    2016-01-01

    The potential for integrating real-time surgical video and state-of-the art animation techniques has not been widely applied to surgical education. This paper describes the use of new technology for creating videos of liver, pancreas and transplant surgery, annotating them with 3D animations, resulting in a freely-accessible online resource: The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery ( http://tvasurg.ca ). The atlas complements the teaching provided to trainees in the operating room, and the techniques described in this study can be readily adapted by other surgical training programmes.

  2. [Choice of surgical procedure and management of postoperative incision for anal fistula].

    Science.gov (United States)

    Chen, Chaowen; Peng, Bo

    2015-12-01

    Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  3. Two simple multivariate procedures for monitoring planetary gearboxes in non-stationary operating conditions

    Science.gov (United States)

    Zimroz, Radoslaw; Bartkowiak, Anna

    2013-07-01

    . In the second approach, the CDA method has been proposed for the first time in such a context. It should be noted that existing PCA based approaches already proposed in literature also use PCA for data reduction, but they do not analyse their geometry after projection. Moreover, they considered simple laboratory data, with artificially introduced local damage; they were not applied to real case study with distributed form of wear as presented here. It should be added that just a few works may be found in the context of planetary gearbox, time varying load and multivariate statistics. So, we believe that the data processing procedure proposed here may be interesting both for scientists and engineers.

  4. A simple procedure for the isolation and purification of protamine messenger ribonucleic acid from trout testis.

    Science.gov (United States)

    Gedamu, L; Iatrou, K; Dixon, G H

    1978-06-01

    Preparation of milligram quantities of purified poly(A)+ (polyadenylated) protamine mRNA from trout testis tissue was accomplished by a simple procedure using gentle conditions. This involves chromatography of the total nucleic acids isolated by dissociation of polyribosomes with 25 mM-EDTA to release messenger ribonucleoprotein particles and deproteinization of the total postmitochondrial supernatant with 0.5% sodium dodecyl sulphate in 0.25 M-NaCl by binding it to a DEAE-cellulose column. Total RNA was bound under these conditions, and low-molecular-weight RNA, lacking 18S and 28S RNA, could be eluted with 0.5 M-NaCl and chromatographed on oligo(dT)-cellulose columns to select for poly(A)+ RNA. Further purification of both the unbound poly(A)- RNA and the bound poly(A)+ mRNA on sucrose density gradients showed that both 18S and 28S rRNA were absent, being removed during the DEAE-cellulose chromatography step. Poly(A)- RNA sedimented in the 4S region whereas the bound poly(A)+ RNA fraction showed a main peak at 6S [poly(A+) protamine mRNA] and a shoulder in the 3-4S region. Analysis of the main peak and the shoulder on a second gradient showed that most of the main peak sedimented at 6S, whereas the shoulder sedimented slower than 4S. The identity of the poly(A)+ protamine mRNA was established by the following criteria: (1) purified protamine mRNA migrated as a set of four bands on urea/polyacrylamide-gel electrophoresis; (2) analysis of the polypeptides synthesized in the wheat-germ extract by starch-gel electrophoresis showed a single band of radioactivity which co-migrated exactly with the carrier trout testis protamine standard; and (3) chromatography of the polypeptide products on CM-cellulose (CM-52) showed the presence of three or four radioactively labelled protamine components that were co-eluted with the unlabelled trout testis protamine components added as carrier. The availability of large quantities of purified protamine mRNA should now permit a more

  5. A New Surgical Procedure for Penile Reconstruction by Combined Free Radial Forearm Flap and Dorsalis Pedis Flap.

    Science.gov (United States)

    Ma, Sunxiang; Cheng, Kaixiang; Liu, Yang; Chen, Fuguo

    2016-11-01

    To introduce a new surgical procedure for penile reconstruction, emphasizing both the aesthetic appearance and the function by combined free radial forearm flap and dorsalis pedis flap. In this procedure, the penis was subdivided into 2 anatomic subunits: the penile shaft and the glans penis. A sequential innervated radial forearm free flap was combined with a dorsalis pedis free flap to reconstruct the penile shaft and the glans, separately. Cartilage prosthesis was implanted at the same time. Since May 2011, 14 biologically male patients with total penile losses by various reasons were treated with this procedure. Patient satisfaction was evaluated by questionnaire, and sensory testing was performed. The ages of the patients ranged between 21 and 53 years (mean, 35.2 years). The average follow-up period was 38.1 months (range, 25.5-56 months). Twenty-five flaps in 11 patients were 100% viable. One dorsalis pedis flap in a patient underwent partial necrosis. There were no cases of urethral fistula or urethral stenosis, but 1 case of prosthesis infection and 1 case of abdominal hernia were recorded. The sensation of the neophallus recovered 3-6 months after surgery, and the patient satisfaction rate was quite high. The new surgical procedure of combined free radial forearm flap and dorsalis pedis flap for penile reconstruction achieves both satisfactory aesthetic and functional results. We recommend this procedure as an alternative ideal method for total penile reconstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures

    NARCIS (Netherlands)

    Mourits, M. P.; Bijl, H.; Altea, M. A.; Baldeschi, L.; Boboridis, K.; Curro, N.; Dickinson, A. J.; Eckstein, A.; Freidel, M.; Guastella, C.; Kahaly, G. J.; Kalmann, R.; Krassas, G. E.; Lane, C. M.; Lareida, J.; Marcocci, C.; Marino, M.; Nardi, M.; Mohr, Ch; Neoh, C.; Pinchera, A.; Orgiazzi, J.; Pitz, S.; Saeed, P.; Salvi, M.; Sellari-Franceschini, S.; Stahl, M.; von Arx, G.; Wiersinga, W. M.

    2009-01-01

    Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves' orbitopathy (GO) receiving surgery for disfiguring proptosis. Method: Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompressi

  7. Oral surgical procedures and prevalence of oral diseases in Oral Surgery Department in Faculty of Dentistry Sarajevo

    Directory of Open Access Journals (Sweden)

    Sadeta Šečić

    2013-12-01

    Full Text Available Introduction: The aim of this study is to determine prevalence of oral diseases and oral surgical procedures at Department of Oral Surgery, Faculty of Dental Medicine, University in Sarajevo.Methods: The current study is retrospective analysis of oral surgical procedures performed from January 2011 to December 2012 at Department of Oral Surgery, Faculty of Dental Medicine, University in Sarajevo. The data were statistically analyzed by T-test of independent samples and using Chi-squared test. P value lower than 0,001 was considered to be statistically significant.Results: A total of 1299 patients were included in study. The age range is from 18 to 84 years, with mean age ± SD= 35±15 years. There were 42 different clinical diagnoses, and 13 diagnoses appeared in more than 1% of all patients. Impacted and semi-impacted teeth, periapical lesions and retained roots are the most frequent diagnoses and represent 68% of all diagnoses. Embedded and impacted teeth (35% and diseases of pulp and periapical tissues (31% are the most frequent diagnoses with respect of ICD-10. Impacted teeth is the most common diagnosis and removal of impacted third molars is the most common oral surgical procedure.Conclusion: Study points out variety of dentoalveolar patology and complexity of dental health care that often requires interdisciplinary approach in order to achieve optimal outcome for patient.

  8. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure

    Institute of Scientific and Technical Information of China (English)

    Ye Rim Chang; Sung-Sik Han; Sang-Jae Park; Seung Duk Lee; Tae Suk Yoo; Young-Kyu Kim; Tae Hyun Kim

    2012-01-01

    To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS)for pancreatic cancer.METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center,South Korea.Clinicopathologic data,including age,sex,operative findings,pathologic results,adjuvant therapy,postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study.RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS.Nine patients (37.5%) underwent combined vessel resection,including 8 superior mesenteric-portal vein resections and 1 celiac axis resection.Two patients (8.3%) underwent combined resection of other organs,including the colon,stomach or duodenum.Negative tangential margins were achieved in 22 patients (91.7%).The mean tumor diameter for all patients was 4.09 ± 2.15 cm.The 2 patients with positive margins had a mean diameter of 7.25 cm.The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%.The median survival of the 24 patients was 18.23 ± 6.02 mo.Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P =0.021).Nine patients (37.5%) had postoperative complications,but there were no postoperative mortalities.Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula.On univariate analysis,histologic grade,positive tangential margin,pancreatic fistula and adjuvant therapy were significant prognostic factors for survival.CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.

  9. A novel set of surgical instruments facilitate the procedure of laparoscopic pyeloplasty

    Institute of Scientific and Technical Information of China (English)

    CHEN Wen-zheng; GUO Fei; LI Yun; Riccardo Autorino; LI Jin-yi; WANG Hui-qing; Fatih Altunrende; SUN Ying-hao

    2012-01-01

    Background Open pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction (UPJO),even if new techniques have recently gained a prominent role in this field.Laparoscopic pyeloplasty (LP) is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands.To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty,we designed a set of new instruments and assessed them using porcine model.Methods According to the ideas from the surgeons,our medical engineer designed three new instruments,including the right angle laparoscopy scissors,the petal-shape ureter dilator and the guide tube.Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments.Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time.After general anesthesia was administered,transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments,including placing the double J stent anterograde.Then,the opposite lateral was done by the same surgeon plus these new devices for side-by-side comparative analysis.All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale (VAS) from 1 (none) to 10 (very much).Results The procedures were all technically successful.The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Score were 6.75 and 4.25 respectively,at the same time the New Difficulty Score 1.25 and 1.75.However,the petal-shape ureter dilator got 1.5 Help Score and 6.5 New Difficulty Score.These surgeons made a negative comment and one of surgeons recommended the stone basket was more suitable.Conclusion The right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure

  10. Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

    Science.gov (United States)

    O’Connor, Rory C; Fawthrop, Fiona; Salha, Rami; Sidebottom, Andrew J

    2017-01-01

    Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate. PMID:28638693

  11. An alternative procedure for estimating the population mean in simple random sampling

    Directory of Open Access Journals (Sweden)

    Housila P. Singh

    2012-03-01

    Full Text Available This paper deals with the problem of estimating the finite population mean using auxiliary information in simple random sampling. Firstly we have suggested a correction to the mean squared error of the estimator proposed by Gupta and Shabbir [On improvement in estimating the population mean in simple random sampling. Jour. Appl. Statist. 35(5 (2008, pp. 559-566]. Later we have proposed a ratio type estimator and its properties are studied in simple random sampling. Numerically we have shown that the proposed class of estimators is more efficient than different known estimators including Gupta and Shabbir (2008 estimator.

  12. Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment

    Directory of Open Access Journals (Sweden)

    Yin H

    2016-02-01

    Full Text Available Hongmei Yin,1 Ting Gui2 1Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, 2Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer. Methods: A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. Results: Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hyster­ectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%, with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups. Conclusion: For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence

  13. [A new concept in surgery of the digestive tract: surgical procedure assisted by computer, from virtual reality to telemanipulation].

    Science.gov (United States)

    Marescaux, J; Clément, J M; Vix, M; Russier, Y; Tassetti, V; Mutter, D; Cotin, S; Ayache, N

    1998-02-01

    Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reasons is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which must include five requirements: a) visual fidelity, b) interactivity, c) physical properties, d) physiological properties, e) sensory input and output. In this report we describe how to obtain a realistic 3D model of the liver from bi-dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction.

  14. A simple procedure for retrieval of a cement-retained implant-supported crown: a case report.

    Science.gov (United States)

    Buzayan, Muaiyed Mahmoud; Mahmood, Wan Adida; Yunus, Norsiah Binti

    2014-02-01

    Retrieval of cement-retained implant prostheses can be more demanding than retrieval of screw-retained prostheses. This case report describes a simple and predictable procedure to locate the abutment screw access openings of cementretained implant-supported crowns in cases of fractured ceramic veneer. A conventional periapical radiography image was captured using a digital camera, transferred to a computer, and manipulated using Microsoft Word document software to estimate the location of the abutment screw access.

  15. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    OpenAIRE

    Ettore Taverna; Henri Ufenast; Laura Broffoni; Guido Garavaglia

    2013-01-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect...

  16. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    OpenAIRE

    Ettore Taverna; Henri Ufenast; Laura Broffoni; Guido Garavaglia

    2013-01-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect...

  17. Changes in hospitalisation, surgical procedures, and survival among the oldest-old

    DEFF Research Database (Denmark)

    Oksuzyan, Anna; Jeune, Bernard; Juel, Knud

    2013-01-01

    with more active treatment of the recent cohorts of old-aged persons and reduced age inequalities in the Danish healthcare system. No increase in post-operative mortality suggests that the selection of older patients eligible for a surgical treatment is likely to be based on the health status of old...

  18. The bilateral bispectral and the composite variability indexes during anesthesia for unilateral surgical procedure

    Directory of Open Access Journals (Sweden)

    Pedro Lopes-Pimentel

    2017-01-01

    Conclusions: Our results indicate that the large interindividual variability of BIS and CVI limits their usefulness. We found differences between the left and right measurements in a right-handed series of patients during surgical stimuli though they were not clinically relevant.

  19. Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures

    NARCIS (Netherlands)

    Zijderveld, S.A.; van den Bergh, J.P.A.; Schulten, E.A.J.M.; ten Bruggenkate, C.M.

    2008-01-01

    Purpose To investigate the prevalence of anatomical and surgical findings and complications in maxillary sinus floor elevation surgery, and to describe the clinical implications. Patients and Methods One hundred consecutive patients scheduled for maxillary sinus floor elevation were included. The pa

  20. Magnesium Lowers the Incidence of Postoperative Junctional Ectopic Tachycardia in Congenital Heart Surgical Patients: Is There a Relationship to Surgical Procedure Complexity?

    Science.gov (United States)

    He, Dingchao; Sznycer-Taub, Nathaniel; Cheng, Yao; McCarter, Robert; Jonas, Richard A; Hanumanthaiah, Sridhar; Moak, Jeffrey P

    2015-08-01

    Magnesium sulfate was given to pediatric cardiac surgical patients during cardiopulmonary bypass period in an attempt to reduce the occurrence of postoperative junctional ectopic tachycardia (PO JET). We reviewed our data to evaluate the effect of magnesium on the occurrence of JET and assess a possible relationship between PO JET and procedure complexity. A total of 1088 congenital heart surgeries (CHS), performed from 2005 to 2010, were reviewed. A total of 750 cases did not receive magnesium, and 338 cases received magnesium (25 mg/kg). All procedures were classified according to Aristotle score from 1 to 4. Overall, there was a statistically significant decrease in PO JET occurrence between the two groups regardless of the Aristotle score, 15.3 % (115/750) in non-magnesium group versus 7.1 % (24/338) in magnesium group, P < 0.001. In the absence of magnesium, the risk of JET increased with increasing Aristotle score, P = 0.01. Following magnesium administration and controlling for body weight, surgical and aortic cross-clamp times in the analyses, reduction in adjusted risk of JET was significantly greater with increasing Aristotle level of complexity (JET in non-magnesium vs. magnesium group, Aristotle level 1: 9.8 vs. 14.3 %, level 4: 11.5 vs. 3.2 %; odds ratio 0.54, 95 % CI 0.31-0.94, P = 0.028). Our data confirmed that intra-operative usage of magnesium reduced the occurrence of PO JET in a larger number and more diverse group of CHS patients than has previously been reported. Further, our data suggest that magnesium's effect on PO JET occurrence seemed more effective in CHS with higher levels of Aristotle complexity.

  1. A Simple Gauss-Newton Procedure for Covariance Structure Analysis with High-Level Computer Languages.

    Science.gov (United States)

    Cudeck, Robert; And Others

    1993-01-01

    An implementation of the Gauss-Newton algorithm for the analysis of covariance structure that is specifically adapted for high-level computer languages is reviewed. This simple method for estimating structural equation models is useful for a variety of standard models, as is illustrated. (SLD)

  2. Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures.

    Science.gov (United States)

    Lee, Sung Kwang; Kang, Do Kyun

    2016-06-01

    Flail chest is a life-threatening situation that paradoxical movement of the thoracic cage was caused by multiply fractured ribs in two different planes, or a sternal fracture, or a combination of the two. The methods to achieve stability of the chest wall are controversy between surgical fixation and mechanical ventilation. We report a case of a 33-year-old man who fell from a high place with fail chest due to multiple rib fractures bilaterally and horizontal sternal fracture. The conventional surgical stabilization using metal plates by access to the front of the sternum could not provide stability of the flail segment because the fracture surface was obliquely upward and there were multiple bilateral rib fractures adjacent the sternum. The Nuss procedure was performed for supporting the flail segment from the back. Flail chest was resolved immediately after the surgery. The patient was weaned from the mechanical ventilation on third postoperative day successfully and was ultimately discharged without any complications.

  3. The learning effect of intraoperative video-enhanced surgical procedure training

    NARCIS (Netherlands)

    van Det, M. J.; Meijerink, W. J. H. J.; Hoff, C.; Middel, L. J.; Koopal, S. A.; Pierie, J. P. E. N.

    2011-01-01

    Background The transition from basic skills training in a skills lab to procedure training in the operating theater using the traditional master-apprentice model (MAM) lacks uniformity and efficiency. When the supervising surgeon performs parts of a procedure, training opportunities are lost. To min

  4. Laparoscopic ureterolithotomy for lower ureteric stones: Steps to make it a simple procedure

    Directory of Open Access Journals (Sweden)

    Anil Mandhani

    2009-01-01

    Full Text Available Despite advances in endoscopy and availability of holmium lithotripsy there are ureteric stones, which primarily need to be treated with laparoscopic ureterolithotomy. Literature is replete with the stone retrieval in upper ureteric stone but there are a very few reports on stones removal from ureter below the lower sacroiliac joint. Putting a double J stent before starting the procedure does not give any extra advantage; rather it takes away significant operating room time. This point of technique describes port placement strategy, proximal ureteral occlusion; stone localization, ureterotomy, stone retrieval and laparoscopic stenting are the important steps where one would like to be careful enough to complete the procedure successfully.

  5. Long-term treatment with alendronate increases the surgical difficulty during simple exodontias – an in vivo observation in Holtzman rats

    Directory of Open Access Journals (Sweden)

    Conte-Neto Nicolau

    2012-07-01

    Full Text Available Abstract Background Atraumatic teeth extractions protocols are highly encouraged in patients taking bisphosphonates (Bps to reduce surgical trauma and, consequently, the risk of jaws osteonecrosis development. In this way, this paper aims to report the findings of increased surgical difficulty during simple exodontias in animals treated with bisphosphonates. Methods Sixty male Holtzman rats were randomly distributed into three groups of 20 animals and received daily subcutaneous administration of 1 mg/kg (AL1 or 3 mg/kg (AL3 of alendronate or saline solution (CTL. After 60 days of drug therapy all animals were submitted to first lower molars extractions under general anesthesia. Operatory surgical time and the frequency of teeth fractures were measured as principal outcomes and indicators of surgical difficulty degree. Results Animals treated with alendronate (AL1 and AL3 were associated to higher operatory times and increased frequency of teeth fractures compared to match controls. Conclusions The bisphosphonate therapy may be associated with an increased surgical difficulty and trauma following simple exodontias protocols, which is considered a critical issue when it comes to osteonecrosis development.

  6. Comprehensive evaluation of occupational radiation exposure to intraoperative and perioperative personnel from {sup 18}F-FDG radioguided surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Povoski, Stephen P.; Martin, Edward W. [The Ohio State University, Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, Columbus, OH (United States); Sarikaya, Ismet; Hall, Nathan C.; Knopp, Michael V. [The Ohio State University, Division of Nuclear Medicine, Department of Radiology, Columbus, OH (United States); White, William C.; Marsh, Steven G. [The Ohio State University, The Office of Environmental Health and Safety, Columbus, OH (United States); Hinkle, George H. [The Ohio State University, Division of Nuclear Medicine, Department of Radiology, Columbus, OH (United States); The Ohio State University, College of Pharmacy, Columbus, OH (United States)

    2008-11-15

    The purpose of the current study was to comprehensively evaluate occupational radiation exposure to all intraoperative and perioperative personnel involved in radioguided surgical procedures utilizing {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG). Radiation exposure to surgeon, anesthetist, scrub technologist, circulating nurse, preoperative nurse, and postoperative nurse, using aluminum oxide dosimeters read by optically stimulated luminescence technology, was evaluated during ten actual radioguided surgical procedures involving administration of {sup 18}F-FDG. Mean patient dosage of {sup 18}F-FDG was 699 {+-} 181 MBq (range 451-984). Mean time from {sup 18}F-FDG injection to initial exposure of personnel to the patient was shortest for the preoperative nurse (75 {+-} 63 min, range 0-182) followed by the circulating nurse, anesthetist, scrub technologist, surgeon, and postoperative nurse. Mean total time of exposure of the personnel to the patient was longest for the anesthetist (250 {+-} 128 min, range 69-492) followed by the circulating nurse, scrub technologist, surgeon, postoperative nurse, and preoperative nurse. Largest deep dose equivalent per case was received by the surgeon (164 {+-} 135 {mu}Sv, range 10-580) followed by the anesthetist, scrub technologist, postoperative nurse, circulating nurse, and preoperative nurse. Largest deep dose equivalent per hour of exposure was received by the preoperative nurse (83 {+-} 134 {mu}Sv/h, range 0-400) followed by the surgeon, anesthetist, postoperative nurse, scrub technologist, and circulating nurse. On a per case basis, occupational radiation exposure to intraoperative and perioperative personnel involved in {sup 18}F-FDG radioguided surgical procedures is relatively small. Development of guidelines for monitoring occupational radiation exposure in {sup 18}F-FDG cases will provide reassurance and afford a safe work environment for such personnel. (orig.)

  7. 肝癌手术治疗进展%Progress in surgical procedures of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    樊嘉; 史颖弘

    2009-01-01

    The incidence of hepatocellular carcinoma (HCC) has increased worldwide over the past two decades. Surgical resection and liver transplantation have been demonstrated as potentially curative treatment options, which could be considered in 30% -40% of HCC patients. Recent advancements of surgical treatment have focused not only on the surgical techpiques, but also the hepatic functional reserve evaluation, resectability assessment and the effects of biological characteristics of tumor on prognosis. There is no single variable to evaluate the hepatic functional reserve accurately. Combined Child-Pugh classification, ICGI5, portal vein pressure detection and remanent liver volume measurement are required prior to liver resection. The 5-year survival rate after liver resection for HCC is about 50%. The results are acceptable for some selected patients that underwent tumor resection with thrombectomy, including HCC with portal vein tumor thrombus or bile duct thrombosis. The choice of local resection or regular hepatectomy is still controversial although the former is commonly performed to treat HCC with cirrhosis, and the latter is applied to HCC patients without liver cirrhosis. The results of liver transplanta-tion for HCC are better than liver resection, and the Milan criteria is generally accepted. Any attempts to expand the selection criteria should be cautious because of organ shortage. Salvage transplantation for intrabepatic recurrence after liver resection may be a good choice in some resectable HCC. The recurrence and metastasis after surgical treatment are the main obstacles to achieve better results. Identification of predictive factors could be helpful to develop prevention strategies. Due to the importance of biological characteristics in tumor recurrence and metastasis, a molecular classification to predict prognosis of HCC patients will lead to a more personalized medicine. Targeting key molecules of biological pathways could optimize the therapeutic

  8. Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips

    Science.gov (United States)

    Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali

    2016-01-01

    Summary: Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

  9. Outcomes in Patients With Hemophilia and von Willebrand Disease Undergoing Invasive or Surgical Procedures.

    Science.gov (United States)

    Chapin, John; Bamme, Jaqueline; Hsu, Fraustina; Christos, Paul; DeSancho, Maria

    2017-03-01

    Adults with hemophilia A (HA), hemophilia B (HB), and von Willebrand disease (VWD) frequently require surgery and invasive procedures. However, there is variability in perioperative management guidelines. We describe our periprocedural outcomes in this setting. A retrospective chart review from January 2006 to December 2012 of patients with HA, HB, and VWD undergoing surgery or invasive procedures was conducted. Type of procedures, management including the use of continuous factor infusion, and administration of antifibrinolytics were reviewed. Adverse outcomes were defined as acute bleeding (patients with HA and HB. In all, 24 patients had severe hemophilia and 12 had mild/moderate hemophilia. Twelve patients had inhibitors. There were also 5 female carriers of HA and 6 patients with VWD. There were 34 major surgeries (26 orthopedic, 8 nonorthopedic) and 129 minor surgeries. Continuous infusion was used in 55.9% of major surgeries versus 8.5% of minor surgeries. Antifibrinolytics were administered in 14.7% of major surgeries versus 23.2% of minor surgeries. In all, 4 patients developed acute bleeding and 10 patients developed delayed bleeding. Delayed bleeding occurred in 28.6% of genitourinary procedures and in 16.1% of dental procedures. Five patients acquired an inhibitor and 2 had thrombosis. In conclusion, patients with HA, HB, or VWD had similar rates of adverse outcomes when undergoing minor surgeries or major surgeries. This finding underscores the importance of an interdisciplinary management and procedure-specific guidelines for patients with hemophilia and VWD prior to even minor invasive procedures.

  10. Temporomandibular joint ankylosis: Case-series of two different surgical procedures

    Directory of Open Access Journals (Sweden)

    Gholamreza Shirani

    2014-01-01

    Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.

  11. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    Directory of Open Access Journals (Sweden)

    Ettore Taverna

    2013-01-01

    Full Text Available The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect position of the screws: perpendicular to the graft and the glenoid neck and parallel between them.

  12. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression.

    Science.gov (United States)

    Taverna, Ettore; Ufenast, Henri; Broffoni, Laura; Garavaglia, Guido

    2013-07-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect position of the screws: perpendicular to the graft and the glenoid neck and parallel between them.

  13. Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience.

    Science.gov (United States)

    Ceccarelli, Graziano; Codacci-Pisanelli, Massimo; Patriti, Alberto; Ceribelli, Cecilia; Biancafarina, Alessia; Casciola, Luciano

    2013-09-01

    Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique

  14. Pattern recognition in hyperspectral data acquired during surgical procedures: differentiation between nerve and adipose tissue

    NARCIS (Netherlands)

    Schols, R.M.; Laan, M. ter; Stassen, L.P.S.; Bouvy, N.D.; Wieringa, F.P.; Alic, L.

    2016-01-01

    Intraoperative nerve localization is extremely important during surgery, especially laparoscopy. This is particularly challenging when nerves show visual resemblance to surrounding tissue. An example of such a delicate procedure is thyroid and parathyroid surgery, where iatrogenic injury of the recu

  15. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

    Directory of Open Access Journals (Sweden)

    Mohanad Shukry

    2010-03-01

    Full Text Available Mohanad Shukry, Jeffrey A MillerUniversity of Oklahoma Health Sciences Center, Department of Anesthesiology, Children’s Hospital of Oklahoma, Oklahoma City, OK, USAAbstract: Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC, airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg-1, and infusion dose ranged from 0.2 to 10 μg kg-1 h-1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.Keywords: dexmedetomidine, sedation, nonintubated patients

  16. A review of simple multiple criteria decision making analytic procedures which are implementable on spreadsheet packages

    Directory of Open Access Journals (Sweden)

    T.J. Stewart

    2003-12-01

    Full Text Available A number of modern multi-criteria decision making aids for the discrete choice problem, are reviewed, with particular emphasis on those which can be implemented on standard commercial spreadsheet packages. Three broad classes of procedures are discussed, namely the analytic hierarchy process, reference point methods, and outranking methods. The broad principles are summarised in a consistent framework, and on a spreadsheet. LOTUS spreadsheets implementing these are available from the author.

  17. Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

    Science.gov (United States)

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

    2016-01-01

    In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index.

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

    Science.gov (United States)

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

    2008-09-01

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

  19. A simple statistical procedure for the analysis of radon anomalies associated with seismic activity

    Directory of Open Access Journals (Sweden)

    Hugo Gonçalves Silva

    2013-04-01

    Full Text Available This study presents an analysis of data from various radon anomalies that were compiled by Toutain and Baubron [1999], to investigate their relationships with the earthquake parameters of magnitude and distance from epicenter. The simple methodology applied here reveals significant and positive correlation between the duration of the radon anomalies and the ratio between the earthquake preparation radius and the distance between the sensor and the event epicenter. This shows an important relationship between seismic activity and duration of radon anomalies at a local scale. The consequences and implications of this relationship are discussed.

  20. Prevalence of bacteriuria in dogs without clinical signs of urinary tract infection presenting for elective surgical procedures.

    Science.gov (United States)

    McGhie, J A; Stayt, J; Hosgood, G L

    2014-01-01

    To determine the frequency of bacteriuria in dogs presenting for elective surgery, to compare the frequency of bacteriuria in dogs presenting for orthopaedic (non-neurological) procedures to that of dogs presenting for soft tissue procedures and to measure the agreement of microscopic visualisation of bacteria in urine sediment with the occurrence of bacterial growth on culture. Prospective cohort study of 140 client-owned dogs. Urine was collected via prepubic cystocentesis prior to or immediately after induction of anaesthesia. Urine was submitted for quantitative bacteriological culture and urinalysis. The dogs' age, sex, weight and breed were recorded, as well as the surgical procedure performed. In total, 80 orthopaedic and 60 soft tissue surgical cases were included in the study; 3 dogs (2.1%) returned bacterial growth on culture (positive urine culture) and 19 (13.6%) recorded urine sediment with pyuria and/or bacteriuria on urinalysis (positive urinalysis). All dogs with positive urine culture were female and two of them underwent orthopaedic procedures. Each bitch had growth of Escherichia coli >10(5)  CFU/mL. The agreement between positive urinalysis and positive urine culture was poor (κ = 0.15). The prevalence of bacteriuria in dogs without clinical signs of urinary tract infection in this population was low (2.1%). An at-risk population could not be identified because of the small number of positive outcomes. A positive urinalysis showed poor agreement with urine culture results and therefore the decision to treat without performing a urine culture is not advised. © 2014 Australian Veterinary Association.

  1. Single surgical procedure combining epicardial pacemaker implantation and subsequent extraction of the infected pacing system for pacemaker-dependent patients.

    Science.gov (United States)

    Amraoui, Sana; Barandon, Laurent; Whinnett, Zachary; Ploux, Sylvain; Labrousse, Louis; Denis, Arnaud; Oses, Pierre; Ritter, Philippe; Haissaguerre, Michel; Bordachar, Pierre

    2013-08-01

    Management of pacemaker infection in pacing-dependent patients is often challenging. Typically, temporary pacing is used while antibiotic therapy is given for a number of days before reimplantation of a new endocardial system. This results in a prolonged hospital stay and complications associated with temporary pacing. In this study, we examine the feasibility of performing a single combined procedure of epicardial pacemaker implantation followed by system extraction. One hundred consecutive infected pacemaker-dependent patients underwent implantation of 2 epicardial ventricular leads and were converted to a ventricular demand pacing system. The infected pacing system was then extracted during the same procedure. Patients were followed up for 12 months. Significant pericardial bleeding developed during the procedure in 3 patients. The presence of the pericardial drain positioned during the implantation of the epicardial pacing system meant that cardiac tamponade did not occur, allowing surgical repair with sternotomy to be carried out under stable hemodynamic conditions. Two of these 100 patients died in the 30-day postoperative period; 1 death was due to septic shock and 1 to pulmonary distress. Median 1-year epicardial pacing thresholds were stable and excellent (1.4 ± 0.9 volts). However, 1 of the 2 leads developed increased thresholds in 6 patients, which led to the exclusive use of other ventricular lead. A single combined procedure of surgical epicardial pacemaker implantation and pacemaker system extraction appears to be a safe and effective method for managing pacemaker-dependent patients with infected pacemakers. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  2. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis.

    Science.gov (United States)

    Saco, Michael; Howe, Nicole; Nathoo, Rajiv; Cherpelis, Basil

    2015-04-01

    Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists continue to prescribe them. The objective of our systematic review and meta-analysis was to critically assess the efficacy of topical antibiotics in terms of preventing postsurgical wound infections in the dermatology outpatient setting. PubMed, Embase, MD Consult, Science Direct, Springer Link, DynaMed and Cochrane online medical databases were searched from 1980 to 2013. Using random effects modeling, the pooled odds ratio of developing a postsurgical wound infection was 0.71 (95% CI, 0.42-1.19). Pooled data of the four trials in the meta-analysis did not show a statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. In the setting of moist occlusive dressings, there is no statistically significant difference in prophylactic efficacy between applying and not applying ointment to surgical wounds. Wounds at increased risk of developing surgical site infections include wounds in diabetics, wounds located in certain anatomic regions, and wounds created by some surgical procedures. Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.

  3. A novel surgical procedure for papilla reconstruction using platelet rich fibrin

    Directory of Open Access Journals (Sweden)

    Lalitha Tanjore Arunachalam

    2012-01-01

    Full Text Available Loss of interdental papilla predisposes to phonetic, functional, and esthetic problem. Surgical techniques are manifold, but are challenging and very unpredictable. The purpose of this case report is to present the use of platelet rich fibrin (PRF in the reconstruction of papilla in the maxiallry anterior region of a forty year old woman who presented with loss of interdental papillae in 11, 12 and 11, 21 region. PRF was tucked in to the pouch created with a semilunar pedicle flap and the entire gingivopapillary unit was displaced coronally. Optimal fill was noted at 3 and 6 months postoperatively. Use of PRF may thus be the panacea for interdental papilla augmentation.

  4. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery.

    Science.gov (United States)

    Benhaim, L; Honoré, C; Goéré, D; Delhorme, J-B; Elias, D

    2016-04-01

    Complete cytoreductive surgery (CCRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the best-known treatment for pseudomyxoma peritonei (PMP). In 30% of the cases, PMP realize a widespread involvement of the peritoneal cavity. In these extreme situations, we developed, devoted strategies to optimize the feasibility and safety of CCRS. This study describes the surgical resections required for CCRS and the consequent approaches that we propose to achieve CCRS. We defined "huge PMP" by a peritoneal cancer index (PCI) ≥ 28. Surgical procedures of patients operated on between 1994 and 2014 were retrospectively reviewed from a prospective database in a single institution. During this period, 311 patients were operated on and 247 (79%) underwent CCRS + HIPEC. Among them, 100 patients presented "huge" PMP and 54 patients underwent CCRS + HIPEC. In patients with "huge" PMP, the rate of CCRS + HIPEC was 25% before 2002 and reached 71% between 2011 and 2014. We identified 3 conditions for CCRS 1) to guaranty a sufficient length of residual small bowel 2) to preserve the left gastric vessels in order to preserve the superior third of the stomach 3) to ensure that the hepatic pedicle can be entirely cleared from its tumor involvement. None of the other peritonectomy procedures were decisional for CCRS. Our learning curve improved the selection and completion rate of CCRS + HIPEC for "huge PMP". Some anatomical and physiological prerequisites guarantee the feasibility and safety of such extensive surgeries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure.

    Science.gov (United States)

    Zilberlicht, Ariel; Feiner, Benjamin; Haya, Nir; Auslender, Ron; Abramov, Yoram

    2016-11-01

    Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.

  6. Anaplastic carcinoma of the pancreas: Is there a role for palliative surgical procedure?

    Directory of Open Access Journals (Sweden)

    Rajan Vaithianathan

    2014-01-01

    Full Text Available Anaplastic carcinoma (AC or undifferentiated carcinoma of the pancreas is a rare variant among the malignant pancreatic neoplasms. These tumors have a poor prognosis with survival measured in months. The role of surgical palliation to improve the quality of life is not well defined in these patients. We report a case of AC of pancreas in a 65-year-old male patient. Patient had upper abdominal pain with frequent bilious vomiting. Computed tomography scan of the abdomen showed a mass in the body of pancreas with possible infiltration of duodenojejunal flexure (DJF. Laparotomy revealed an inoperable mass with posterior fixity and involvement of the DJF. Patient underwent a palliative duodenojejunostomy. Tissue biopsy from the tumor showed pleomorphic type AC with giant cells. Patient had good symptomatic relief from profuse vomiting and progressed well at follow up. AC of pancreas is a rare and aggressive malignancy with dismal outlook. If obstructive symptoms are present due to duodenal involvement, a palliative bypass may be a worthwhile surgical option in selected cases.

  7. Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center.

    Science.gov (United States)

    Horowitz, Gilad; Amit, Moran; Fried, Itzhak; Neufeld, Miri Y; Sharf, Liad; Kramer, Uri; Fliss, Dan M

    2013-01-01

    In 1997, the US Food and Drug Administration approved the use of intermittent stimulation of the left vagal nerve as adjunctive therapy for seizure control. Vagal nerve stimulation (VNS) has since been considered a safe and effective treatment for medically intractable seizures. The objective of this study is to present our experience with the surgical procedure and outcomes after VNS insertion in the first 100 consecutive patients treated at the Tel-Aviv "Sourasky" Medical Center (TASMC). All patients who underwent VNS device implantation by the authors at TASMC between 2005 and 2011 were studied. The collected data included age at onset of epilepsy, seizure type, duration of epilepsy, age at VNS device implantation, seizure reduction, surgical complications, and adverse effects of VNS over time. Fifty-three males and 47 females, age 21.2 ± 11.1 years, underwent VNS implantation. Indications for surgery were medically refractory epilepsy. The most common seizure type was focal (55 patients, 55 %). Seizure duration until implantation was 14.4 ± 9 years. Mean follow-up time after device insertion was 24.5 ± 22 months. Complications were encountered in 12 patients. The most common complication was local infection (6 patients, 6 %). Six devices were removed-four due to infection and two due to loss of clinical effect. Currently, 63 patients remain in active long-term follow-up; of these, 35 patients have >50 % reduction in frequency of attacks.VNS is a well-tolerated and effective therapeutic alternative in the management of medically refractory epilepsy. The surgical procedure is safe and has a low complication rate.

  8. A case report of retrograde laparoscopic Spiegel lobectomy: an alternative surgical procedure

    Institute of Scientific and Technical Information of China (English)

    CAI Xiu-jun; DAI Yi; YU Hong; LIANG Xiao; WANG Yi-fan; ZHOU Wei; PENG Shu-you

    2009-01-01

    @@ The first laparoscopic hepatectomy case was reportedby Reich et al1 in 1991. Initially the laparoscope was utilized diagnostically for resection and biopsy of superficial liver lesions. Recently due to the technological advancement and instrumental improvement, the laparoscopic hepatic resection procedures have evolved significantly. Among them, the caudate lobectomy is considered to be one of the most challenging surgeries on account of its unique anatomic location in the core of the liver within the abdomen. So far, there are only a few reported laparoscopic caudate lobectomy cases in the literature and the most cases were performed utilizing a traditional procedure.2,3

  9. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the "pros" of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other in various subspecialties, and correlated these with patients′ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery, preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection, along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS.

  10. Development and evaluation of accessories to improve the posture of veterinary surgeons in surgical procedures conducted in the field

    Directory of Open Access Journals (Sweden)

    V.A.S. Vulcani

    Full Text Available ABSTRACT The study was conducted based on the information collected on rural properties in the state of Goiás, during practical classes of Surgical Clinic in Large Animals at the Veterinary Hospital of the Escola de Veterinária e Zootecnia of the Universidade Federal de Goiás and during the implementation of outreach projects developed by the institution. An acropostite-phimosis surgical procedure in the bulls in the field was selected, lasting over 30 minutes and requiring movements, posture and strength on the part of the surgeon. Devices were proposed and developed to provide improved comfort and safety to surgeons. The first device was a stool to be used by the professional during the execution of the surgical intervention. The use enabled the surgeon to sit down and rest their feet on the ground, reducing knee bending and distributing the support forces in various muscle groups. For the movement restriction of the surgeon, another accessory was developed to support the foreskin of the animal. Made of wood, this other device serves as a support for keeping the foreskin away from the ground and close to the surgeon. Its length, width and thickness established a good relation with the stool height, providing minimal discomfort to the professional. The third device was designed to assist in the immobilization of the animal and increase safety for the patient and surgical team. A fourth accessory was designed to protect the scapular region and avoid the occurrence of injuries in the radial nerve, myopathies and traumas during the rollover or prolonged stay of the animal in lateral decubitus. The choice of the shape, dimensions and softness of the device was mainly based on the weight of the animal. Such devices have proven to be effective, reducing the time of surgery, making cervical and lumbar movement easier, in addition to providing better support to the surgeon, reducing risks of musculoskeletal diseases.

  11. Design of a global soil moisture initialization procedure for the simple biosphere model

    Science.gov (United States)

    Liston, G. E.; Sud, Y. C.; Walker, G. K.

    1993-01-01

    Global soil moisture and land-surface evapotranspiration fields are computed using an analysis scheme based on the Simple Biosphere (SiB) soil-vegetation-atmosphere interaction model. The scheme is driven with observed precipitation, and potential evapotranspiration, where the potential evapotranspiration is computed following the surface air temperature-potential evapotranspiration regression of Thomthwaite (1948). The observed surface air temperature is corrected to reflect potential (zero soil moisture stress) conditions by letting the ratio of actual transpiration to potential transpiration be a function of normalized difference vegetation index (NDVI). Soil moisture, evapotranspiration, and runoff data are generated on a daily basis for a 10-year period, January 1979 through December 1988, using observed precipitation gridded at a 4 deg by 5 deg resolution.

  12. Simple and reliable procedure for PCR amplification of genomic DNA from yeast cells using short sequencing primers

    DEFF Research Database (Denmark)

    Haaning, J; Oxvig, C; Overgaard, Michael Toft;

    1997-01-01

    Yeast is widely used in molecular biology. Heterologous expression of recombinant proteins in yeast involves screening of a large number of recombinants. We present an easy and reliable procedure for amplifying genomic DNA from freshly grown cells of the methylotrophic yeast Pichia pastoris...... by means of PCR without any prior DNA purification steps. This method involves a simple boiling step of whole yeast cells in the presence of detergent, and subsequent amplification of genomic DNA using short sequencing primers in a polymerase chain reaction assay with a decreasing annealing temperature...

  13. Preliminary experience with dexmedetomidine for monitored anesthesia care during ENT surgical procedures.

    Science.gov (United States)

    Busick, Tamra; Kussman, Mary; Scheidt, Troy; Tobias, Joseph D

    2008-01-01

    Dexmedetomidine is an alpha2-adrenergic agonist that produces anxiolysis, amnesia, sedation, potentiation of opioid analgesia, and sympatholysis. It is currently approved by the U.S. Food & Drug Administration for the sedation of adults in the intensive care setting for up to 24 hours during mechanical ventilation. Given its beneficial sedative and anxiolytic properties and limited adverse effect profile, it has been used in several other clinical scenarios. The authors present their experience using dexmedetomidine for monitored anesthesia care (MAC) during "awake" ENT procedures such as thyroplasty, a procedure requiring a patient to verbalize when requested but to otherwise remain immobile to allow for completion of the procedure, and in a patient with post-polio syndrome with poor pulmonary reserve requiring esophagoscopy with dilation and botulinum toxin injection for cricopharyngeal dysfunction. Our preliminary experience suggests that dexmedetomidine provides effective sedation as the primary agent for MAC during such procedures in adult patients. The end-organ effects of dexmedetomidine and previous reports of its use during MAC are reviewed.

  14. Simple and rapid screening procedure for 143 new psychoactive substances by liquid chromatography-tandem mass spectrometry.

    Science.gov (United States)

    Adamowicz, Piotr; Tokarczyk, Bogdan

    2016-07-01

    In recent years, many new psychoactive substances (NPS) from several drug classes have appeared on the drug market. These substances, also known as 'legal highs', belong to different chemical classes. Despite the increasing number of NPS, there are few comprehensive screening methods for their detection in biological specimens. In this context, the purpose of this study was to develop a fast and simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) screening procedure for NPS in blood. The elaborated method allows the simultaneous screening of 143 compounds from different groups (number of compounds): cathinones (36), phenethylamines (26), tryptamines (18), piperazines (9), piperidines (2), synthetic cannabinoids (34), arylalkylamines (7), arylcyclohexylamines (3), aminoindanes (2), and other drugs (6). Blood samples (0.2 mL) were precipitated with acetonitrile (0.6 mL). The separation was achieved with gradient mobile phase of 0.1% formic acid in acetonitrile and 0.1% formic acid in water in 14 min. Detection of all compounds was based on multiple reaction monitoring (MRM) transitions. The total number of transitions monitored in dynamic mode was 432. The whole procedure was rapid and simple. The limits of detection (LODs) estimated for 104 compounds were in the range 0.01-3.09 ng/mL. The extraction recoveries determined for 32 compounds were from 1.8 to 133%. The procedure was successfully applied to the analysis of forensic blood samples in routine casework. The developed method should have wide applicability for rapid screening of new drugs of abuse in forensic or clinical samples. The procedure can be easily expanded for more substances. Copyright © 2015 John Wiley & Sons, Ltd.

  15. The Surgical Illustrator: a web enabled computer program for documenting clinical and procedural details.

    Science.gov (United States)

    Pugh, Carla M; Ratiu, Peter

    2004-01-01

    The medical record not only stores information on actions taken regarding patient care but it is also a source of education for those who read it. Nurses, residents, interns, students and consulting clinicians look to the medical record to gain an understanding of clinical disease and the diagnostic studies and treatment regimens used to affect the disease. We have presented our initial findings and our framework for developing and evaluating The Surgical Illustrator, a software program that will enable clinicians to include in EMRs information that is usually hand drawn in traditional medical records. The future of the EMR will be a direct result of research and development devoted to creating innovative means of conveying clinically pertinent data. Our goal is to make a major contribution to this effort.

  16. Training for endoscopic surgical procedures should be performed in the dissection room: a randomized study.

    Science.gov (United States)

    Klitsie, Pieter J; Ten Brinke, Bart; Timman, Reinier; Busschbach, Jan J V; Theeuwes, Hilco P; Lange, Johan F; Kleinrensink, Gert-Jan

    2017-04-01

    Laparoscopic surgery is associated with a shallow learning curve. AnubiFiX embalming technique enables laparoscopic surgical training on supple embalmed and hence insufflatable human specimens in the dissection room. Aim of the present trial is to test whether dissection-based anatomy education is superior to classical frontal classroom education on the short and long term. A total of 112 medical students were randomized in three groups. Group I attended classroom education, group II laparoscopic dissection-based education and group III received both. All groups completed an anatomy test on human specimens before, immediately after and 3 weeks after the anatomy training. Group II and III scored significantly better compared to group I immediately after the anatomy training (p I-II superior outcomes on the short and long term, as compared to classical frontal classroom education.

  17. Surgical Procedures for External Auditory Canal Carcinoma and the Preservation of Postoperative Hearing

    Directory of Open Access Journals (Sweden)

    Hiroshi Hoshikawa

    2012-01-01

    Full Text Available Carcinoma of the external auditory canal (EAC is an unusual head and neck malignancy. The pathophysiology of these tumors is different from other skin lesions because of their anatomical and functional characteristics. Early-stage carcinoma of the EAC can be generally cured by surgical treatment, and reconstruction of the EAC with a tympanoplasty can help to retain hearing, thus improving the patients’ quality of life. In this study, we present two cases of early-stage carcinoma of the EAC treated by canal reconstruction using skin grafts after lateral temporal bone resection. A rolled-up skin graft with a temporal muscle flap was useful for keeping the form and maintaining the postoperative hearing. An adequate size of the skin graft and blood supply to the graft bed are important for achieving a successful operation.

  18. Laparoscopic Gastric Plication: An Emerging Bariatric Procedure with High Surgical Revision Rate.

    Science.gov (United States)

    Albanese, Alice; Prevedello, Luca; Verdi, Daunia; Nitti, Donato; Vettor, Roberto; Foletto, Mirto

    2015-09-01

    Introduction: Laparoscopic gastric plication (LGCP) reduces gastric volume without resecting or implanting a foreign body. Although still considered investigational, it could be appropriate for young patients with a low body mass index (BMI) and for those unwilling to undergo sleeve gastrectomy, gastric banding, or bypass. Objectives: The aim of this study was to assess the mid-term results (2 years) of LGCP in terms of safety and efficacy. Methods: A total of 56 obese patients (47 female; mean age=30.5±11.7 years; mean BMI=40.31±4.7 kg/m(2)) were candidates for LGCP from January 2011 to October 2013. Early and late complications, BMI, and excess BMI loss (EBL) were prospectively recorded at 3, 6, 9, 12, 18, and 24 months follow-up. Results: Mean operative time was 72.4±15.6 minutes. No conversion was required. Mean hospital stay was 3 days. Mean %EBL was 34.3±18.40%, 40.1±24.5%, 47.4±30.2%, 46.5±34.6%, 47.8±43.2%, and 55.3±53.6% at 3, 6, 9, 12, 18, and 24 months, respectively. The overall complication rate was 32.14%. Perioperative mortality was zero. Surgical revision was needed in 30 patients: 12 for unsatisfactory weight loss and 18 for gastric prolapse (one acute within 30 days), respectively. Conclusion: LGCP showed high complication rates requiring surgical revision.

  19. Laparoscopic Gastric Plication: An Emerging Bariatric Procedure with High Surgical Revision Rate

    Science.gov (United States)

    Albanese, Alice; Prevedello, Luca; Verdi, Daunia; Nitti, Donato; Vettor, Roberto

    2015-01-01

    Introduction: Laparoscopic gastric plication (LGCP) reduces gastric volume without resecting or implanting a foreign body. Although still considered investigational, it could be appropriate for young patients with a low body mass index (BMI) and for those unwilling to undergo sleeve gastrectomy, gastric banding, or bypass. Objectives: The aim of this study was to assess the mid-term results (2 years) of LGCP in terms of safety and efficacy. Methods: A total of 56 obese patients (47 female; mean age=30.5±11.7 years; mean BMI=40.31±4.7 kg/m2) were candidates for LGCP from January 2011 to October 2013. Early and late complications, BMI, and excess BMI loss (EBL) were prospectively recorded at 3, 6, 9, 12, 18, and 24 months follow-up. Results: Mean operative time was 72.4±15.6 minutes. No conversion was required. Mean hospital stay was 3 days. Mean %EBL was 34.3±18.40%, 40.1±24.5%, 47.4±30.2%, 46.5±34.6%, 47.8±43.2%, and 55.3±53.6% at 3, 6, 9, 12, 18, and 24 months, respectively. The overall complication rate was 32.14%. Perioperative mortality was zero. Surgical revision was needed in 30 patients: 12 for unsatisfactory weight loss and 18 for gastric prolapse (one acute within 30 days), respectively. Conclusion: LGCP showed high complication rates requiring surgical revision. PMID:26421246

  20. Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures.

    Science.gov (United States)

    Sinceri, S; Carbone, M; Marconi, M; Moglia, A; Ferrari, M; Ferrari, V

    2015-01-01

    In recent years the clinical interest for structured training in endovascular procedures has increased. Such procedures respect the physical integrity of the patient and at the same time ensure good therapeutic results. This study describes the development and testing of the B.E.S.T. (Basic Endovascular Skills Trainer) simulator. The B.E.S.T is an innovative physical endovascular simulator to learn basic skills of endovascular surgery. The simulator was tested by 25 clinicians with different levels of experience: novices, intermediates, and experts. All clinicians agree on affirming the importance of training in endovascular surgery; in particular they consider the B.E.S.T a valid simulator to learn specific basic skills of vascular surgery.

  1. A simple procedure to evaluate the performance of fats and oils at frying temperatures.

    Directory of Open Access Journals (Sweden)

    Barrera-Arellano, D.

    1997-08-01

    Full Text Available A standard procedure is proposed to evaluate the performance of fats and oils at frying temperatures, taking the advantages provided by the Rancimat apparatus, i. e., standard vessels, temperature correction and temperature homogenity in all vessels resulting from the particular characteristics of the heating block. The results obtained in oil samples of 8 g heated at 180° C for 10 h in triplicate gave coefficients of variation lower than 6% for total polar compounds and polymers. In case of limited amount of oil, it is additionally proposed to use only 2 g of sample provided that a similar surface-to-oil volume ratio is maintained, and coefficients of variation of the same order than those for 8 g samples were thus obtained. Advantages of the procedure as well as potential applications for evaluation of frying fats and oils are Included. As an example, the effect of α-tocopherol on performance of sunflower oils was analyzed.

    Se propone un procedimiento estándar para evaluar el comportamiento de aceites y grasas a temperaturas de fritura. En este procedimiento se utilizan las ventajas del aparato Rancimat, que permite el uso de tubos estándar, la corrección de la temperatura, en su caso, y la igualdad de temperatura en todos los tubos dadas las características del bloque de calentamiento. De los resultados obtenidos en muestras de 8 g de aceite calentadas a 180° C durante 10 h, analizadas por triplicado, se obtuvieron coeficientes de variación inferiores al 6% para la determinación de compuestos polares y polímeros. En caso de limitación en la cantidad de aceite, se propone utilizar 2 g de muestra, manteniendo similares valores para la relación superficie a volumen de aceite, lo que permite obtener valores de alteración y coeficientes de variación del mismo orden. Se analizan finalmente las ventajas globales del procedimiento y sus distintas posibilidades en la evaluación de grasas de fritura. Como ejemplo, se aplica el

  2. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    OpenAIRE

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creatin...

  3. Outcomes of ophtalmologic surgical procedures of esotropia in children and adolescents

    Directory of Open Access Journals (Sweden)

    Kljaković-Avramović Tamara

    2008-01-01

    Full Text Available Background/Aim. Esotropia is the most common manifestation form of strabism accompanied by refraction deviations and amblyopia. The aim of this prospective study was to present the outcomes of surgical treatment of esotropia in children and adolescents. Methods. Within the period from January 1st 2006 to February 1st 2007 at the Clinic for Ophtalmology, Military Medical Academy, Belgrade a total of 25 patients with esotropia (34 eyes and previously corrected refraction anomaly and treated amblyopia were operated on. The patients were 4-19-year of age. All of the patients were submitted to a complete ophtalmologic and orthoptic examination prior to the surgery, and a month, three months and six months after the surgery. The surgery was performed under general anesthesia. Out of the total number of the patients nine were operated on both eyes, while 16 patients on one eye with amblyopia or frequent esodeviation. Nine patients were submitted to retroposition of the inner straight muscle, two to myectomy of the outer straight muscle, while in 14 of the patients a combination of retroposition and myectomy was performed. The patients were divided into three groups according to the preoperative angle at the distance and followed-up accordingly after the surgery. Deviation angle at the distance in the group I was 18-25 DP, in the group II 26-35 PD, while in the group III it was 36-60 PD. Results. The most numerous, group I (12 patients; 48%, a month following the surgery showed angle reduction by 55.58%, after three months 63.25%, and after six months 63.92%. The group II consisted of 8 patients (32% showed angle reduction by 70.75% a month following the surgery, by 76% after three months, and by 79.12% after six months. The group III (5 patients; 20% showed angle reduction by 72.20% a month following the surgery, 79.20 after three months, and 80.12% after six months following the surgery. Conclusion. The best postoperative outcomes after a month, three

  4. Clinical observation of radical surgical procedure in the treatment of perianal abscess: a report of 601 cases%一次性根治术治疗肛周脓肿601例临床观察

    Institute of Scientific and Technical Information of China (English)

    王连生

    2011-01-01

    Objective To investigate the clinical efficacy of radical surgical procedure in the treatment of perianal abscess. Methods Clinical data of 601 patients with Perianal Abscess underwent radical surgical procedure from September 2007 to September 2009 in our hospital were retrospectively analyzed. Results After a follow up of six months to one year, of these 593 cases healed completely well, 2 cases were delayed healing and 6 cases was operated again, the cure rate was 98 %. Conclusion Radical surgical procedure is simple, safe and easy feasible for perianal abscess.%目的 探讨一次性根治术治疗肛周脓肿的临床效果.方法 对我院2007年9月至2009年9月采用一次性根治术治疗肛周脓肿601例的临床资料进行回顾性分析.结果 术后随访6个月至1年,593例治愈无复发,2例延迟愈合,6例进行二次手术,治愈率98﹪.结论 一次性根治术操作简便、易于施行,可以缩短病程,患者容易接受.是一种可行的、疗效可靠的治疗肛周脓肿的术式.

  5. [The clinical estimation of ketoprofen lysine salt effect on the intensitivity of acute pain syndrome in the oral cavity during surgical procedures and postoperative period].

    Science.gov (United States)

    Durnovo, E A; Shashurina, S V; Bespalova, N A; Khomutinnikova, N E; Gliavina, I A; Marochkina, M S; Iartseva, A V

    2013-01-01

    Is studying and control of the clinical efficacy and safety of ketoprofen lysine salt (КLS) (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in the form of sachets and solutions for application in postoperative period after dental surgeries procedures. The comparison of the analgetic effect of systemic and local forms of the "Oki" drug, depending on the type and extent of surgery procedures. Was carried out surgical treatment and patients examination in the postoperative period. Surgical procedures included: vestibulolasty, vestibulolasty with apically-displaced flap, vestibulolasty with apically-displaced flap and a free palatal mucogingival graft, removal impacted and dystopic teeth, periodontal surgery. The research was conducted in the Surgical stomatology and Maxillofacial surgery Department (stomatological policlinic of the Nizhny Novgorod State Medical Academy). Was noted rapid advanced of anesthesia when using sachets and solutions of the ketoprofen lysine salt (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in postoperative period after dental surgical procedures. Was noted a more advanced of analgetic effect in the application therapy by DCI solution when open surgical wound presented. Analgetic effect was observed after 20-30 min and was maintained in the postoperative period to an average of 8 hours. Local application sachets and solution of the ketoprofen lysine salt (KLS ), in our opinion, is the most appropriate and is highly effective when open surgical wound presented. Ketoprofen lysine salt (KLS) has a neutral pH and does not irritate the gastrointestinal tract, that determines the safety of its used.

  6. Treatment of penile curvature--how to combine the advantages of simple plication and the Nesbit-procedure by superficial excision of the tunica albuginea.

    Science.gov (United States)

    Schneider, T; Sperling, H; Schenck, M; Schneider, U; Rübben, H

    2003-05-01

    Different treatment options for penile curvature exist, such as the Nesbit procedure with complete excision of the tunica albuginea or the simple plication. We prefer a modification with only superficial excision, not opening the corpora cavernosa. From January 1997 to June 2000, 68 patients were treated surgically due to penile curvature. Data was obtained from 48 patients by telephone interview. The mean penile deviation was 46 degrees. Excision of the tunica was performed only superficially and non-absorbable inverted sutures were used. The mean follow-up time in this study was 25 months. A total of 36 (75%) patients were satisfied postoperatively, 12 were unsatisfied. Eleven (23%) patients described a complete straightening, 37 (77%) a rest-curvature of 5-50 degrees (mean 14 degrees ) and 21 (44%) described a shortening of 0.5-5 cm (mean 1.2 cm). Six patients reported a recurrence. No new erectile dysfunction occurred. Superficial excision of the tunica albuginea offers the advantage of tissue-contraction due to scarring without destroying the integrity of the corpora, leading in combination with non-absorbable inverted sutures to good functional and cosmetic results.

  7. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    Science.gov (United States)

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  8. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

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    Hintermann Beat

    2011-10-01

    Full Text Available Abstract Background Simultaneous osteoarthritis (OA of the ankle joint complicates primary total knee arthroplasty (TKA. In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week and hospital stay (12 days of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.

  9. Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study

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    Shobha K

    2010-01-01

    Full Text Available Background and Objectives: The purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown-lengthening in human subjects. Materials and Methods: A clinical trial study involving 15 patients was carried out for a period of 6 months. Sites were divided into 3 groups: treated (TT sites, adjacent (AD sites and nonadjacent (NAD sites. Free gingival margin [FGM], attachment level, pocket depth, bone level, biological width [BW] were recorded at baseline, 1, 3 and 6 months. Direct bone level after flap reflection was recorded before and after osseous resection at baseline only. Level of osseous crest was lowered based on BW, and supracrestal tooth structure needed using a combination of rotary and hand instruments. Statistical Analysis: Student t test and ANOVA were used. Results: Overall, apical displacement of FGM at TT, AD and NAD sites was statistically significant compared to baseline. The apical displacement of FGM at TT site was more when compared to that at AD and NAD sites at 3 and 6 months. The BW at the TT site was smaller at 1, 3 and 6 months compared to that at baseline. However, at all sites, BW was reestablished to the baseline value at the end of 6 months. Interpretation and Conclusion: The BW at TT sites was reestablished to its original vertical dimension by 6 months. In addition, a consistent 2-mm gain of coronal tooth structure was observed at the 1, 3 and 6-month examinations.

  10. Do absorption and realistic distraction influence performance of component task surgical procedure?

    Science.gov (United States)

    Pluyter, Jon R; Buzink, Sonja N; Rutkowski, Anne-F; Jakimowicz, Jack J

    2010-04-01

    Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient.

  11. POEM Procedure: What the Radiologist Needs to Know for This New Surgical Intervention for Achalasia.

    Science.gov (United States)

    Williams, Brian; Kass, Jonathan; Maheshwary, Rishi; Gurram, Krishna; Hartman, Matthew

    Achalasia is a debilitating condition resulting from the failure of appropriate lower esophageal sphincter relaxation. Traditionally, the treatment of choice for achalasia has been a Heller myotomy, performed either via laparotomy or laparoscopically. The latter method has gained wide popularity in its documented lower postoperative morbidity. Recently, however, a new technique has been developed that can be performed by both thoracic surgeons and endoscopists-Per-Oral Endoscopic Myotomy. This procedure offers an alternative to invasive surgery and provides excellent outcomes with minimal recovery time.(1) This article would help familiarize radiologists with this new technique, as well as both normal and abnormal postoperative appearances. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. A simple and rapid procedure for the detection of genes encoding Shiga toxins and other specific DNA sequences.

    Science.gov (United States)

    Nejman-Faleńczyk, Bożena; Bloch, Sylwia; Januszkiewicz, Aleksandra; Węgrzyn, Alicja; Węgrzyn, Grzegorz

    2015-11-13

    A novel procedure for the detection of specific DNA sequences has been developed. This procedure is based on the already known method employing PCR with appropriate primers and a sequence-specific DNA probe labeled with the fluorescent agent 6-carboxylfluorescein (FAM) at the 5' end and the fluorescence quencher BHQ-1 (black hole quencher) at the 3' end. However, instead of the detection of the fluorescence signal with the use of real-time PCR cyclers, fluorescence/luminescence spectrometers or fluorescence polarization readers, as in all previously-reported procedures, we propose visual observation of the fluorescence under UV light directly in the reaction tube. An example for the specific detection of the Shiga toxin-producing Escherichia coli (STEC) strains, by detecting Shiga toxin genes, is demonstrated. This method appears to be specific, simple, rapid and cost effective. It may be suitable for use in research laboratories, as well as in diagnostic units of medical institutions, even those equipped only with a thermocycler and a UV transilluminator, particularly if rapid identification of a pathogen is required.

  13. A Simple and Rapid Procedure for the Detection of Genes Encoding Shiga Toxins and Other Specific DNA Sequences

    Directory of Open Access Journals (Sweden)

    Bożena Nejman-Faleńczyk

    2015-11-01

    Full Text Available A novel procedure for the detection of specific DNA sequences has been developed. This procedure is based on the already known method employing PCR with appropriate primers and a sequence-specific DNA probe labeled with the fluorescent agent 6-carboxylfluorescein (FAM at the 5′ end and the fluorescence quencher BHQ-1 (black hole quencher at the 3′ end. However, instead of the detection of the fluorescence signal with the use of real-time PCR cyclers, fluorescence/luminescence spectrometers or fluorescence polarization readers, as in all previously-reported procedures, we propose visual observation of the fluorescence under UV light directly in the reaction tube. An example for the specific detection of the Shiga toxin-producing Escherichia coli (STEC strains, by detecting Shiga toxin genes, is demonstrated. This method appears to be specific, simple, rapid and cost effective. It may be suitable for use in research laboratories, as well as in diagnostic units of medical institutions, even those equipped only with a thermocycler and a UV transilluminator, particularly if rapid identification of a pathogen is required.

  14. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures

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    Jaya Lalwani

    2010-01-01

    Full Text Available The laryngeal mask airway (LMA is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA, a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05 after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO 2 (% and EtCO 2 levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures.

  15. Continuous intraoperative temperature measurement and surgical site infection risk: analysis of anesthesia information system data in 1008 colorectal procedures.

    Science.gov (United States)

    Melton, Genevieve B; Vogel, Jon D; Swenson, Brian R; Remzi, Feza H; Rothenberger, David A; Wick, Elizabeth C

    2013-10-01

    To investigate the association between intraoperative temperature and surgical site infection (SSI) in colorectal surgery with anesthesia information system data. Continuously measured intraoperative anesthesia information system temperature data for adult abdominal colorectal surgery procedures at a large tertiary center for 1 year were linked to 30-day American College of Surgeons National Surgical Quality Improvement Program SSI outcomes. Univariable and multivariable analyses of SSI to descriptive temperature statistics, absolute and relative temperature threshold times, and other clinically relevant variables were performed. Overall, 1008 patients (48% female, median age: 53 years) underwent major colorectal procedures (7% emergent, 72% open, 173 ± 95 minutes mean procedure time) with median intraoperative temperature 36.0°C, using active rewarming in 92% and 1-hour presurgical antibiotic administration in 91%. Thirty-day overall and organ/space infection rates were 17.4% (175) and 8.5% (86). Maximum, minimum, ending, and median temperatures were similar for those with or without SSI (36.6°C vs 36.5°C, 34.9°C vs 35.0°C, 36.4°C vs 36.2°C, and 36.1°C vs 36.0°C, P = not significant) and percent minutes using incremental cutoffs failed to correlate SSI with temperature. Absolute minutes for higher temperature cutoffs correlated with SSI because of longer procedure times. On multivariable analysis, factors associated with SSI were preoperative diabetes [odds ratio: 1.81 (1.07-3.07), P = 0.022] and blood loss of more than 500 mL [odds ratio: 1.61 (1.01-2.58), P = 0.047]. Although active rewarming remains an accepted and valid process measure, highly granular anesthesia information system temperature data did not demonstrate a correlation between temperature measures and SSI. SSI prevention efforts should focus on more efficacious interventions as opposed to currently mandated publicly reported normothermia measures.

  16. PROCEDIMIENTO EN CIRUGÍA: TORACOSTOMÍA CERRADA Surgical procedures: closed thoracostomy

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    Juan de Dios Díaz-Rosales

    2010-12-01

    Full Text Available La toracostomía consiste en la introducción de un tubo en la cavidad pleural, para drenar aire, sangre, bilis, pus u otros líquidos. Este artículo detalla paso por paso la técnica para la colocación del tubo pleural. También mencionamos las indicaciones, contraindicaciones y las posibles complicaciones asociadas a este procedimientoThoracostomy is the insertion of a tube into the pleural cavity to drain air, blood, bile, pus, or other fluids. This paper provides one approach step-by-step to insertion of chest tube and offers a rationale for practice. It also discusses indications, contraindications and potential complications associated with the procedure

  17. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta.

    Science.gov (United States)

    Chandraharan, Edwin; Rao, Sridevi; Belli, Anna-Maria; Arulkumaran, Sabaratnam

    2012-05-01

    The reported maternal mortality for morbidly adherent placenta ranges from 7% to 10% worldwide. Current treatment modalities for this potentially life-threatening condition include radical approaches such as elective peripartum hysterectomy with or without bowel/bladder resection or ureteric re-implantation (for placenta percreta infiltrating these organs), and conservative measures such as compression sutures with balloon tamponade and the placenta remaining in situ. However, both conservative and radical measures are associated with significant maternal morbidity and mortality. The present article describes the Triple-P procedure-which involves perioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; pelvic devascularization; and placental non-separation with myometrial excision and reconstruction of the uterine wall-as a safe and effective alternative to conservative management or peripartum hysterectomy. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    Science.gov (United States)

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. PMID:26703927

  19. Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: a retrospective cohort study.

    Science.gov (United States)

    Wang, Haibo; Zhou, Ailing; Fan, Min; Li, Ping; Qi, Shengwei; Gao, Licai; Li, Xiujuan; Zhao, Jinrong

    2015-04-01

    Laparoscopy surgery has been widely used for many decades and combined laparoscopic procedures have become favorable choices for concomitant pathologies in the abdomen. However, the type of combination procedures and their safety in obese women have not been well elucidated in obese women. Here we retrospectively reported 147 obese women underwent combined laparoscopic gynecological surgery and cholecystectomy/appendicectomy in our hospital from January 2003 to December 2011. Of the total number of patients (n = 147), various laparoscopic gynecological surgeries were combined with laparoscopic cholecystectomy in 93 patients, and were combined with laparoscopic appendectomy in the rest 54 patients. Patients' ages ranged from 24 to 55 years with an average of 33 years. Our results showed that combined procedures caused various operative time and blood loss, with no difference considering the time to resume oral intake and length of hospital stay. Intraoperative complications occurred in a total of 7 patients (4.8%). None of the patients suffered from major complications after laparoscopic surgery, and minor postoperative complications occurred in 30 patients (20.4%). The follow-up period ranged from 6 to 24 months (average, 18.5 months). None of the patients developed complications during follow-up, except that one patient suffered from colporrhagia. Our results further suggest that the combined abdominal laparoscopic procedures of gynecologic and general surgery are safe and economic choices for obese women, and benefit patients in many ways including lesser pain, shorter hospital stays and earlier recovery. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Multiscale modelling as a tool to prescribe realistic boundary conditions for the study of surgical procedures.

    Science.gov (United States)

    Laganà, K; Dubini, G; Migliavacca, F; Pietrabissa, R; Pennati, G; Veneziani, A; Quarteroni, A

    2002-01-01

    This work was motivated by the problems of analysing detailed 3D models of vascular districts with complex anatomy. It suggests an approach to prescribing realistic boundary conditions to use in order to obtain information on local as well as global haemodynamics. A method was developed which simultaneously solves Navier-Stokes equations for local information and a non-linear system of ordinary differential equations for global information. This is based on the principle that an anatomically detailed 3D model of a cardiovascular district can be achieved by using the finite element method. In turn the finite element method requires a specific boundary condition set. The approach outlined in this work is to include the system of ordinary differential equations in the boundary condition set. Such a multiscale approach was first applied to two controls: (i) a 3D model of a straight tube in a simple hydraulic network and (ii) a 3D model of a straight coronary vessel in a lumped-parameter model of the cardiovascular system. The results obtained are very close to the solutions available for the pipe geometry. This paper also presents preliminary results from the application of the methodology to a particular haemodynamic problem: namely the fluid dynamics of a systemic-to-pulmonary shunt in paediatric cardiac surgery.

  1. Optimising aesthetic outcome after nipple-areola complex-sparing mastectomy and immediate one-stage prosthetic reconstruction: A simple surgical trick to fix nipple-areola complex position.

    Science.gov (United States)

    Maione, Luca; Lisa, Andrea; Barbera, Federico; Siliprandi, Mattia; Vinci, Valeriano; Klinger, Francesco; Klinger, Marco

    2017-01-01

    Nipple-areola complex (NAC) sparing mastectomy (NSM) is mostly indicated in patients with small-/medium-sized and non-ptotic breasts, while skin-reducing mastectomy is used in patients with medium or large breasts with severe ptosis. NAC location on the reconstructed breast is one of the major factors in determining the final aesthetic result and patients' satisfaction. An optimum result obtained at the end of surgical procedure may be altered and compromised by skin redistribution and consequently NAC depositioning during the post-operative period in patients with medium-sized breasts and a moderate degree of ptosis. In the present study, we propose a simple surgical trick to fix the NAC in the desired position with a long-lasting result. We selected 35 patients undergoing NAC sparing mastectomy for breast cancer and immediate one-stage prosthetic reconstruction and we performed a single suture to fix NAC in the desired position before closing the skin envelope. We evaluated NAC complex position stability overtime comparing pre-operative standard photographs with early (3 weeks after surgery) and late (1 year after surgery). In all patients, we were able to place the NAC complex on the desired position, and the result was stable at 1 year follow-up. The aesthetic outcome was satisfactory in all patients with no change in the complication rate. This simple surgical trick has been shown to be safe and effective in optimising the aesthetic outcome in a patient undergoing NAC sparing mastectomy and immediate one-stage prosthetic reconstruction. Level IV: evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

  2. Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis.

    Science.gov (United States)

    Spivak, Hadar; Sakran, Nasser; Dicker, Dror; Rubin, Moshe; Raz, Itamar; Shohat, Tamy; Blumenfeld, Orit

    2017-07-01

    The scale and variables linked to bariatric surgery's effect on dyslipidemia have not been conclusive. To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (LAGB) on dyslipidemia SETTING: National bariatric surgery registry. Plasma lipids and associated variables were compared at baseline and 1 year (12±4 mo) after surgery for registry patients with dyslipidemia enrolled from June 2013 to August 2014. The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4 to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2 mg/dL (8.9%, n = 1515; P<.001). Normal TC levels of below 200 mg/dL were achieved by 76% post-RYGB patients compared with 43.5% post-SG patients (odds ratio [OR] = 6.24, 95% confidence interval [CI]: 3.69-10.53) and 25.6% post-LABG patients (OR = 9.66, 95% CI: 4.11-22.67; P<.01). Although equivalent patterns were observed for low-density-lipoprotein cholesterol (LDL), the levels of high-density-lipoprotein cholesterol (HDL) were most improved post-SG, reaching normal levels in 58.1% of SG male patients versus 39.5% of RYGB male patients (OR = 1.56, 95% CI: 1.04-2.35), (P = .02). The lowering of triglyceride levels by approximately 75% was comparable after SG and RYGB procedures. The type of surgery was the strongest independent predictor for all lipid level improvements or remissions. Male sex was an independent predictor for LDL normalization only (OR = 1.88, 95% CI: 1.24-2.85). Excess weight loss offered no meaningful prediction for lipid improvement (OR = 1.01-1.03). Particular types of bariatric surgeries had different effects on dyslipidemia, independent of weight loss. Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia. Copyright © 2017 American

  3. MANAGEMENT OF PATIENTS ON ANTICOAGULANT THERAPY UNDERGOING DENTAL SURGICAL PROCEDURES. Review Article.

    Directory of Open Access Journals (Sweden)

    Atanaska Dinkova

    2013-07-01

    Full Text Available Dental treatment performed in patients receiving oral anticoagulant drug therapy is becoming increasingly common in dental offices.The aim of oral anticoagulant therapy is to reduce blood coagulability to an optimal therapeutic range within which the patient is provided some degree of protection from thromboembolic events. This is achieved at the cost of a minor risk of haemorrhage. Frequently raised questions concern the safety and efficacy of the various anticoagulation regimens and their accompanying thromboembolic and bleeding risks relative to invasive dental procedures.The aim of this literature review is to evaluate the available evidence on the impact of anticoagulant medications on dental treatment and highlight certain patient management issues closely interrelated to various aspects of dental treatment. For that purpose literature search in the electronic database of Medscape, Pubmed-Medline, Science Direct, and EBSCO host, in the data base of Medical University Plovdiv and specialised published books in general medicine and dentistry was made.A total of 33 publications between 1995 and 2013 were identified: 12 review articles, 11 randomized controlled and non-randomised studies, 6 guidelines and practical guides, 1 meta-analysis and 3 specialised books.

  4. Surgical procedure for limbal dermoid and palpebral coloboma-dermoid in English bulldog puppy

    Directory of Open Access Journals (Sweden)

    Božinović Stanko

    2009-01-01

    Full Text Available A dermoid is a malformation, a congenital choristoma, in fact an ectopic part of the skin. This malformation can be located on the eyelids (palpebral, on the palpebral or bulbar part of the conjunctive, on the third eyelid or on the cornea, the limbus edge of the eyelid. Ocular dermoids consist of a cornified squamous-stratified epithelium that can be pigmented to various degrees, located on irregular dermis in which there are hair follicles, sweat and fat glands, and, in rare cases, cartilage and bone can also be observed. Corneal dermoids can be classified into three types: limbal or epibulbar dermoid, a dermoid which covers the greater part or the entire cornea, a dermoid that covers the entire front segment of the eye. Coloboma presents a congenital malformation that is characterized by the absence of an eyelid and it can be located on the upper or on the lower lid. This paper presents the case of an English bulldog puppy in which a limbal dermoid and a palpebral coloboma-dermoid were observed at the same time. In this case, superficial keratectomy was selected for the treatment of the limbal dermoid, while the palpebral colobomadermoid was treated using excision with a plastic reconstruction procedure. A microscopic examination of sample tissue of the corneal demoid showed, on the surface, cornified squamous-stratified epithelium lying on the dermis. The dermis was observed to contain hair follicles, as well as sweat and fat glands.

  5. A Novel Surgical Procedure for Er:YAG Laser-Assisted Periodontal Regenerative Therapy: Case Series.

    Science.gov (United States)

    Taniguchi, Yoichi; Aoki, Akira; Sakai, Kazuto; Mizutani, Koji; Meinzer, Walter; Izumi, Yuichi

    2016-01-01

    The objective of this study was to evaluate an Er:YAG laser (ErL) application for periodontal regenerative surgery in angular bone defects at nine sites in six patients. Debridement was thoroughly performed using a combination of curettage with a Gracey-type curette and ErL irradiation at a panel setting of 70 mJ/pulse and 20 Hz with sterile saline spray. After applying an enamel matrix derivative and autogenous bone grafting, ErL was used to form a blood clot coagulation on the grafted bone surface at 50 mJ/pulse and 20 Hz without water spray for approximately 30 seconds. Twelve months after surgery the mean probing depth had improved from 6.2 mm to 2.0 mm, the mean clinical attachment level had reduced from 7.5 mm to 3.4 mm, and bleeding on probing had improved from (+) to (-). Mean intrabony defect depth decreased from 6.0 mm before surgery to 1.0 mm 12 months after surgery. A novel procedure for periodontal regenerative surgery applying ErL irradiation for thorough decontamination during debridement as well as blood coagulation following autogenous bone grafting seems to have achieved favorable and stable healing of periodontal pockets with significant clinical improvement and desirable regeneration of angular bone defects, including one-wall defects.

  6. A simple two-step purification procedure for the iC3b binding collectin conglutinin

    DEFF Research Database (Denmark)

    Krogh-Meibom, Thomas; Ingvartsen, Klaus Lønne; Tornoe, Ida

    2010-01-01

    Bovine conglutinin is a serum protein involved in innate immunity. It binds calcium dependently to iC3b, a product of the complement component C3 deposited on cell surfaces, immune complexes or artificial surfaces after complement activation. We here present a simple and efficient two....... In the second step, conglutinin is separated from iC3b and IgM by ion-exchange chromatography. This purification procedure yielded 81 μg of conglutinin per ml of serum with a recovery of 61.2%. Surface plasmon resonance analysis showed that the purified conglutinin had a high affinity for mannan (K(d)=2.3-3.2 n...

  7. Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling.

    Science.gov (United States)

    Edelman, Eric R; van Kuijk, Sander M J; Hamaekers, Ankie E W; de Korte, Marcel J M; van Merode, Godefridus G; Buhre, Wolfgang F F A

    2017-01-01

    For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT) and other variables relevant to TPT. We extracted data from a Dutch benchmarking database of all surgeries performed in six academic hospitals in The Netherlands from 2012 till 2016. The final dataset consisted of 79,983 records, describing 199,772 h of total OR time. Potential predictors of TPT that were included in the subsequent analysis were eSCT, patient age, type of operation, American Society of Anesthesiologists (ASA) physical status classification, and type of anesthesia used. First, we computed the predicted TPT based on a previously described fixed ratio model for each record, multiplying eSCT by 1.33. This number is based on the research performed by van Veen-Berkx et al., which showed that 33% of SCT is generally a good approximation of anesthesia-controlled time (ACT). We then systematically tested all possible linear regression models to predict TPT using eSCT in combination with the other available independent variables. In addition, all regression models were again tested without eSCT as a predictor to predict ACT separately (which leads to TPT by adding SCT). TPT was most accurately predicted using a linear regression model based on the independent variables eSCT, type of operation, ASA classification, and type of anesthesia. This model performed significantly better than the fixed ratio model and the method of predicting ACT separately. Making use of these more accurate predictions in planning and sequencing algorithms may enable an increase in utilization of ORs, leading to significant financial and productivity related benefits.

  8. Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling

    Directory of Open Access Journals (Sweden)

    Eric R. Edelman

    2017-06-01

    Full Text Available For efficient utilization of operating rooms (ORs, accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT and other variables relevant to TPT. We extracted data from a Dutch benchmarking database of all surgeries performed in six academic hospitals in The Netherlands from 2012 till 2016. The final dataset consisted of 79,983 records, describing 199,772 h of total OR time. Potential predictors of TPT that were included in the subsequent analysis were eSCT, patient age, type of operation, American Society of Anesthesiologists (ASA physical status classification, and type of anesthesia used. First, we computed the predicted TPT based on a previously described fixed ratio model for each record, multiplying eSCT by 1.33. This number is based on the research performed by van Veen-Berkx et al., which showed that 33% of SCT is generally a good approximation of anesthesia-controlled time (ACT. We then systematically tested all possible linear regression models to predict TPT using eSCT in combination with the other available independent variables. In addition, all regression models were again tested without eSCT as a predictor to predict ACT separately (which leads to TPT by adding SCT. TPT was most accurately predicted using a linear regression model based on the independent variables eSCT, type of operation, ASA classification, and type of anesthesia. This model performed significantly better than the fixed ratio model and the method of predicting ACT separately. Making use of these more accurate predictions in planning and sequencing algorithms may enable an increase in utilization of ORs, leading to significant financial and productivity related

  9. The influence of a eutectic mixture of lidocaine and prilocaine on minor surgical procedures: a randomized controlled double-blind trial.

    LENUS (Irish Health Repository)

    Shaikh, Faisal M

    2012-01-31

    BACKGROUND: A eutectic mixture of lidocaine and prilocaine (EMLA) has been shown to be effective in reducing pain from needle sticks, including those associated with blood sampling and intravenous insertion. OBJECTIVE: To evaluate the effectiveness of EMLA cream applied before needle puncture for local anesthetic administration before minor surgical procedures in this double-blind, randomized, controlled, parallel-group study. MATERIALS AND METHODS: Patients were randomly assigned to receive EMLA or placebo cream (Aqueous) applied under an occlusive dressing. After the procedure, patients were asked to rate the needle prick and procedure pain on a visual analog scale (0=no pain; 10=maximum pain). RESULTS: A total of 94 minor surgical procedures (49 in EMLA and 45 in control) were performed. The mean needle-stick pain score in the EMLA group was significantly lower than in the control group (2.7 vs. 5.7, p<.001, Mann-Whitney U-test). There was also significantly lower procedure pain in the EMLA group than in the control group (0.83 vs. 1.86, p=.009). There were no complications associated with the use of EMLA. CONCLUSION: EMLA effectively reduces the preprocedural needle-stick pain and procedural pain associated with minor surgical procedures.

  10. Computing procedure of spatial geo-referencing of satellite image; Un procedimiento simple de geo-referenciacion de imagenes de satelite

    Energy Technology Data Exchange (ETDEWEB)

    Santos, J.; Vazquez, M.; Fernandes, F.; Prado, T.; Castro, R.

    2004-07-01

    In this paper a computing procedure of spatial geo-referencing is described that, by means of the terrestrial spatial geometry, permits to obtain the Latitude and Longitude that corresponds to a given pixel of a satellite image, the pixel being defined by a pair Line- Pixel. The procedure also permits to compute the other way round. This procedure is more clear and simple than those proposed by Eumetsat and Goes and can be applied to any satellite image. (Author)

  11. Adaptation of lateral pterygoid and anterior digastric muscles after surgical mandibular advancement procedures in different vertical craniofacial types : A magnetic resonance imaging study

    NARCIS (Netherlands)

    Dicker, Gertjan J.; van Spronsen, Peter H.; van Ginkel, Floris C.; Castelijns, Jonas A.; van Schijndel, Ronald A.; Boom, Heleen P. W.; Tuinzing, D. Bram

    Objective. Surgical mandibular advancement procedures induce major adaptations of jaw-closing muscles. In this study, adaptation of antagonist muscles, the lateral pterygoid (LPM) and anterior digastric (DigA) muscles, was evaluated. Study design. Eighteen adult patients with mandibular retrognathia

  12. Adaptation of lateral pterygoid and anterior digastric muscles after surgical mandibular advancement procedures in different vertical craniofacial types : A magnetic resonance imaging study

    NARCIS (Netherlands)

    Dicker, Gertjan J.; van Spronsen, Peter H.; van Ginkel, Floris C.; Castelijns, Jonas A.; van Schijndel, Ronald A.; Boom, Heleen P. W.; Tuinzing, D. Bram

    2008-01-01

    Objective. Surgical mandibular advancement procedures induce major adaptations of jaw-closing muscles. In this study, adaptation of antagonist muscles, the lateral pterygoid (LPM) and anterior digastric (DigA) muscles, was evaluated. Study design. Eighteen adult patients with mandibular retrognathia

  13. Rapid attachment of adipose stromal cells on resorbable polymeric scaffolds facilitates the one-step surgical procedure for cartilage and bone tissue engineering purposes

    NARCIS (Netherlands)

    W.J. Jurgens; R.J. Kroeze; R.A. Bank; M.J.P.F. Ritt; M.N. Helder

    2011-01-01

    The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In

  14. Rapid Attachment of Adipose Stromal Cells on Resorbable Polymeric Scaffolds Facilitates the One-Step Surgical Procedure for Cartilage and Bone Tissue Engineering Purposes

    NARCIS (Netherlands)

    Jurgens, Wouter J.; Kroeze, Robert Jan; Bank, Ruud A.; Ritt, Marco J. P. F.; Helder, Marco N.

    2011-01-01

    The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In

  15. Choice of Surgical Procedure for Patients With Non-Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection

    DEFF Research Database (Denmark)

    Dai, Chenyang; Shen, Jianfei; Ren, Yijiu

    2016-01-01

    PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15,760 patie...

  16. Surgical efficiencies and quality in the performance of voluntary medical male circumcision (VMMC procedures in Kenya, South Africa, Tanzania, and Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Dino Rech

    Full Text Available INTRODUCTION: This analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC, quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider's time with the client (PPTC and total elapsed operating time (TEOT. METHODS: Two serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23-25 minutes and 6-15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized. After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT. CONCLUSIONS: SYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume

  17. CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL Ph DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To investigate the changes of perioperative serum levels of interleukin-6 ( IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation. Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol, pHi and plasma lactate were also measured at the same time points. Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation. CRP was not detectable until the first day after operation. Peak concentration of IL-6 had positive relationship with CRP. These variables changed more significantly in colorectal group than that in orthopaedic group (P < 0. 05). pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group ( P < 0. 05 ).Conclusion IL-6 may reflect tissue damage more sensitively than CRP. Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

  18. Comparison of early outcomes of surgical ablation procedures for atrial fibrillation concomitant to non-mitral cardiac surgery: a Japan Adult Cardiovascular Surgery Database study.

    Science.gov (United States)

    Takai, Hideaki; Miyata, Hiroaki; Motomura, Noboru; Sasaki, Kenichi; Kunihara, Takashi; Takamoto, Shinichi

    2017-05-23

    Although the benefit of surgical ablation for atrial fibrillation (AF) performed concomitant to mitral valve surgery is established, whether that performed concomitant to non-mitral cardiac surgery is beneficial remains unclear. In non-mitral, non-left-atriotomy cardiac surgery, the optimal surgical approach for AF remains to be established. Therefore, using the Japan Adult Cardiovascular Surgery Database (JACVSD), we compared 2 surgical ablation procedures [the maze procedure and pulmonary vein isolation (PVI)] performed concomitant to non-mitral cardiac surgery. Of 3402 JACVSD patients who had undergone elective non-mitral cardiac surgery by 2012, 1797 (53%) had undergone concomitant PVI, and 1339 (39%) had undergone the maze procedure. To compensate for patient heterogeneity, we conducted a propensity score-matched analysis of 1952 patients who had undergone PVI or the maze procedure (976 patients each). Operative procedures took significantly longer in the Maze Group. Although postoperative AF occurred in 34.3% of the PVI Group patients and in 31.9% of the Maze Group patients (p = 0.371), the incidence of first-time pacemaker implantation was significantly lower in the PVI Group (1.9 vs. 4.1%, respectively; p = 0.005). There was no significant difference in other morbidities or in operative mortality. Postoperative hospital and ICU stays tended to be longer in the Maze Group. Our data indicate that surgical ablation of AF concomitant to non-mitral cardiac surgery is beneficial. Furthermore, PVI and the maze procedure appear to be of equal benefit in this context, except that the maze procedure may more frequently result in the need for pacemaker implantation.

  19. IC Treatment: Surgical Procedures

    Science.gov (United States)

    ... IC Epidemiology (RICE) Study Boston Area Community Health (BACH) Survey ICA Pilot Research Program Funding Opportunities Clinical ... IC Epidemiology (RICE) Study Boston Area Community Health (BACH) Survey ICA Pilot Research Program Funding Opportunities Clinical ...

  20. Mastectomy -- The Surgical Procedure

    Science.gov (United States)

    ... your arm and there is some risk of lymphedema. Lymphedema is a condition where fluid collects in the ... management of surgery-related pain . Learn more about lymphedema . Transportation, lodging, child care and elder care assistance ...

  1. IC Treatment: Surgical Procedures

    Science.gov (United States)

    ... Complicated IC Cases Promising IC Diagnostic Tests Wrong Diagnosis IC Treatment Guideline IC Treatments IC Diet & Self Management Physical Therapy Antidepressants Antihistamines Pentosan Polysulfate Sodium Bladder Instillations Immunosuppresants ...

  2. Inhibition of spontaneous induction of lambdoid prophages in Escherichia coli cultures: simple procedures with possible biotechnological applications

    Directory of Open Access Journals (Sweden)

    Wrobel Borys

    2001-04-01

    Full Text Available Abstract Background Infections of bacterial cultures by bacteriophages are serious problems in biotechnological laboratories. Apart from such infections, prophage induction in the host cells may also be dangerous. Escherichia coli is a commonly used host in biotechnological production, and many laboratory strains of this bacterium harbour lambdoid prophages. These prophages may be induced under certain conditions leading to phage lytic development. This is fatal for further cultivations as relatively low, though still significant, numbers of phages may be overlooked. Thus, subsequent cultures of non-lysogenic strains may be infected and destroyed by such phage. Results Here we report that slow growth of bacteria decreases deleterious effects of spontaneous lambdoid prophage induction. Moreover, replacement of glucose with glycerol in a medium stimulates lysogenic development of the phage after infection of E. coli cells. A plasmid was constructed overexpressing the phage 434 cI gene, coding for the repressor of phage promoters which are necessary for lytic development. Overproduction of the cI repressor abolished spontaneous induction of the λimm434 prophage. Conclusions Simple procedures that alleviate problems with spontaneous induction of lambdoid prophage and subsequent infection of E. coli strains by these phages are described. Low bacterial growth rate, replacement of glucose with glycerol in a medium and overproduction of the cI repressor minimise the risk of prophage induction during cultivation of lysogenic bacteria and subsequent infection of other bacterial strains.

  3. A simple mathematical procedure to estimate heat flux in machining using measured surface temperature with infrared laser

    Directory of Open Access Journals (Sweden)

    Hocine Mzad

    2015-09-01

    Full Text Available Several techniques have been developed over time for the measurement of heat and the temperatures generated in various manufacturing processes and tribological applications. Each technique has its own advantages and disadvantages. The appropriate technique for temperature measurement depends on the application under consideration as well as the available tools for measurement. This paper presents a procedure for a simple and accurate determination of the time-varying heat flux at the workpiece–tool interface of three different metals under known cutting conditions. A portable infrared thermometer is used for surface temperature measurements. A spline smoothing interpolation of the surface temperature history enables to determine the local heat flux produced during stock removal. The measured temperature is represented by a third-order spline approximation. Nonetheless, the accuracy of polynomial interpolation depends on how close are the interpolated points; an increase in degree cannot be used to increase the accuracy. Although the data analysis is relatively complicated, the computing time is very small.

  4. A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited

    Directory of Open Access Journals (Sweden)

    James A. Stephenson

    2015-01-01

    Full Text Available Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4–18 mm located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.

  5. Matching Procedures at the Time of Immediate Breast Reconstruction: An American College of Surgeons National Surgical Quality Improvement Program Study of 24,191 Patients.

    Science.gov (United States)

    Cooney, Carisa M; Sebai, Mohamad E; Ogbuagu, Onyebuchi; Devulapalli, Chris; Manahan, Michele A; Rosson, Gedge D

    2016-12-01

    The purpose of this study was to assess for compounded risk of postoperative morbidity with the addition of a simultaneous contralateral breast matching procedure at the time of mastectomy and immediate breast reconstruction. 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program databases were used to identify cases of mastectomy and immediate breast reconstruction with and without simultaneous contralateral breast matching procedures. Matching procedures included mastopexy, reduction mammaplasty, and augmentation mammaplasty. Thirty-day postoperative morbidity was assessed using univariable and multivariable logistic regression. Of 59,766 mastectomy patients, 24,191 (40 percent) underwent immediate breast reconstruction: 903 (3.7 percent) underwent matching procedures and 23,288 (96.3 percent) did not. Univariable logistic regression demonstrated that the matching procedure group had statistically significantly higher overall morbidity (OR, 1.288; 95 percent CI, 1.022 to 1.623; p = 0.032). Although surgical and systemic morbidity did not differ significantly, the matching procedure group demonstrated higher risk for superficial surgical-site infection (OR, 1.57; 95 percent CI, 1.066 to 2.31; p = 0.022), reconstruction failure (OR, 1.69; 95 percent CI, 1.014 to 2.814; p = 0.044), and pulmonary embolism (OR, 2.54; 95 percent CI, 1.01 to 6.37; p = 0.048). Controlling for possible confounders, multivariable logistic regression rendered the relationship between matching procedure and complications insignificant (OR, 1.17; 95 percent CI, 0.92 to 1.48; p = 0.2). These data suggest that preoperative comorbidities and other patient-related factors may have a larger influence on postoperative morbidity than the addition of a contralateral matching procedure alone. Therapeutic, III.

  6. 负压吸引在低位肛周脓肿根治术后引流效果的临床观察%Negative pressure drainage in patients underwent primary radical surgical procedure for low perianal abscess

    Institute of Scientific and Technical Information of China (English)

    岳中文; 张建余

    2011-01-01

    目的 探讨负压吸引装置在低位肛周脓肿根治术后的应用效果.方法 将60例低位肛周脓肿患者随机分为两组,治疗组30例,采用负压吸引装置引流;对照组30例,采用生理盐水纱条引流,就一次治愈率、愈合时间及住院天数进行对比分析.结果 肛周脓肿根治术后应用负压吸引装置提高了愈合率,加快切口愈合,缩短住院时间.结论 负压吸引装置操作简便,安全可靠,是低位肛周脓肿根治术后引流有效的方法之一.%Objective To evaluate the effect of negative pressure drainage in patients underwent primary radical surgical procedure for low perianal abscess. Methods Sixty patients with low perianal abscess were divided randomly into the treatment group (30 cases) and the control group (30 cases). After primary radical surgical procedure, the treatment group was treated by negative pressure drainage, and the control group drained by normal saline gauze. Results The treatment group had a higher cure rate, shorter wound healing time and hospital stay than those of the control group. Conclusion Negative pressure drainage is a simple, safe and effective method for low perianal abscess after primary radical surgical procedure.

  7. A retrospective analysis of patients referred for implant placement to a specialty clinic: indications, surgical procedures, and early failures.

    Science.gov (United States)

    Bornstein, Michael M; Halbritter, Sandro; Harnisch, Hendrik; Weber, Hans-Peter; Buser, Daniel

    2008-01-01

    This retrospective study analyzed the pool of patients referred for treatment with dental implants over a 3-year period in a referral specialty clinic. All patients receiving dental implants between 2002 and 2004 in the Department of Oral Surgery and Stomatology, University of Bern, were included in this retrospective study. Patients were analyzed according to age, gender, indications for implant therapy, location of implants, and type and length of implants placed. A cumulative logistic regression analysis was performed to identify and analyze potential risk factors for complications or failures. A total of 1,206 patients received 1,817 dental implants. The group comprised 573 men and 633 women with a mean age of 55.2 years. Almost 60% of patients were age 50 or older. The most frequent indication for implant therapy was single-tooth replacement in the maxilla (522 implants or 28.7%). A total of 726 implants (40%) were inserted in the esthetically demanding region of the anterior maxilla. For 939 implants (51.7%), additional bone-augmentation procedures were required. Of these, ridge augmentation with guided bone regeneration was performed more frequently than sinus grafting. Thirteen complications leading to early failures were recorded, resulting in an early failure rate of 0.7%. The regression analysis failed to identify statistically significant failure etiologies for the variables assessed. From this study it can be concluded that patients referred to a specialty clinic for implant placement were more likely to be partially edentulous and over 50 years old. Single-tooth replacement was the most frequent indication (> 50%). Similarly, additional bone augmentation was indicated in more than 50% of cases. Adhering to strict patient selection criteria and a standardized surgical protocol, an early failure rate of 0.7% was experienced in this study population.

  8. Matching bacteriological and medico-administrative databases is efficient for a computer-enhanced surveillance of surgical site infections: retrospective analysis of 4,400 surgical procedures in a French university hospital.

    Science.gov (United States)

    Leclère, Brice; Lasserre, Camille; Bourigault, Céline; Juvin, Marie-Emmanuelle; Chaillet, Marie-Pierre; Mauduit, Nicolas; Caillon, Jocelyne; Hanf, Matthieu; Lepelletier, Didier

    2014-11-01

    Our goal was to estimate the performance statistics of an electronic surveillance system for surgical site infections (SSIs), generally applicable in French hospitals. Three detection algorithms using 2 different data sources were tested retrospectively on 9 types of surgical procedures performed between January 2010 and December 2011 in the University Hospital of Nantes. The first algorithm was based on administrative codes, the second was based on bacteriological data, and the third used both data sources. For each algorithm, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. The reference method was the hospital's routine surveillance: a comprehensive review of the computerized medical charts of the patients who underwent one of the targeted procedures during the study period. A 3,000-bed teaching hospital in western France. We analyzed 4,400 targeted surgical procedures. Sensitivity results varied significantly between the three algorithms, from 25% (95% confidence interval, 17-33) when using only administrative codes to 87% (80%-93%) with the bacteriological data and 90% (85%-96%) with the combined algorithm. Fewer variations were observed for specificity (91%-98%), PPV (21%-25%), and NPV (98% to nearly 100%). Overall, performance statistics were higher for deep SSIs than for superficial infections. A reliable computer-enhanced SSI surveillance can easily be implemented in French hospitals using common data sources. This should allow infection control professionals to spend more time on prevention and education duties. However, a multicenter study should be conducted to assess the generalizability of this method.

  9. Predicting the risk of death following coronary artery bypass graft made simple: a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database.

    Science.gov (United States)

    Chung, Paul J; Carter, Timothy I; Burack, Joshua H; Tam, Sophia; Alfonso, Antonio; Sugiyama, Gainosuke

    2015-04-29

    Risk models to predict 30-day mortality following isolated coronary artery bypass graft is an active area of research. Simple risk predictors are particularly important for cardiothoracic surgeons who are coming under increased scrutiny since these physicians typically care for higher risk patients and thus expect worse outcomes. The objective of this study was to develop a 30-day postoperative mortality risk model for patients undergoing CABG using the American College of Surgeons National Surgical Quality Improvement Program database. Data was extracted and analyzed from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files (2005-2010). Patients that had ischemic heart disease (ICD9 410-414) undergoing one to four vessel CABG (CPT 33533-33536) were selected. To select for acquired heart disease, only patients age 40 and older were included. Multivariate logistic regression analysis was used to create a risk model. The C-statistic and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model. Bootstrap-validated C-statistic was calculated. A total of 2254 cases met selection criteria. Forty-nine patients (2.2%) died within 30 days. Six independent risk factors predictive of short-term mortality were identified including age, preoperative sodium, preoperative blood urea nitrogen, previous percutaneous coronary intervention, dyspnea at rest, and history of prior myocardial infarction. The C-statistic for this model was 0.773 while the bootstrap-validated C-statistic was 0.750. The Hosmer-Lemeshow test had a p-value of 0.675, suggesting the model does not overfit the data. The American College of Surgeons National Surgical Quality Improvement Program risk model has good discrimination for 30-day mortality following coronary artery bypass graft surgery. The model employs six independent variables, making it easy to use in the clinical setting.

  10. Adaptation of jaw closing muscles after surgical mandibular advancement procedures in different vertical craniofacial types : a magnetic resonance imaging study

    NARCIS (Netherlands)

    Dicker, Gertjan; Van Spronsen, Peter; Van Schijndel, Ronald; van Ginkel, Floris; Manoliu, Radu; Boom, Heleen; Tuinzing, D. Bram

    2007-01-01

    Objective. Surgical mandibular advancement influences the biomechanics of the mandible and as a result may provoke relapse. In this study, the adaptation of the masseter (MAS) and medial pterygoid muscles (MPM) after surgical mandibular advancement was evaluated. Study design. Of 12 patients with ma

  11. Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.

    Science.gov (United States)

    Olsen, Margaret A; Tian, Fang; Wallace, Anna E; Nickel, Katelin B; Warren, David K; Fraser, Victoria J; Selvam, Nandini; Hamilton, Barton H

    2017-02-01

    To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.

  12. A simple standard technique for labyrinthectomy in the rat: A methodical communication with a detailed description of the surgical process.

    Science.gov (United States)

    Nádasy, G L; Raffai, G; Fehér, E; Schaming, G; Monos, E

    2016-09-01

    Aims Labyrinthectomized rats are suitable models to test consequences of vestibular lesion and are widely used to study neural plasticity. We describe a combined microsurgical-chemical technique that can be routinely performed with minimum damage. Methods Caudal leaflet of the parotis is elevated. The tendinous fascia covering the bulla is opened frontally from the sternomastoid muscle's tendon while sparing facial nerve branches. A 4 mm diameter hole is drilled into the bulla's hind lower lateral wall to open the common (in rodents) mastoid-tympanic cavity. The cochlear crista (promontory) at the lower posterior part of its medial wall is identified as a bony prominence. A 1 mm diameter hole is drilled into its lower part. The perilymphatic/endolymphatic fluids with tissue debris of the Corti organ are suctioned. Ethanol is injected into the hole. Finally, 10 µL of sodium arsenite solution (50 µM/mL) is pumped into the labyrinth and left in place for 15 min. Simple closure in two layers (fascia and skin) is sufficient. Results and conclusion All rats had neurological symptoms specific for labyrinthectomy (muscle tone, body position, rotatory movements, nystagmus, central deafness). Otherwise, their behavior was unaffected, drinking and eating normally. After a few days, they learned to balance relying on visual and somatic stimuli (neuroplasticity).

  13. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth

    Directory of Open Access Journals (Sweden)

    Sembronio Salvatore

    2006-11-01

    Full Text Available Abstract There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth.

  14. [Esthetic and social indications for the "redressement forcé" technic and the hazards of this surgical procedure].

    Science.gov (United States)

    Roykó, A; Razouk, G; Dénes, J

    1995-11-01

    The authors report on-, and evaluate the type of operation known as "redressement force" for the correction of retained upper canines. The risk of the surgical intervention is extremely high, but there are good reasons for the indications, too.

  15. Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Maarouf A Hoteit; Amaar H Ghazale; Andrew J Bain; Eli S Rosenberg; Kirk A Easley; Frank A Anania; Robin E Rutherford

    2008-01-01

    AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 ± 3.9 vs 12.6 ± 4.7, P = 0.9) or in the mean CTP (7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP: 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3).CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

  16. A COMPARATIVE STUDY OF 2 AGENTS, AIR AND DISTILLED WATER FOR INFLATION OF THE CUFFS OF ENDOTRACHEAL TUBES DURING LAPAROSCOPIC SURGICAL PROCEDURES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Sistla Gopala Krishna

    2016-03-01

    Full Text Available BACKGROUND & AIM During Nitrous Oxide+ Oxygen anaesthesia and during laparoscopic surgeries using carbon dioxide for creating pneumoperitoneum, if cuff of endotracheal tube is inflated with air, cuff pressure can rise to dangerous limits and it can produce ischemia of tracheal mucosa. Hence distilled water as an alternative agent to air for inflation of cuffs of endotracheal tubes was used for our study. Our aim is to investigate the difference in increase of intra-cuff pressure with time during laparoscopic surgical procedures under general endotracheal anaesthesia with Nitrous oxide+ Oxygen+ relaxant technique when cuffs of endotracheal tube were inflated by air & distilled water. METHODS Fifty patients (n=50 undergoing different laparoscopic surgical procedures under general endotracheal anaesthesia were randomly divided into 2 groups. In group A, air was used & in group D, distilled water was used to inflate the cuffs of endotracheal tubes. General anaesthesia was given with Nitrous oxide+ Oxygen+ relaxant technique. The intra-cuff pressures of endotracheal tube cuffs were recorded in the beginning and at the end of laparoscopic surgical procedures. Increase of pressures with time were recorded and analysed. RESULTS In group in whom we inflated the cuffs with air, there was a significant increase in intra-cuff pressures with time and there was definite diffusion of gases into the cuffs. Increase of pressure with time was statistically highly significant (P=0.00001. But in group in whom we used distilled water to inflate the cuffs, there was no change in the volume of water used for inflation and water came out of cuffs at the end of the laparoscopic surgical procedures. No additional air could be aspirated from the cuffs at the end of laparoscopic surgeries in distilled water group, indicating that there was no diffusion of gases into the cuffs or the gases diffused got dissolved in distilled water. Hence there was no increase of volume

  17. How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby.

    Science.gov (United States)

    Brueren, B R; Mast, E G; Suttorp, M J; Ernst, J M; Bal, E T; Plokker, H W

    1999-03-01

    The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest-risk category complications can occur.

  18. Update on bariatric surgical procedures and an introduction to the implantable weight loss device: the Maestro Rechargeable System

    Directory of Open Access Journals (Sweden)

    Hwang SS

    2016-08-01

    Full Text Available Stephanie S Hwang,1 Mark C Takata,1 Ken Fujioka,2 William Fuller1 1Division of General/Bariatric Surgery, Scripps Clinic Weight Management, 2Division of Diabetes and Endocrinology, Scripps Clinic, La Jolla, CA, USA Abstract: There are many different methods of treating obesity, ranging from various medical options to several surgical therapies. This paper briefly summarizes current surgical options for weight loss with a focus on one of the newest US Food and Drug Administration-approved devices for surgical weight loss therapy, the Maestro Rechargeable System. Also known as the vagal blocking for obesity control implantable device, this tool blocks vagal nerve activity to induce weight loss. Keywords: VBLOC device, vagal, vagus, obesity

  19. A simple, flexible and efficient PCR-fusion/Gateway cloning procedure for gene fusion, site-directed mutagenesis, short sequence insertion and domain deletions and swaps

    Directory of Open Access Journals (Sweden)

    Etchells J Peter

    2009-10-01

    Full Text Available Abstract Background The progress and completion of various plant genome sequencing projects has paved the way for diverse functional genomic studies that involve cloning, modification and subsequent expression of target genes. This requires flexible and efficient procedures for generating binary vectors containing: gene fusions, variants from site-directed mutagenesis, addition of protein tags together with domain swaps and deletions. Furthermore, efficient cloning procedures, ideally high throughput, are essential for pyramiding of multiple gene constructs. Results Here, we present a simple, flexible and efficient PCR-fusion/Gateway cloning procedure for construction of binary vectors for a range of gene fusions or variants with single or multiple nucleotide substitutions, short sequence insertions, domain deletions and swaps. Results from selected applications of the procedure which include ORF fusion, introduction of Cys>Ser mutations, insertion of StrepII tag sequence and domain swaps for Arabidopsis secondary cell wall AtCesA genes are demonstrated. Conclusion The PCR-fusion/Gateway cloning procedure described provides an elegant, simple and efficient solution for a wide range of diverse and complicated cloning tasks. Through streamlined cloning of sets of gene fusions and modification variants into binary vectors for systematic functional studies of gene families, our method allows for efficient utilization of the growing sequence and expression data.

  20. Immediate prostheses on one-piece trans-mucosal implants in flapless surgical procedures Case Series Report. Part I: full arch rehabilitations

    Directory of Open Access Journals (Sweden)

    Aris Petros Tripodakis

    2012-06-01

    Full Text Available Aim: The aim of the present case series report is to illustrate a clinical technique and present the application of onepiece transmucosal implants in flapless surgical procedures, supporting full arch immediate prostheses. Materials and methods: A total of 294 implants (Xive TG, Friadent, Germany have been used to support full arch immediate prostheses, over the last six years and have been in function for at least one year. The surgical placement of five or more implants per case involved immediate extraction and intrasocket flapless placement, combined with minimal flap elevation in the areas of healed extraction sites (43 mandibular and 7 maxillary arches. In all cases immediate provisionalization followed. Detailed three-dimensional cone-beam localized volumetric tomography preceeded the surgical procedures. The delivery of the final ceramo-metal prostheses was accomplished within a 20 day period. Materials and methods: Results Six implants failed to osseointegrate. All other implants are still successfully bearing the final prosthesis for the time that they have been followed. Soft tissue reaction was favorable from both the biologic and esthetic point of view. Conclusion: The flapless placement of one piece implants into edentulous healed sites is a predictable procedure in the presence of abundance of supporting bone as confirmed by 3-D imaging. On the other hand, immediate extraction placement of one piece implants allows the engagement of sound bone located deeper into the socket and provides adequate mechanical support of the soft tissue architecture that is preserved predictably. In all cases the prosthetic procedures are accomplished without disturbing the hardsoft tissue interface as the abutment-prosthesis interface is coronally elevated by the virtual design of the implant.

  1. A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures.

    Science.gov (United States)

    Kampf, G; Ostermeyer, C

    2009-11-01

    We studied the effect of a 1-min hand wash on the bacterial hand flora in two consecutive surgical hand disinfection procedures. A propanol-based hand rub (PBHR; Sterillium) and n-propanol (60%, v/v) were tested in a Latin-square design according to EN 12791 in four variations. The reference alcohol was always applied for 3 min after a 1-min hand wash (variation 1). The PBHR was applied for 1.5 min (first application) or 0.5 min (second application). Variation 2 included a 1-min hand wash before both applications, variation 3 included the hand wash before application 1, in variation 4 hands were not washed at all before application. Pre- and post-values were obtained according to EN 12791. The reference disinfection reduced bacteria by 2.99 log(10) (immediate efficacy) and 2.22 log(10) after 3 h. The second reference disinfection reduced bacteria by 0.95 log(10) (immediate efficacy) and 0.68 log(10) after 3 h. The PBHR always yielded an equivalent reduction with and without a preceding hand wash (p > 0.05; Friedman test). A 1-min hand wash before application of the PBHR did not significantly change its efficacy for surgical hand disinfection in two consecutive surgical procedures of 3 h.

  2. Looking at plastic surgery through Google Glass: part 1. Systematic review of Google Glass evidence and the first plastic surgical procedures.

    Science.gov (United States)

    Davis, Christopher R; Rosenfield, Lorne K

    2015-03-01

    Google Glass has the potential to become a ubiquitous and translational technological tool within clinical plastic surgery. Google Glass allows clinicians to remotely view patient notes, laboratory results, and imaging; training can be augmented via streamed expert master classes; and patient safety can be improved by remote advice from a senior colleague. This systematic review identified and appraised every Google Glass publication relevant to plastic surgery and describes the first plastic surgical procedures recorded using Google Glass. A systematic review was performed using PubMed National Center for Biotechnology Information, Ovid MEDLINE, and the Cochrane Central Register of Controlled Trials, following modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key search terms "Google" and "Glass" identified mutually inclusive publications that were screened for inclusion. Eighty-two publications were identified, with 21 included for review. Google Glass publications were formal articles (n = 3), editorial/commentary articles (n = 7), conference proceedings (n = 1), news reports (n = 3), and online articles (n = 7). Data support Google Glass' positive impact on health care delivery, clinical training, medical documentation, and patient safety. Concerns exist regarding patient confidentiality, technical issues, and limited software. The first plastic surgical procedure performed using Google Glass was a blepharoplasty on October 29, 2013. Google Glass is an exciting translational technology with the potential to positively impact health care delivery, medical documentation, surgical training, and patient safety. Further high-quality scientific research is required to formally appraise Google Glass in the clinical setting.

  3. Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

    Directory of Open Access Journals (Sweden)

    Kyoichi Deie

    2016-01-01

    Full Text Available We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

  4. The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.

    Science.gov (United States)

    Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph

    2010-06-01

    This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible.

  5. 新生儿单纯颅骨凹陷骨折的非手术治疗%Non-surgical therapy on skull simple depressed fractures in neonate

    Institute of Scientific and Technical Information of China (English)

    余雷; 余腾; 胡家高

    2012-01-01

    目的 探讨非手术方式治疗新生儿单纯颅骨凹陷性骨折的可行性.同时结合文献复习,期望为新生儿颅骨凹陷骨折提供一个合理的治疗方案.方法 回顾分析1997年8月至2012年2月非手术治疗的11例新生儿单纯颅骨凹陷性骨折的临床转归.全部病例均是出生后即发现颅骨凹陷.入院年龄为出生后9h~17d,凹陷深度0.3~1.0 cm,其中6例凹陷深度>0.5 cm.合并颅内出血4例,有神经系统症状1例.10例采取观察,待其自然恢复;1例采取产科负压吸引器抽吸颅骨凹陷.结果 10例观察患儿颅骨凹陷在1~7个月后恢复,没有后遗神经系统并发症;1例颅骨凹陷使用产科负压吸引器抽吸后,颅骨凹陷立即恢复.复查脑CT,原有颅内出血灶无增大,颅内颅外也未见新出血灶及病变.结论 非手术疗法可成为新生儿单纯颅骨凹陷性骨折之选择;在不增加危险的情况下,负压抽吸术是一种快速解决更大而深骨折凹陷的选择,还可以减轻患儿家属的焦虑情绪.%Objective The purpose of this study is to offer a rational principle for neonate suffering from skull simple depressed fractures through the investigation of non-surgical therapy and relevant references review.Methods Between August 1997 and February 2012,total 11 neonates underwent non-surgical treatment in our department and better efficacy was found in them.Their clinical data was reviewed and analyzed.All of them were diagnosed as skull depressed fractures in post-born and admitted once definite diagnosis.The depressed depth ranged from 0.3 cm to 1.0 cm in depth and 6 of them were more than 0.5 cm.4 cases were found to be complicated with intracranial hemorrhage,only 1 case presented nervous symptoms.10 cases underwent the conservative therapy and vacuum extraction was performed in 1 case.Results Spontaneous restoration was observed in 10 patients within a period ranging from 1 to 7 months and no neurological deficits was

  6. Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain.

    Science.gov (United States)

    Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer

    2008-01-01

    The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97

  7. Surgical Navigation

    DEFF Research Database (Denmark)

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

    2017-01-01

    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  8. The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure.

    Science.gov (United States)

    Stornelli, Nicole; Wydra, Frank B; Mitchell, Justin J; Stahel, Philip F; Fabbri, Stefka

    2016-01-01

    Lower extremity acute compartment syndrome after gynecologic surgery in the lithotomy position is a rare, yet potentially devastating complication. A high level of suspicion is paramount for early recognition and mitigation of acute compartment syndrome originating from prolonged surgery in lithotomy position. A 23-year-old female, gravida 1, para 0, underwent a laparoscopic salpingectomy for a ruptured ectopic pregnancy. Surgical time was 90 min. Postoperatively, the patient developed acute compartment syndrome of both legs necessitating emergent bilateral four-compartment fasciotomies, with repeated returns to the operating room for 2nd look procedures and delayed wound closures. The patient regained full function within 3 months and returned to an unrestricted baseline activity level. Technical diligence in applying a lithotomy position is paramount for preventing postoperative lower extremity compartment syndrome. A high level of suspicion for this severe complication in conjunction with early recognition and immediate surgical management can mitigate long-term adverse sequelae and improve postoperative outcomes.

  9. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2012-05-01

    Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

  10. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    Science.gov (United States)

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (pTrends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (pTrends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (pmodels estimate that each hospital admission translates to 0.27 procedures, per 100 000 (95% CI 0.25 to 0.30, r 0.99, ptrends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  11. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

    Science.gov (United States)

    Lei, Jianyong; Zhu, Jinqiang; Li, Zhihui; Gong, Rixiang; Wei, Tao

    2016-01-01

    Objective We sought to evaluate and compare the outcomes of different surgical protocols for papillary thyroid cancer (PTC) located in the isthmus in a retrospective intention-to-treat analysis. Patients and methods The data of 3,068 patients who received thyroidectomy due to thyroid cancer in our center were reviewed. Of these, 103 patients had a dominant carcinoma located in the isthmus. Various baseline and tumor characteristics and surgical outcomes were evaluated and compared with respect to the different surgical protocols (85 cases with total thyroidectomy and 18 cases with less-than-total thyroidectomy). Univariate and multivariate analyses were performed to identify resected patients who developed recurrence with isthmic PTC. Results The postoperative complication rates were comparable between the two groups (17.6% versus 11.1%, P=0.500). Although the total thyroidectomy group showed a much higher rate (P=0.004) and number (P0.05). Tumor recurrence was observed in five patients, including two patients in the total thyroidectomy group and three patients in the less-than-total thyroidectomy group; the tumor recurrence rate in the total thyroidectomy group was significantly lower than that in the less-than-total thyroidectomy group (P=0.040). Univariate and multivariate analyses indicated less-than-total thyroidectomy as a risk factor for tumor recurrence in PTC cases with tumors located at the isthmus (hazard ratio: 1.870, 95% confidence interval: 1.320–2.218, P<0.001). Conclusion Our findings indicate that total thyroidectomy is an appropriate initial surgical protocol for isthmic PTC due to the lower recurrence rate, comparable postoperative complication rate, and parathyroid function recovery. PMID:27578987

  12. Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study.

    Directory of Open Access Journals (Sweden)

    Jian-Xian Lin

    Full Text Available BACKGROUND: Laparoscopic gastrectomy (LG for gastric cancer has increased in popularity due to advances in surgical techniques. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy (OG. METHODS: The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy (2,041 patients or open gastrectomy (1,539 patents between January 2005 and October 2013. The surgical outcomes were compared between the two groups. RESULTS: Laparoscopic gastrectomy was associated with significantly less blood loss, transfused patient number, time to ground activities, and post-operative hospital stay, but with similar operation time, time to first flatus, and time to resumption of diet, compared with the open gastrectomy. No significant difference in the number of lymph nodes dissected was observed between these two groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (13.6% vs. 14.4%, P = 0.526, and 0.3% vs. 0.2%, P = 0.740. The 3-year disease-free and overall survival rates between the two groups were statistically significant (P<0.05. According to the UICC TNM classification of gastric cancer, the 3-year disease-free and overall survival rates were not statistically different at each stage. CONCLUSIONS: Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes. This result was also true of local advanced gastric cancer (AGC. A well-designed randomized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out.

  13. A Simple Procedure for the Synthesis of [32P]Phosphoenol Pyruvate via the Pyruvate Kinase Exchange Reaction at Equilibrium

    NARCIS (Netherlands)

    Roossien, F.F.; Brink, J.; Robillard, G.T.

    1983-01-01

    A one step procedure is presented for the preparation of [32P]phosphoenolpyruvate from [γ-32P]ATP using pyruvate kinase. The reaction is carried out at chemical equilibrium and involves only an exchange of isotope between ATP and phosphoenolpyruvate. The initial phosphoenolpyruvate/ATP ratio in the

  14. Usefulness of Infrared Thermal Imaging Camera for Screening of Postoperative Surgical Site Infection after the Nuss Procedure

    Directory of Open Access Journals (Sweden)

    Kenya Fujita

    2013-01-01

    Full Text Available Introduction and Objective. The Nuss procedure is widely used in the treatment of pectus excavatum worldwide. Postoperative pectus bar infection is one of the most serious complications associated with this procedure. Therefore, early detection of signs of implant infection is very important. However, this is difficult, and effective methods have yet to be established. Methods. We use a handheld infrared thermal imaging camera to screen patients for postoperative infection following the Nuss procedure. Here, we report a 28-year-old man with recurrent postoperative (Ravitch procedure pectus excavatum. Results. Infrared thermography camera clearly indicated slight cellulitis in the right chest. Conclusion. Our technique may assist in preventing postoperative bar infection and removal caused by severe bar infection. Furthermore, this camera is potentially suitable for many situations in infection monitoring following subcutaneous implant surgery.

  15. Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: case report

    Directory of Open Access Journals (Sweden)

    Paolo Capozzi

    2014-09-01

    Full Text Available Purpose. To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK. Methods. We report the case of a 17 years old patient with a history of congenital glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK, a two step procedure was performed. At first the patient underwent a combined HLA matched limbal stem cells allograft (LAT and AMT and then, 10 months later, a new PK. Results. During 12 months of follow-up, the corneal graft remained stable and smooth, with no sign of graft rejection. Conclusions. In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival.

  16. A simple metal staining procedure for identification and visualization of single cells by LA-ICP-MS.

    Science.gov (United States)

    Herrmann, A J; Techritz, S; Jakubowski, N; Haase, A; Luch, A; Panne, U; Mueller, L

    2017-05-21

    High lateral resolution of metal detection in single cells by use of laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) demands powerful staining methods. In this work different staining procedures for the single cell analysis with LA-ICP-MS were optimized. An iridium intercalator was utilized to stain the cell nuclei whereas the whole cell was stained by the use of maleimido-mono-amide-DOTA (mDOTA) complexing lanthanide(iii) ions. The content of the artificially introduced metals per cell was quantified using a matrix matched calibration approach based on cellulose membranes onto which standards were spotted by a microarray spotter. Absolute metal stain amounts in the range of 2.34 to 9.81 femtomole per cell were determined. The metal staining procedures allow direct identification and visualization of single cells and their cell compartments by element microscopy without the use of bright field images of the sample.

  17. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm 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 ...

  18. [Surgical-orthodontic correction of unerupted upper canine teeth and motivation for the procedure from the patient's viewpoint].

    Science.gov (United States)

    Razouk, G; Roykó, A; Dénes, J

    1995-10-01

    The surgical correction of the retention of upper canines is made easier by the direct bonding method, furthermore it increases the chances of successful treatment. At the same time at teen-age the treatment is usually missing, since the persistent milk-teeth in the place of impacted canines are ensuring the aesthetic effect. The late treatment is motivated by aesthetic aspects also by loosing the milk-canines. Thus the indication of the treatment is a cure only from the orthodontist's aspect, from the patient's view it's only the aesthetics.

  19. COMPARISON OF GLYCEMIC EFFECT OF ADRENALIN CONTAINING LOCAL ANESTHETIC IN DIABETIC AND NON-DIABETIC PATIENTS UNDERGOING MINOR ORAL SURGICAL PROCEDURE

    Directory of Open Access Journals (Sweden)

    Pradeep

    2015-12-01

    Full Text Available AIM To compare the changes in blood glucose level associated with administration of adrenaline containing local anesthetic in diabetic and non-diabetic patients undergoing minor oral surgical procedures. METHODS AND MATERIAL The study included 150 well controlled diabetic patients and 150 non-diabetic healthy patients in age group of 40-60 years who underwent minor oral surgical procedures (trans alveolar extractions, alveoplasty and flap surgeries. Patients in both the group were administered 1.8ml of local anesthetic agent containing 1:100,000 adrenaline for inferior alveolar nerve block and 0.2 ml of anesthetic agent for long buccal nerve block. Blood glucose levels were assessed and compared during pre-operative and one hour post-operative period. STATISTICAL ANALYSIS The comparison of the random blood sugar levels preop and postop in both the groups were compared using paired t test and RBS levels between two groups were analysed using unpaired t test. P value less than 0.05 was considered statistically significant. RESULTS No statistically significant change in post-operative blood glucose level was noted between the diabetic and non-diabetic patients. CONCLUSION The study concluded that it is safe to administer local anesthetic containing 1:100,000 adrenaline in smaller volumes to well controlled diabetic patients.

  20. Simple decomposition procedure for determination of selenium in whole blood, serum and urine by hydride generation atomic absorption spectroscopy.

    Science.gov (United States)

    Tiran, B; Tiran, A; Rossipal, E; Lorenz, O

    1993-12-01

    A digestion procedure for selenium determination by hydride generation atomic absorption spectroscopy (AAS) in whole blood, serum and urine is described, it employs sulfuric acid, hydrogen peroxide and vanadium (V) sulfuric acid reagent solution. The method is rapid, uses no explosive reagents and can be performed at a constant temperature of 100 degrees C. Therefore, it is easily applicable in a routine clinical laboratory for a large amount of samples. The coefficient of intra-assay variation was 4.3-5.6%, the coefficient for inter-assay variation was 5-5.9% in the medium and high concentration range, and 5.8-8.6% in the low range. In analyzing several commercial reference materials our results showed good agreement with the target values. Analytical recovery by addition of sodium selenite and seleno-DL-methionine to samples ranged between 97 and 104%. The correlation between the described digestion procedure and the nitric, sulfuric and perchloric acid digestion procedure recommended by the International Union of Pure and Applied Chemistry showed good agreement for whole blood, serum and for urine. We determined selenium in serum (n = 58) and whole blood (n = 50) in a collective of healthy children from 1 to 5 years living in Styria, Austria. The low values in serum (35 +/- 11 micrograms/L) and whole blood (42 +/- 6 micrograms/L) at one year of life increased significantly to 48 +/- 13 mu/L (p = 0.033) and 55 +/- 6 micrograms/L (p = 0.004) at three years of life in serum and whole blood, respectively. The selenium concentration showed no further increase up to five years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift procedure

    NARCIS (Netherlands)

    Bartelink, L.R.; Feitz, W.F.J.; Kluivers, K.B.; Withagen, M.I.J.; Vierhout, M.E.

    2011-01-01

    The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift procedure for the repair of severe uterine prolapse

  2. Micro-surgical endodontics.

    Science.gov (United States)

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

    2014-02-01

    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.

  3. Modified Sauve-Kapandji procedure for disorders of the distal radioulnar joint in patients with rheumatoid arthritis. Surgical technique.

    Science.gov (United States)

    Fujita, Satoru; Masada, Kazuhiro; Takeuchi, Eiji; Yasuda, Masataka; Komatsubara, Yoshio; Hashimoto, Hideo

    2006-03-01

    The Sauvé-Kapandji procedure has become popular for the treatment of disorders of the distal radioulnar joint in patients with rheumatoid arthritis, but this procedure is impossible to perform in patients with poor bone quality in the distal part of the ulna. We have modified the procedure for patients with poor bone quality in the distal part of the ulna. The modified procedure involves resecting the distal part of the ulna, making a drill-hole in the ulnar cortex of the distal part of the radius, rotating the resected portion of the ulna 90 degrees, inserting it into the distal part of the radius, and fixing it at that site with use of an AO cancellous-bone screw. In the present report, we describe the new operative technique and report the results after a minimum duration of follow-up of three years. This operation was performed in fifty-six patients (sixty-six wrists) with rheumatoid arthritis. The mean age at the time of the operation was 59.3 years. The mean duration of follow-up was forty-eight months. Patients were evaluated in terms of wrist pain, grip strength, and range of motion. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. Osseous union was achieved in all cases. Wrist pain resolved or decreased in all patients. The mean total range of forearm rotation increased from 144 degrees preoperatively to 167 degrees at the time of the most recent follow-up (p Kapandji procedure results in rigid fixation of the grafted bone. The technique provides sufficient osseous support of the carpus even in patients with rheumatoid arthritis and poor bone quality in the distal part of the ulna.

  4. Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

    2016-09-01

    OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.029). CONCLUSIONS This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery

  5. Surgical treatment of perforated gastric ulcer

    Directory of Open Access Journals (Sweden)

    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  6. Acellular dermal allograft for vestibuloplasty--an alternative to autogenous soft tissue grafts in preprosthetic surgical procedures: a clinical report.

    Science.gov (United States)

    Bhola, Monish; Newell, Donald H; Hancock, Everett B

    2003-06-01

    Various vestibular extension procedures have been described in the literature over the past 6 decades, including the use of free gingival grafts. An acellular dermal allograft has been used as a substitute for autogenous soft tissue grafts in root coverage procedures. This clinical report describes the use of such an allograft as a substitute for palatal donor tissue in the vestibular extension of an edentulous maxillary arch with multiple frenum attachments before fabrication of a complete denture. In this patient, healing was uneventful, and 6-month clinical observations demonstrated an apical positioning of the mucogingival junction with an increase in vestibular depth, and the absence of multiple frenae. The acellular dermal allograft appears to be a useful substitute for autogenous palatal grafts in preprosthetic surgery. This approach has many advantages over the free gingival graft, including no donor site morbidity, unlimited availability, and better color match.

  7. Thyromental Height Test for Prediction of Difficult Laryngoscopy in Patients Undergoing Coronary Artery Bypass Graft Surgical Procedure

    OpenAIRE

    Nilesh Jain; Sucharita Das; Muralidhar Kanchi

    2017-01-01

    Background: Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observ...

  8. An evaluation of a periodontal plastic surgical procedure for the reconstruction of interdental papillae in maxillary anterior region: A clinical study

    Directory of Open Access Journals (Sweden)

    Madhuri Lokhande Sawai

    2012-01-01

    Full Text Available Background: In today′s world, people are very much aware about their looks and personality. They are getting more concerned about the esthetics and thus are not ready to compromise the appearance of black holes, especially in the anterior region of the mouth. Various techniques like orthodontic correction, prosthetic veneers and various periodontal surgical methods have been used to cover these unaesthetic open embrasures. In the present study, a variant technique given by Beagle in 1992 was used to cover these open gingival embrasures. The technique uses a gingival flap from the labial aspect to close the open gingival embrasures thus solving the problem of black holes. Aims and Objectives: This clinical study was aimed to reconstruct the lost or blunted interdental papillae with gingival tissue for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetics. Materials and Methods: The patients selected were those who were having a complaint of at least one black hole in the maxillary anterior region with grade ′0′ or ′1′ type of contour of interdental tissues. A total of 39 open embrasures were surgically closed using this technique. Various indices were taken pre-surgically and then again post surgically. Results: Plaque index and gingival index showed an initial increase in the scores at the end of 1 week. Later, there was a gradual fall till the end of the study. Bleeding index significantly increased at the end of 12 weeks ( P<0.001 but reduced to insignificant levels at the end of 24 weeks ( P<0.09. The sulcus depth increased by about 1.19 mm. There was improvement in the contour of interdental tissues in 51% of cases and in 38.46% the interdental papillae completely obliterated the open embrasures. Conclusion: The surgical technique used here for reconstruction of interdental papilla was fairly successful. However, use of bone grafts or

  9. Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures.

    Science.gov (United States)

    Gaia, Diego Felipe; Braz, Ademir Massarico; Simonato, Matheus; Dvir, Danny; Breda, João Roberto; Ribeiro, Gustavo Calado; Ferreira, Carolina Baeta; Souza, José Augusto Marcondes; Buffolo, Enio; Palma, José Honório

    2017-04-01

    Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 ± 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%; 64.8%; P  = 0.3). The mitral gradient showed a significant reduction (11 mmHg; 6 mmHg; P  implant in a failed bioprosthesis is an effective procedure. This possibility might alter prosthesis selection in the future initial surgical prosthesis selection, favouring bioprostheses. Further large trials should explore its safety.

  10. Same-day identification and antibiotic susceptibility testing on positive blood cultures: a simple and inexpensive procedure.

    Science.gov (United States)

    Maelegheer, K; Nulens, E

    2016-11-26

    Fast diagnostic tools are becoming a hot topic in microbiology, especially in the case of septic patients. Therefore, we attempted to develop a fast, inexpensive, accurate and easy method to identify bacteria and perform an antibiotic susceptibility test directly on positive blood cultures that could be used in a routine laboratory. A procedure based on centrifugation and washing steps was performed on 110 non-duplicated (including nine seeded) positive blood culture bottles. Direct identification (DID) and antimicrobial susceptibility testing (AST) was conducted on the pellet with the MALDI Biotyper and Phoenix, respectively. Identification (ID) to the species level was correct in 44/45 (97%) cases for Gram-negative bacteria and 44/56 (79%) cases for Gram-positive bacteria. In total, 98.9% of the AST results were identical to the routine laboratory result. No very major errors, four major errors and eight minor errors were detected. A reliable identification and a high AST agreement were obtained from blood cultures seeded with multi-resistant bacteria. We simulated the timeline of DID and demonstrated an identification and AST result within 24 h using Escherichia coli- and Staphylococcus aureus-positive blood cultures as examples. We developed an easy, fast and cheap method to generate reliable ID and AST results. Moreover, this method may be used to obtain results within 24 h after incubating the blood culture bottles in the microbiology lab.

  11. 肛旁脓肿的术式选择%The selections of surgical procedures in perianal abscess

    Institute of Scientific and Technical Information of China (English)

    梅世文; 金黑鹰

    2016-01-01

    Perianal abscess is the most common disease in anal, almost in man. It is caused by infections of anal glands, and the inflammations spread to the perianal gap, eventually abscess formation in perianal. There are a number of perianal abscess diseases caused by systemic diseases, such as inflammatory bowel disease, cancer and hematological system diseases. Whatever the perianal abscess arises from the infection of anal glands or the systemic diseases, in common, the strategy of therapy is incision and drainage. But after incision and drainage, the formation of fistula rate is higher. Abscess often spread widely in perianal, so improper surgical treatment may cause potentially residual cavity, leading to recurrent abscess and fistula formation. according to the characteristics of the anatomy around the anus, The author takes″three cavity clearance″ to drainage the perianal abscess completely, and achieves certain results. The Commentary will discuss the perianal abscess surgical options.%肛周脓肿是肛门部最常见疾病,青年男性多见,发病率较高,多由肛腺感染引起,向肛周间隙蔓延,最终形成脓肿。还有一些全身性疾病引起的肛周脓肿,例如炎症性肠病,血液肿瘤等。肛周脓肿无论是原发于肛腺感染还是全身疾病导致局部脓肿,目前公认的治疗方案为肛周脓肿的切开引流,同时也符合外科感染的治疗原则。但切开引流术后肛瘘的形成率较高,肛门部脓肿常无固定,手术处理不当可能将潜在腔系残留,导致脓肿的复发及肛瘘形成。笔者根据肛门周围解剖结构的特点,采用“三间隙引流”对肛周脓肿行彻底的敞开引流,取得了一定的效果。本述评就肛周脓肿的术式选择展开论述。

  12. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  13. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

    Science.gov (United States)

    Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

    2017-01-01

    Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency

  14. The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study.

    Science.gov (United States)

    Doll, Kemi M; Barber, Emma L; Bensen, Jeannette T; Revilla, Matthew C; Snavely, Anna C; Bennett, Antonia V; Reeve, Bryce B; Gehrig, Paola A

    2016-10-01

    There are currently no assessments of the impact of surgical complications on health-related quality of life in gynecology and gynecologic oncology. This is despite complications being a central focus of surgical outcome measurement, and an increasing awareness of the need for patient-reported data when measuring surgical quality. We sought to measure the impact of surgical complications on health-related quality of life at 1 month postoperatively, in women undergoing gynecologic and gynecologic oncology procedures. This is a prospective cohort study of women undergoing surgery by gynecologic oncologists at a tertiary care academic center from October 2013 through October 2014. Patients were enrolled preoperatively and interviewed at baseline and 1, 3, and 6 months postoperatively. Health-related quality of life measures included validated general and disease-specific instruments, measuring multiple aspects of health-related quality of life, including anxiety and depression. The medical record was abstracted for clinical data and surgical complications were graded using validated Clavien-Dindo criteria, and women grouped into those with and without postoperative complications. Bivariate statistics, analysis of covariance, responder analysis, and multivariate modeling was used to analyze the relationship of postoperative complications to change health-related quality of life from baseline to 1 month. Plots of mean scores and change over time were constructed. Of 281 women enrolled, response rates were 80% (n = 231/281) at baseline, and from that cohort, 81% (n = 187/231), 74% (n = 170/231), and 75% (n = 174/231) at 1, 3, and 6 months, respectively. The primary analytic cohort comprised 185 women with completed baseline and 1-month interviews, and abstracted clinical data. Uterine (n = 84, 45%), ovarian (n = 23, 12%), cervical (n = 17, 9%), vulvar (n = 3, 2%), and other (n = 4, 2%) cancers were represented, along with 53 (30%) cases of benign disease. There

  15. Surgical procedure for sliding inguinal hernia%腹股沟滑动性疝的手术处理

    Institute of Scientific and Technical Information of China (English)

    岳中屹; 夏清华

    2013-01-01

    目的 总结腹股沟滑动性疝的处理方法和经验.方法 回顾性分析2009年7月至2012年5月收治的46例腹股沟滑动性疝患者的临床资料.结果 46例手术均成功完成,术中未损伤滑出的脏器,术后无感染、浆液肿、阴囊肿大.随访1~15个月,无复发病例.结论 术中警惕滑疝的可能,合理选择手术方式,术中仔细轻柔的操作,腹股沟滑动性疝可安全地完成手术.%Objective To summarize the method and experience of repairing sliding inguinal hernia. Methods The clinical data of 46 sliding inguinal hernia patients, who were treated in our department from July 2009 to May 2012, were analyzed retrospectively. Results All 46 procedures were conducted successfully, without postoperative wound infection, serous swelling or scrotal edema. The follow-up time ranged from 1 to 15 months and there was no recurrence. Conclusion If surgeons keep the occurrence of sliding hernia in mind, choose the method reasonably and operate carefully, the procedure of treating sliding inguinal hernia will be conducted successfully.

  16. Flexible delivery of Er:YAG radiation at 2.94 µm with negative curvature silica glass fibers: a new solution for minimally invasive surgical procedures.

    Science.gov (United States)

    Urich, A; Maier, R R J; Yu, Fei; Knight, J C; Hand, D P; Shephard, J D

    2013-02-01

    We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm(2). Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures.

  17. Lung Volume Reduction in Chronic Obstructive Pulmonary Disease (COPD AND#8211; An Updated Review of Surgical and Endoscopic Procedures

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-08-01

    Full Text Available The conventional medical management of emphysema using bronchodilators and anti-inflammatory agents has a limited benefit in patients having advanced hyperinflation of lungs due to destruction of elastic tissue. The natural course of Chronic Obstructive Pulmonary Disease (COPD has been shown to be altered by only smoking cessation and oxygen therapy so far. The lung volume reduction surgery is viewed as another modality to change the natural history of emphysema in recent years. For patients with more generalized emphysema, resection of lung parenchyma improves elastic recoil and chest wall mechanics. An extensive literature search has demonstrated that carefully selected patients of emphysema (i.e. upper lobe predominant disease, low exercise capacity and Forced Expiratory Volume in First Second (FEV1 and DLco and #8804; 20% of predicted receive benefits in terms of symptomatic improvement and physiologic response following Lung Volume Reduction Surgery (LVRS. The resurgent interest in LVRS and National Emphysema Treatment Trial findings for emphysema have stimulated a range of innovative methods, to improve the outcome and reduce complications associated with current LVRS techniques. These novel approaches include surgical resection with compression/banding devices, endobronchial blockers, sealants, obstructing devices and valves and endobronchial bronchial bypass approaches. Experimental data and preliminary results are becoming available for some of these approaches. Most of the published studies so far have been uncontrolled and unblinded. Overall, extensive research in the near future will help to determine the potential clinical applicability of these new approaches to the treatment of emphysema symptoms. [Arch Clin Exp Surg 2012; 1(4.000: 249-257

  18. Lumbosubarachnoid-lumboepidural shunting in patients with idiopathic normal-pressure hydrocephalus: surgical procedures and follow-up study of five cases.

    Science.gov (United States)

    Takeuchi, Totaro; Fukushima, Shintaro; Misaki, Daigoro; Shibata, Satoshi

    2013-01-01

    The objective of the study is to introduce the surgical procedure of the lumbosubarachnoid-lumboepidural (L-L) shunting performed as treatment for idiopathic normal-pressure hydrocephalus (iNPH) and its follow-up. The subjects were five patients with probable iNPH (aged 78-85 years; mean age 81 years; four males and one female) who were judged to be at high risk from general or lumbar anesthesia due to their systemic complications and age. The L-L shunt operation was performed for all the patients under local anesthesia using Codman-Hakim Programmable Valve(®) (Codman & Shurtleff, Inc., Raynham, Massachusetts, USA). The initial pressure for all patients was set at 8 cmH2O. The evaluation of shunt efficacy and the lumbar epidural space cerebrospinal fluid (CSF) absorption test (injection of contrast media into epidural space) were performed both on the operation day and during follow-up period (9-12 months). The shunt operation was judged to be effective in four out of five patients (regarded as shunt responders), whereas no improvement in symptoms was seen in one patient (regarded as shunt nonresponder) where the shunting had no effect after the initial pressure was changed to 4 cmH2O. The lumbar epidural space CSF absorption test both on the operation day and during the follow-up period confirmed absorption in all patients. The L-L shunting is useful for patients with probable iNPH who are at high risk from general or lumbar anesthesia due to their systemic complications and age. CSF was continuously absorbed in the lumbar epidural space during postoperative follow-up period. A longer follow-up is required to establish this surgical procedure.

  19. Comparison of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Gurudas Kini

    2014-01-01

    Full Text Available Background: We compared i-gel and ProSeal laryngeal mask airway (PLMA regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle′s tube insertion, and postoperative sore throat assessment. Materials and Methods: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle′s tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. Results: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001. Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H 2 O. The fiberoptic view of glottis, ease of Ryle′s tube insertion, and incidence of complications were comparable. Conclusion: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H 2 O were more in PLMA group which indicates its better suitability for controlled ventilation.

  20. Number of Surgical Procedures for Patients With Cleft lip and Palate From Birth to 21 Years Old at a Single Children's Hospital.

    Science.gov (United States)

    McIntyre, Joyce K; Sethi, Harleen; Schönbrunner, Anna; Proudfoot, James; Jones, Marilyn; Gosman, Amanda

    2016-05-01

    Pediatric patients with cleft lip and palate undergo numerous surgeries throughout their childhood and early adulthood to correct the aesthetic and functional stigmata of their diagnoses. This study identifies patient and clinical factors that contribute to the number of surgeries and anesthesia events children undergo for their cleft repair. Retrospective chart review was performed using the genetic and dysmorphology database at Rady Children's Hospital San Diego. All patients with cleft lip or cleft palate diagnosis who underwent surgery at Rady Children's Hospital San Diego between 1988 and 2014 were included. A sample size of 71 patients was analyzed. Poisson regression was used to determine if there is a relationship between each variable of interest and the number of procedures. For our sample of 71 patients, the average number of surgical procedures was 8.6 (SD, 4.4). The average number of anesthesia events was 6.7 (SD, 3.3). Across and within diagnosis, race and sex were not statistically significant factors in patients' number of surgeries. Patients with bilateral cleft lip and palate (BCLP) and unilateral cleft lip and palate had, on average, 10 and 9.4 procedures, respectively. This is in contrast to patients with unilateral cleft lip and isolated cleft palate who had, on average, 5.3 and 5.9 procedures, respectively. This difference was significant (P value = 0.01). Patients were also compared based on continuity of care. Patients who had their cleft surgeries by multiple plastic surgeons affiliated with our children's hospital had significantly more surgeries (P = 0.01). A surgical outlier subset of 17 patients (24%) was identified who had more than 10 surgeries. These patients also had, on average, 11.3 (unilateral cleft lip and palate) and 11.8 (bilateral cleft lip and palate) anesthesia events; this is in contrast to the nonoutliers who had, on average, 4.1 to 8 anesthesia events. This retrospective review identifies patient and clinical factors

  1. Comparative clinical study of the effect of LLLT in the immediate and late treatments of hypoesthesia due to surgical procedures

    Science.gov (United States)

    Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Pinheiro, Antonio L. B.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Takamoto, Marcia; Siqueira, Jose T.; Dias, Pedro; Campos, Roberto A. d. C.

    2002-06-01

    We evaluated the effect of LLLT in 68 patients who presented hypoesthesia due to odontological surgery procedures: dental implant surgeries (N=51); extraction of impacted lower third molars (N=10); endodontics in lower first molars (N=7). Lesions treated within 30 days after the nerve injury had occurred were part of the immediate group, and lesions with more than 30 days from the occurrence of the injury were part of the late group. Treatments were carried out with an infrared diode laser of 40 mW-830nm, continuous wave emission, spot size 3 mm2, and a total dosage of 18 joules per session in a contact mode of application, 20 sessions altogether. The efficacy of laser therapy in peripheral nerve regeneration is also related to the degree of the peripheral nerve lesion, and not only to the lesion duration. LLLT resulted in neurosensory functional improvement in both immediate and late treatments of hypoesthesia.

  2. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

    Science.gov (United States)

    Driscoll, Elizabeth BS; Maleki, Ana Hosseinzadeh; Jahromi, Leila; Hermecz, Brittany Nelson; Nelson, Lauren E; Vetter, Imelda L; Evenhuis, Spencer; Riesenberg, Lee Ann

    2016-01-01

    A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. PMID:27785097

  3. Prophylactic beta-blockade to prevent myocardial infarction perioperatively in high-risk patients who undergo general surgical procedures.

    Science.gov (United States)

    Taylor, Rebecca C; Pagliarello, Giuseppe

    2003-06-01

    The benefit of administering beta-adrenergic blocking agents perioperatively to surgical patients at high risk for myocardial ischemia has been demonstrated in several well-designed randomized controlled trials. These benefits have included a reduction in the incidence of myocardial complications and an improvement in overall survival for patients with evidence of or at risk for coronary artery disease (CAD). We designed a retrospective study at the Ottawa Civic Hospital to investigate the use of beta-blockers in the perioperative period for high-risk general surgery patients who underwent laparotomy and to explore the reasons for failure to prescribe or administer beta-blockers when indicated. All 236 general surgery patients over the age of 50 years who underwent laparotomy for major gastrointestinal surgery between Jan. 1, 2001, and Dec. 31, 2001, were assigned a cardiac risk classification using the risk stratification described by Mangano and colleagues. The perioperative prescription and administration of beta-blockers were noted as were the patient's heart rate and blood pressure parameters for the first postoperative week, in-hospital adverse cardiac events and death. Of the 143 patients classified as being at risk for CAD or having definite evidence of CAD, 87 (60.8%) did not receive beta-blockers perioperatively. Of those who did, 43 were previously on beta-blockers and 13 had them ordered preoperatively. Patients with definite CAD were significantly more likely than others to receive beta-blockers perioperatively (p nurses irrespective of nil par os status. The mean heart rate and blood pressure parameters for patients receiving beta-blockers postoperatively was 82 beats/min and 110 mm Hg, respectively, and these values were not significantly different from the mean heart rate of patients not receiving beta-blockers. The number of postoperative cardiac events was significantly higher in patients with definite evidence of CAD, and among this group, the

  4. FastMG: a simple, fast, and accurate maximum likelihood procedure to estimate amino acid replacement rate matrices from large data sets.

    Science.gov (United States)

    Dang, Cuong Cao; Le, Vinh Sy; Gascuel, Olivier; Hazes, Bart; Le, Quang Si

    2014-10-24

    Amino acid replacement rate matrices are a crucial component of many protein analysis systems such as sequence similarity search, sequence alignment, and phylogenetic inference. Ideally, the rate matrix reflects the mutational behavior of the actual data under study; however, estimating amino acid replacement rate matrices requires large protein alignments and is computationally expensive and complex. As a compromise, sub-optimal pre-calculated generic matrices are typically used for protein-based phylogeny. Sequence availability has now grown to a point where problem-specific rate matrices can often be calculated if the computational cost can be controlled. The most time consuming step in estimating rate matrices by maximum likelihood is building maximum likelihood phylogenetic trees from protein alignments. We propose a new procedure, called FastMG, to overcome this obstacle. The key innovation is the alignment-splitting algorithm that splits alignments with many sequences into non-overlapping sub-alignments prior to estimating amino acid replacement rates. Experiments with different large data sets showed that the FastMG procedure was an order of magnitude faster than without splitting. Importantly, there was no apparent loss in matrix quality if an appropriate splitting procedure is used. FastMG is a simple, fast and accurate procedure to estimate amino acid replacement rate matrices from large data sets. It enables researchers to study the evolutionary relationships for specific groups of proteins or taxa with optimized, data-specific amino acid replacement rate matrices. The programs, data sets, and the new mammalian mitochondrial protein rate matrix are available at http://fastmg.codeplex.com.

  5. The effect of medicaid expansion in new york state on use of subspecialty surgical procedures by medicaid beneficiaries and the uninsured.

    Science.gov (United States)

    Giladi, Aviram M; Aliu, Oluseyi; Chung, Kevin C

    2014-05-01

    Understanding the benefits of Medicaid is crucial as states decide whether to expand Medicaid under the Patient Protection and Affordable Care Act. We used the 2001 Medicaid expansion in New York to evaluate changes in use by Medicaid beneficiaries and the uninsured of breast cancer reconstruction, panniculectomy, and lower-extremity trauma management. Data for all patients 19 to 64 years old having undergone the selected procedures between 1998 and 2006 were obtained from the State Inpatient Database. We used an interrupted time series using variance weighted least squares regression to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients received the procedures. We also determined the predicted use had there been no expansion. New York Census data were used for population-adjusted case-volume calculations. Likelihood of Medicaid as the primary payer increased significantly after expansion, 0.34% per quarter (95% CI, 0.28-0.40), without a decrease in uninsured patients receiving these procedures. This resulted in a 7.2% increase in the proportion of Medicaid beneficiaries receiving these procedures, an additional 1.9 Medicaid cases per quarter per 100,000 New York residents. In subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction (0.28% per quarter; 95% CI, 0.21-0.35) and panniculectomy (0.19% per quarter; 95% CI, 0.1-0.28) without a decrease for the uninsured. Lower-extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight increase for Medicaid beneficiaries (not significant). Subspecialty surgeons responded to expansion by increasing volume of procedures for Medicaid beneficiaries. This occurred without decline in care for the uninsured, suggesting that Medicaid expansion resulted in increased access for underserved patients. Although more patients received needed care once they had coverage, subgroup analysis identified

  6. Relationship between periodontics and restorative procedures: surgical treatment of the restorative alveolar interface (rai)--case series.

    Science.gov (United States)

    Almeida, A L P F; Esper, L A; Sbrana, M C; Cunha, M J S; Greghi, S L A; Carrilho, G P B; Pegoraro, L F

    2013-12-01

    Maintenance of a healthy periodontium is fundamental for the long term success of prosthetic restorations. Thus, prosthetic procedures with subgingival margins may affect the periodontal health if the distances between the junctional epithelium and supracrestal connective tissue attachment aren't respected, or if there is insufficient space to maintain the health of the interproximal tissues, leading to gingival inflammation, connective tissue attachment loss and bone resorption. The restorative alveolar interface (RAI) technique was described as the portion of the root surface extending from the alveolar crest apically to the restorative margin coronally. RAI consists of modifying the restorative margin position into a healthier environment, respecting the biological width and therefore allowing effective plaque control. This paper describes four clinical cases with indication for the RAI technique for maintenance of periodontal health. The cases were associated with prostheses. All cases were evaluated at 90 days and exhibited a healthy periodontal tissue. Successful outcomes were observed in the different indications for the RAI technique.

  7. Reported analgesic administration to rabbits, pigs, sheep, dogs and non-human primates undergoing experimental surgical procedures.

    Science.gov (United States)

    Coulter, C A; Flecknell, P A; Richardson, C A

    2009-07-01

    Reported analgesic use following experimental surgery is low in rodents and there has been little published information on the frequency of analgesic use in other laboratory species. A structured literature review was conducted to examine analgesic administration in larger laboratory animals. The Scirus search engine was used to identify studies published in peer-reviewed journals that reported carrying out experimental surgery on 'large' laboratory animals, specifically rabbits, pigs, sheep, dogs and non-human primates. Seventy-four studies between 2000 and 2001 and 75 studies between 2005 and 2006 were included in the review. There was an increase in the reported administration of systemic analgesics to these species from 50% in 2000-2001 to 63% in 2005-2006. When all agents with analgesic properties were considered (systemic analgesics, local anaesthetics and anaesthetics with analgesic components), the proportion of papers that reported some form of analgesic administration to 'large' laboratory animals increased from 86% in 2000-2001 to 89% in 2005-2006. Overall rabbits, pigs, sheep, dogs and non-human primates were more likely to receive analgesics following potentially painful experimental procedures than has been reported in laboratory rodents but analgesic administration to 'large' laboratory species is still not optimal.

  8. A new surgical procedure for phallic reconstruction in partial penis necrosis: penile elongation in combination with glanuloplasty.

    Science.gov (United States)

    Xiao, Kaiyan; Cheng, Kaixiang; Song, Nan

    2014-01-01

    The radial forearm flap transfer has proved to be the standard technique in penile reconstruction. However, this operation still leads to a residual scar on the forearm. In the reconstruction of partial penis necrosis, achieving a desirable appearance and functional recovery while minimizing donor-site damage remains an unsolved problem. In this study, we report our experience using penile elongation combined with glanuloplasty to rebuild the partially necrotic penis.A retrospective review of a consecutive series of 33 patients with partial penis necrosis after microwave thermotherapy (not from our hospital) from December 2008 to May 2012 was conducted at the Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital. These patients, with an age range from 20 to 36 years, first underwent a scrotal skin flap transfer to cover residual cavernosum. The penis was simultaneously elongated at the proximal end. Six months later, all patients received glanuloplasty using expanded polytetrafluoroethylene that was implanted at the distal end of transferred scrotal skin flap to create the neoglans.Anthropometric measurements of preoperative and postoperative penile length were performed with an average follow-up period of 28 months. The mean extended penile length average was 2.57 cm, ranging from 3.16 to 5.73 cm. Patients' satisfaction rate was 88%. In addition, preoperative and postoperative photographs were reviewed for objective and subjective assessment of outcome parameters such as appearance of neophallus, urination, and erogenous sensation. Most importantly, the rebuilt penis postoperatively showed almost normal shape and restoration of basic physiologic function in most of the patients, with an acceptable complication rate. These preliminary results may provide a useful strategy for the reconstruction of a partially necrotic penis using a novel, simple, and effective approach.

  9. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial.

    Science.gov (United States)

    Alam, Murad; Roongpisuthipong, Wanjarus; Kim, Natalie A; Goyal, Amita; Swary, Jillian H; Brindise, Renata T; Iyengar, Sanjana; Pace, Natalie; West, Dennis P; Polavarapu, Mahesh; Yoo, Simon

    2016-09-01

    Guided imagery and music can reportedly reduce pain and anxiety during surgery, but no comparative study has been performed for cutaneous surgery to our knowledge. We sought to determine whether short-contact recorded guided imagery or relaxing music could reduce patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures. Subjects were adults undergoing excisional surgery for basal and squamous cell carcinoma. Randomization was to guided imagery (n = 50), relaxing music (n = 54), or control group (n = 51). Primary outcomes were pain and anxiety measured using visual analog scale and 6-item short-form of the State-Trait Anxiety Inventory, respectively. Secondary outcomes were anxiety of surgeons measured by the 6-item short-form of the State-Trait Anxiety Inventory and physical stress of patients conveyed by vital signs, respectively. There were no significant differences in subjects' pain, anxiety, blood pressure, and pulse rate across groups. In the recorded guided imagery and the relaxing music group, surgeon anxiety was significantly lower than in the control group. Patients could not be blinded. Short-contact recorded guided imagery and relaxing music appear not to reduce patient pain and anxiety during excisional procedures under local anesthetic. However, surgeon anxiety may be reduced when patients are listening to such recordings. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  10. Multilayered Gore-Tex patch for temporary coverage of deep noninfectious corneal defects: surgical procedure and clinical experience.

    Science.gov (United States)

    Rüfer, Florian; Eisenack, Johannes; Klettner, Alexa; Zeuner, Rainald; Hillenkamp, Jost; Westphal, Gundolf; Roider, Johann; Nölle, Bernhard

    2011-04-01

    To evaluate the multilayer Gore-Tex patch as temporary coverage of deep, noninfectious corneal defects. Retrospective, interventional case series. University Medical Center Schleswig-Holstein, Kiel, Germany. Thirty-nine eyes of 38 patients with noninfectious, deep corneal defects. Underlying disorders included neurotrophic or immunologic ulcers in 37 eyes (94.9%) and traumatic defects in 2 eyes (5.1%). Intervention procedures: Corneal defects were covered with multiple Gore-Tex layers, of which the uppermost was sutured to the cornea. The Gore-Tex patch was kept in place until an appropriate corneal transplant was obtained and effective systemic immunosuppression was initiated. Long-term preservation of the eye, frequency of resuturing of the Gore-Tex patch, and best-corrected visual acuity. In 38 cases, the eye could be preserved. In 10 eyes, additional sutures were required. Before surgery, the mean best-corrected visual acuity (logMAR) was 1.14 ± 0.45 (20/250), and that at final follow-up was 1.13 ± 0.41 (20/250). The Gore-Tex patch remained in place 4 days to 32 months (mean, 6.4 ± 8.3 months) until corneal transplantation (27 eyes) or until an alternative way of defect coverage could be performed. Three eyes did not require further coverage after explantation of the Gore-Tex patch. In 6 eyes, either the Gore-Tex patch was kept in place or the patients died. Temporary coverage of deep corneal defects with multilayer Gore-Tex patches allows time until an appropriate corneal transplant is obtained. The technique is particularly useful in patients with underlying autoimmune disorders, because an effective systemic immunosuppression can be initiated before corneal transplantation. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Quality of life in Chinese women treated surgically for breast cancer with one of three different procedures

    Institute of Scientific and Technical Information of China (English)

    任敏

    2015-01-01

    Objective To determine the quality of life of patients treated with one of three different types of surgery for breast cancer.Methods This was a cross-sectional study using a questionnaire survey completed by Chinese patients without active disease after at least 2 years of follow-up after breast cancer surgery.Results This study totally included 139 breast cancer patients:44 ( 31.6%) had undergone modified radical mastectomy with reconstruction, 41(29.5%)had a quadrantectomy with axillary lymph node dissection, and 54(38.9%)had a modified radical mastectomy without reconstruction.The EORTC QLQ-C30 and EORTC QLQ-BR23 question-naires were used;their reliability was>0.82.Global health status(94.30 ±12.04, P=0.028)and role functio-ning(85.16 ±17.23, P=0.138)were highest in the quadrantectomy group.Pain score was highest in the modi-fied radical mastectomy with reconstruction group(26.13 ±30.15, P =0.042).The breast symptom score (22.56 ±22.30, P=0.009)and body image perception(85.56 ±19.72, P=0.025)were highest in the conser-vative treatment group.The overall health of patients given modified radical mastectomy without reconstruction was lower(72.61 ±20.89, P=0.014) in women older than 50 years compared with younger women.Conclu-sions The quadrantectomy with axillary lymph node dissection procedure had better acceptance, but the overall health status did not differ between groups.Overall health status is lower in women older than 50 years receiving a modified radical mastectomy without reconstruction.

  12. Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure.

    Science.gov (United States)

    Jain, Nilesh; Das, Sucharita; Kanchi, Muralidhar

    2017-01-01

    Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. A total of 345 patients undergoing CABG of either sex, in the age group of 35-80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1) years (35-80 years). This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

  13. Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

    Directory of Open Access Journals (Sweden)

    Nilesh Jain

    2017-01-01

    Full Text Available Background: Patients undergoing coronary artery bypass graft (CABG procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. Methodology: A total of 345 patients undergoing CABG of either sex, in the age group of 35–80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. Results: A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1 years (35–80 years. This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. Conclusion: TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

  14. A simple and fast ultrasound-assisted extraction procedure for Fe and Zn determination in milk-based infant formulas using flame atomic absorption spectrometry (FAAS).

    Science.gov (United States)

    Machado, Ignacio; Bergmann, Gabriela; Pistón, Mariela

    2016-03-01

    A simple and fast ultrasound-assisted procedure for the determination of iron and zinc in infant formulas is presented. The analytical determinations were carried out by flame atomic absorption spectrometry. Multivariate experiments were performed for optimization; in addition, a comparative study was carried out using two ultrasonic devices. A method using an ultrasonic bath was selected because several samples can be prepared simultaneously, and there is less contamination risk. Analytical precision (sr(%)) was 3.3% and 4.1% for iron and zinc, respectively. Trueness was assessed using a reference material and by comparison of the results obtained analyzing commercial samples using a reference method. The results were statistically equivalent to the certified values and in good agreement with those obtained using the reference method. The proposed method can be easily implemented in laboratories for routine analysis with the advantage of being rapid and in agreement with green chemistry.

  15. Surgical ethics and the challenge of surgical innovation.

    Science.gov (United States)

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  16. Deformidade de Sprengel: tratamento cirúrgico pela técnica de green modificada Sprengel's deformity: surgical correction by a modified green procedure

    Directory of Open Access Journals (Sweden)

    Sandro da Silva Reginaldo

    2009-06-01

    Full Text Available OBJETIVO: Demonstrar os resultados estéticos e funcionais de pacientes submetidos à correção cirúrgica de escápula alta congênita - deformidade de Sprengel - por uma modificação da técnica de Green, bem como avaliar o grau de satisfação dos pacientes e as complicações da técnica utilizada. MÉTODOS: Foram avaliados nove pacientes operados pela técnica de Green modificada, no período de setembro de 1993 a abril de 2008. Como modificação da técnica original foram realizados descolamento muscular subperiosteal, ressecção apenas da porção súpero-medial da escápula e, em vez da utilização de tração esquelética, optou-se pela fixação com fio de aço subcutâneo da porção medial da espinha da escápula à crista ilíaca posterior contralateral. A idade média dos pacientes foi de sete anos e três meses. O seguimento pós-operatório médio foi de três anos e sete meses. RESULTADOS: Houve incremento médio na elevação de cerca de 39º (variando de 0º a 80º . Segundo a classificação de Cavendish, obteve-se a melhora estética de dois graus em oito casos e de três graus em um. Todos os pacientes ficaram satisfeitos com o resultado. CONCLUSÕES: Os pacientes com deformidade de Sprengel submetidos a tratamento cirúrgico por meio de uma modificação da técnica de Green, com fixação da escápula na crista ilíaca posterior contralateral em vez de se utilizar tração esquelética, apresentaram melhora tanto funcional como estética; todos os pacientes e/ou familiares ficaram satisfeitos e as complicações relacionadas com a técnica cirúrgica não interferiram no resultado final.OBJECTIVE: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity using modified Green's Procedure, as well as patients' satisfaction and complications. METHODS: Nine patients submitted to surgical treatment from September 1993 to April 2008 have

  17. Tratamiento periodontal quirúrgico: Revisión. Conceptos. Consideraciones. Procedimientos. Técnicas Periodontal surgical therapy: Review. Concepts. Considerations. Procedures. Techniques

    Directory of Open Access Journals (Sweden)

    R. Matos Cruz

    2011-12-01

    considered as an adjunct to cause-related periodontal therapy. The kind of surgery performed, the number of sites included and the moment at which it should performed is decided after evaluating for the initial cause-related therapy results. The ultimate objective of periodontal surgical treatment is the long term preservation of the periodontium. Periodontal surgery can contribute to this end creating accessibility for an adequate scaling and root planning therefore restoring the gingival morphology which facilitates the automatic plaque control of the patient. Developed surgical techniques must be evaluated on the basis of their potential to facilitate the elimination of subgingival deposits, as well as facilitate plaque control and thus improve the long term preservation of the periodontium. In the present article the authors review the basis of surgical periodontal treatment as well as related concepts and considerations, objectives, indications and contraindications, procedures and factors that determine the selection of one or the other surgical technique.

  18. A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

    Directory of Open Access Journals (Sweden)

    A. F. Ozer

    2013-01-01

    Full Text Available Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations.

  19. THE GONIOSETON, A SURGICAL-TREATMENT FOR CHRONIC GLAUCOMA

    NARCIS (Netherlands)

    VANDERVEEN, G; JONGEBLOED, WL; WORST, JGF

    1990-01-01

    A new and simple technique for glaucoma filtering surgery is presented. It is based on the introduction of a stainless steel microspiral or gonioseton into a goniopuncture by way of an ab interno procedure, minimising surgical trauma to the filtration area. Preliminary results are presented.

  20. THE GONIOSETON, A SURGICAL-TREATMENT FOR CHRONIC GLAUCOMA

    NARCIS (Netherlands)

    VANDERVEEN, G; JONGEBLOED, WL; WORST, JGF

    1990-01-01

    A new and simple technique for glaucoma filtering surgery is presented. It is based on the introduction of a stainless steel microspiral or gonioseton into a goniopuncture by way of an ab interno procedure, minimising surgical trauma to the filtration area. Preliminary results are presented.

  1. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

    Science.gov (United States)

    van der Meij, Eva; Huirne, Judith Af; Bouwsma, Esther Va; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter Kg; Geomini, Peggy Maj; Consten, Esther Cj; Schraffordt Koops, Steven E; van Kesteren, Paul Jm; Stockmann, Hein Bac; Ten Cate, A Dorien; Davids, Paul Hp; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus Jhj; Bonjer, H Jaap; Anema, Johannes R

    2016-12-21

    Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social participation, self-rated health

  2. Simple operative management of ingrown toenail using bipolar diathermy.

    Science.gov (United States)

    Farrelly, P J; Minford, J; Jones, M O

    2009-10-01

    Ingrowing toenails (IGTN) cause significant discomfort for children and adults alike. Where conservative treatment fails, a surgical approach is usually adopted. Many surgical procedures have been described with varying complexity and outcome. We report a novel, simple technique which involves wedge excision of the ingrowing nail, and bipolar diathermy of the nail bed. Three-hundred and fifty-three procedures were carried out on 302 patients during the study period. Our re-operation rate for recurrence is 9.9%, which compares favourably with other techniques, and which lends itself to utilisation for minor surgery lists in primary care.

  3. Surgical Lasers In Gynecology

    Science.gov (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  4. Conscious sedation for surgical procedures

    Science.gov (United States)

    ... of the time, it will not be an anesthesiologist. The medicine will wear off quickly, so it ... J, Sitsen E, Reekers M. Intravenous anesthetics. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  5. Augmented reality in surgical procedures

    NARCIS (Netherlands)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, O.; Gersak, B.

    2008-01-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantia

  6. Surgical Procedures in Hidradenitis Suppurativa

    NARCIS (Netherlands)

    Janse, Ineke; Bieniek, Andrzej; Horvath, Barbara; Matusiak, Lukasz

    2016-01-01

    Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; besides the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory

  7. Augmented reality in surgical procedures

    NARCIS (Netherlands)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, O.; Gersak, B.

    2008-01-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers

  8. Surgical Procedures in Hidradenitis Suppurativa

    NARCIS (Netherlands)

    Janse, Ineke; Bieniek, Andrzej; Horvath, Barbara; Matusiak, Lukasz

    Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; besides the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory

  9. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic ...

  10. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by restricting the ... Online Education Directory Search Patient Learning Center Bariatric Surgery ... Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  11. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría

    2014-10-01

    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  12. 不同术式治疗尿道下裂48例体会%Different surgical procedures for hypospadia:a report of 48 cases

    Institute of Scientific and Technical Information of China (English)

    王胜利; 杨大强; 张端卫; 孙毅伦

    2011-01-01

    Objective: To observe and summarize the therapeutic effects and complications of different surgical procedures for treatment of hypospadia so as to provide basis for patients to choose a suitable pattern. Methods:Different surgical procedures were applied to 48 patients with hypospadia. Duckett was adopted by 23 cases, Denis-Browne 3 cases, Duplay 10 cases, MAGPI 1 case,Duckett + Duplay 3 cases, scrotal septal vascular pediclen flap 3 cases and Hodgson 5 cases. The success rate and the complication of each procedure were analyzed retrospectively. Results:Of the 23 cases treated by Duckett, one-stage success was achieved in 18 cases,urinary fistula occurred in 3 cases, anastomotic stricture in one case and skin edge necrosis in one case; of the 3 cases treated by DenisBrowne ,2 cases achieved successful results and 1 developed urethral stricture; of the 10 cases adopting Duplay, one-stage success was achieved in 7 cases and urinary fistula occurred in 3 cases;the operation was successful in the one case treated by MAGP;of the 3 cases adopting Duckett + Duplay, the operation was successful in 1 case, urinary fistula occurred in lcase and anastomotic stricture in 1 case;of the 3 cases treated by scrotal septal vascular pediclenflap, successful result was achieved in 2 cases and urinary fistula occurred in one case;of the 5 cases adopting Hodgson,4 cases achieved good results and urinary fistula occurred in 1 case. Conclusions:Different surgical procedures should be applied to different types of hypespadia. To most patients receiving the therapy for the first time, Duckett and Hodgson procedures should be taken as the first choice; patients receiving the penis diorthosis surgery for the second time may choose Duplay or Denis-Browne; patients having experienced failed operations or lacking external genital organ skin source should consider using dissociation substitution tissues( cheek mucous membrane, tongue mucous membrane and so on).%目的:总结不同术式治疗

  13. Deparaffinization with mineral oil: a simple procedure for extraction of high-quality DNA from archival formalin-fixed paraffin-embedded samples.

    Science.gov (United States)

    Heikal, Nahla; Nussenzveig, Roberto H; Agarwal, Archana M

    2014-09-01

    Extracting DNA from formalin-fixed paraffin-embedded (FFPE) archival samples remains difficult. Successful polymerase chain reactions (PCR) with DNA extracted from FFPE samples is still very low. We extracted DNA from 12 recent and old archival FFPE bone marrow trephine biopsies by use of a simple protocol on the basis of deparaffinization with molecular biology-grade mineral oil followed by DNA extraction with the Qiagen FFPE kit. Comparison of this deparaffinization method with standard protocols, for example, xylene or Hemo-D with subsequent rehydration using graded ethanols, was investigated. The quality and quantity of extracted DNA were tested by a combination of ultraviolet spectroscopy, analysis on a Caliper LabChip GX, and real-time PCR combined with high-resolution melt analysis. Highest quality PCR-amplifiable DNA was obtained by deparaffinization with mineral oil, whereas more variable results were obtained for the other 2 deparaffinization procedures. This result was confirmed by real-time PCR and high-resolution melt analysis. Besides improvements in the quality of extracted DNA, use of mineral oil for deparaffinization has the added benefit of decreased time (20 vs. 75 min) and a significant reduction of hands-on labor (1 step vs. multiple hands-on centrifugation and decanting steps).

  14. Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic

    DEFF Research Database (Denmark)

    Sander, P; Mouritsen, L; Andersen, J T

    2000-01-01

    Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open-access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non-surgical tr......Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open-access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non....... The minimal care program and interdisciplinary structure in the incontinence clinic offer effective and low cost treatment for urinary incontinence. The open-access, interdisciplinary incontinence clinic model is recommended. Neurourol. Urodynam. 18:9-17, 2000....

  15. Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic

    DEFF Research Database (Denmark)

    Sander, P; Mouritsen, L; Andersen, J T

    2000-01-01

    Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open-access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non-surgical tr......Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open-access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non....... The minimal care program and interdisciplinary structure in the incontinence clinic offer effective and low cost treatment for urinary incontinence. The open-access, interdisciplinary incontinence clinic model is recommended. Neurourol. Urodynam. 18:9-17, 2000....

  16. Surgical crown lengthening for function and esthetics.

    Science.gov (United States)

    Allen, E P

    1993-04-01

    Clinical crown lengthening is a useful procedure to provide tooth length for proper restoration of a tooth without compromising the periodontium or the retentive qualities of the restoration. It is also useful for enhancing maxillary anterior esthetics. Crown lengthening may be as simple as a limited removal of soft tissue or as complex as orthodontic extrusion followed by flap with osseous surgery on a tooth requiring endodontic therapy. Total treatment could thus involve endodontic, orthodontic, periodontic, and restorative procedures. Careful evaluation, case selection, treatment planning, and surgical treatment following the principles outlined in this article can achieve results that meet the functional and esthetic challenges of current dental practice.

  17. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

    Science.gov (United States)

    Huirne, Judith AF; Bouwsma, Esther VA; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter KG; Geomini, Peggy MAJ; Consten, Esther CJ; Schraffordt Koops, Steven E; van Kesteren, Paul JM; Stockmann, Hein BAC; ten Cate, A Dorien; Davids, Paul HP; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus JHJ; Bonjer, H Jaap; Anema, Johannes R

    2016-01-01

    Background Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social

  18. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  19. [Long-term results of peripheral vascular injuries in patients' limbs following reconstructive surgical procedures and influence on the quality of life].

    Science.gov (United States)

    Deja, Włodzimierz; Wieczorek, Dariusz; Deja, Agata; Lasek, Jerzy; Kawecka, Aleksandra; Marks, Wojciech

    2006-01-01

    Major vascular injuries in extremities are rare and constitute problems for surgeons and their sequelae strongly influence remote future of the patients. The aim of study is to evaluate surgical treatment of vascular injuries in extremities and some aspects of quality of life. Since 1983 until 2002 sixty four patients with vascular limbs injuries were treated in the department. Remote evaluation has been performed in 33 persons. Severity of limb injuries was measured by Mangled Extremity Severity Score (MESS). In 20 patients (60.6%) very good and good recent results were obtained, satisfactory in 24.2% and bad results in 15.2% persons. Evaluation of functional status has been made by means of locomotion test and Jebsen-Taylor's test, social approval questionnaire, depression Beck's scale, the scale of hypochondria and by an original questionnaire to evaluate the quality of life. As considerable interdependence has been found between the functional status and the following factors: injury severity expressed in MESS (p < 0.01), clinic reception procedure (p < 0.001), ischemia time (p < 0.01), coincidence of other injuries (fractures and dislocations, muscle, tendon and nerve lesions) (p < 0.01), limb amputation (p < 0.01). Hand function significantly influences the quality of life. Patients who were in shock after trauma in the remote assessment showed susceptibility to the lowered mood and depression (p < 0.05). Quality of life is strongly connected with the features of personality, correlating mainly with the mood and tendencies of concentration upon somatic symptoms. Function of the hand influences strongly the quality of life. Amputated patients may in spite of their crippling limitations are able to adapt to everyday life.

  20. Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database.

    Science.gov (United States)

    Ohya, Junichi; Chikuda, Hirotaka; Oichi, Takeshi; Kato, So; Matsui, Hiroki; Horiguchi, Hiromasa; Tanaka, Sakae; Yasunaga, Hideo

    2017-07-15

    A retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database, a national representative database in Japan. The aim of this study was to examine seasonal variations in the risk of reoperation for surgical site infection (SSI) following spinal fusion surgery. Although higher rates of infection in the summer than in other seasons were thought to be caused by increasing inexperience of new staff, high temperature, and high humidity, no studies have examined seasonal variations in the risk of SSI following spinal fusion surgery in the country where medical staff rotation timing is not in summer season. In Japan, medical staff rotation starts in April. We retrospectively extracted the data of patients who were admitted between July 2010 and March 2013 from the DPC database. Patients were included if they were aged 20 years or older and underwent elective spinal fusion surgery. The primary outcome was reoperation for SSI during hospitalization. We performed multivariate analysis to clarify the risk factors of primary outcome with adjustment for patient background characteristics. We identified 47,252 eligible patients (23,659 male, 23,593 female). The mean age of the patients was 65.4 years (range, 20-101 yrs). Overall, reoperation for SSI occurred in 0.93% of the patients during hospitalization. The risk of reoperation for SSI was significantly higher in April (vs. February; odds ratio, 1.93; 95% confidence interval, 1.09-3.43, P = 0.03) as well as other known risk factors. In subgroup analysis with stratification for type of hospital, month of surgery was identified as an independent risk factor of reoperation for SSI among cases in an academic hospital, although there was no seasonal variation among those in a nonacademic hospital. This study showed that month of surgery is a risk factor of reoperation for SSI following elective spinal fusion surgery, nevertheless, in the country where medical staff rotation timing is not in

  1. Surgical Templates for Dental Implant Positioning; Current ...

    African Journals Online (AJOL)

    applied scientifically based research techniques to develop an endosseous implant that forms ... KEYWORDS: Dental implants, surgical templates, surgical procedure, stent .... during the surgical stage for single implant therapy.[24] Afterward,.

  2. Human Health Risk Assessment Based on Toxicity Characteristic Leaching Procedure and Simple Bioaccessibility Extraction Test of Toxic Metals in Urban Street Dust of Tianjin, China

    Science.gov (United States)

    Yu, Binbin; Wang, Yu; Zhou, Qixing

    2014-01-01

    The potential ecological and human health risk related with urban street dust from urban areas of Tianjin, China was quantitatively analyzed using the method of toxicity characteristic leaching procedure (TCLP) and simple bioaccessibility extraction test (SBET). In the study, Hakason index, Nemerow index (P), the hazard index (HI) and the cancer risk index (RI) were calculated to assess the potential risk. The sequence of potential ecological risk based on Hakason index was arsenic (As) > cadmium (Cd) > lead (Pb) > copper (Cu) > chromium (Cr), in particular, As and Cd were regarded as high polluted metals. While the results of extraction of TCLP were assessed using P, the sequence was As > Pb > Cd > Cr > Cu, which mean that As and Pb should be low polluted, and Cd, Cr and Cu would barely not polluted. For human health, total carcinogenic risk for children and adults was 2.01×10−3 and 1.05×10−3, respectively. This could be considered to be intolerable in urban street dust exposure. The sequence in the hazard quotient (HQ) of each element was As > Cr > Pb > Cu > Cd. The HI value of these toxic metals in urban street dust for children and adults was 5.88×10−1 and 2.80×10−1, respectively. According to the characters of chemistry, mobility, and bioavailability of metals in urban street dust, we estimated the hazards on the environment and human health, which will help us to get more reasonable information for risk management of metals in urban environment. PMID:24651129

  3. A simple procedure for the extraction of DNA from long-term formalin-preserved brain tissues for the detection of EBV by PCR.

    Science.gov (United States)

    Hassani, Asma; Khan, Gulfaraz

    2015-12-01

    Long-term formalin fixed brain tissues are potentially an important source of material for molecular studies. Ironically, very few protocols have been published describing DNA extraction from such material for use in PCR analysis. In our attempt to investigate the role of Epstein-Barr virus (EBV) in the pathogenesis of multiple sclerosis (MS), extracting PCR quality DNA from brain samples fixed in formalin for 2-22 years, proved to be very difficult and challenging. As expected, DNA extracted from these samples was not only of poor quality and quantity, but more importantly, it was frequently found to be non-amplifiable due to the presence of PCR inhibitors. Here, we describe a simple and reproducible procedure for extracting DNA using a modified proteinase K and phenol-chloroform methodology. Central to this protocol is the thorough pre-digestion washing of the tissues in PBS, extensive digestion with proteinase K in low SDS containing buffer, and using low NaCl concentration during DNA precipitation. The optimized protocol was used in extracting DNA from meninges of 26 MS and 6 non-MS cases. Although the quality of DNA from these samples was generally poor, small size amplicons (100-200 nucleotides) of the house-keeping gene, β-globin could be reliably amplified from all the cases. PCR for EBV revealed positivity in 35% (9/26) MS cases, but 0/6 non-MS cases. These findings indicate that the method described here is suitable for PCR detection of viral sequences in long-term formalin persevered brain tissues. Our findings also support a possible role for EBV in the pathogenesis of MS.

  4. Human health risk assessment based on toxicity characteristic leaching procedure and simple bioaccessibility extraction test of toxic metals in urban street dust of Tianjin, China.

    Directory of Open Access Journals (Sweden)

    Binbin Yu

    Full Text Available The potential ecological and human health risk related with urban street dust from urban areas of Tianjin, China was quantitatively analyzed using the method of toxicity characteristic leaching procedure (TCLP and simple bioaccessibility extraction test (SBET. In the study, Hakason index, Nemerow index (P, the hazard index (HI and the cancer risk index (RI were calculated to assess the potential risk. The sequence of potential ecological risk based on Hakason index was arsenic (As > cadmium (Cd > lead (Pb > copper (Cu > chromium (Cr, in particular, As and Cd were regarded as high polluted metals. While the results of extraction of TCLP were assessed using P, the sequence was As > Pb > Cd > Cr > Cu, which mean that As and Pb should be low polluted, and Cd, Cr and Cu would barely not polluted. For human health, total carcinogenic risk for children and adults was 2.01 × 10(-3 and 1.05 × 10(-3, respectively. This could be considered to be intolerable in urban street dust exposure. The sequence in the hazard quotient (HQ of each element was As > Cr > Pb > Cu > Cd. The HI value of these toxic metals in urban street dust for children and adults was 5.88 × 10(-1 and 2.80 × 10(-1, respectively. According to the characters of chemistry, mobility, and bioavailability of metals in urban street dust, we estimated the hazards on the environment and human health, which will help us to get more reasonable information for risk management of metals in urban environment.

  5. 复杂性肾结石不同手术治疗方法的疗效分析%Different surgical procedures for complex renal calculi

    Institute of Scientific and Technical Information of China (English)

    刘永昌; 陈志雄; 潘翔

    2013-01-01

    Objective To compare the clinical efficacy of mini-invasive percutaneous nephrolithotomy (MPCNL) with that of open surgery for the treatment of complex renal calculi.Methods 82 patients with complex renal calculi who had undergone surgical treatment during the period of April 2006 to April 2011 were assigned to MPCNL group (41 patients) and open-surgery group (41 patients) based on the type of procedures.Surgical duration,intraoperative bleeding volume,rate of complications,postoperative length of hospital stay,total medical cost,and rate of calculi clearance were compared between the two groups.Results Surgical duration and length of hospital stay were shorter,intraoperative bleeding volume was less,rate of complications was lower,medical cost was greater,and rate of calculi clearance was higher in MPCNL group than in open-surgery group [(110 ± 21)min vs.(178 ± 33)min,(7.31 ± 0.94)days vs.(13.32 ± 2.84)days,(96.25 ± 12.34)ml vs.(176.56 ± 11.35)ml,12.2% (5/41) vs.29.3% (12/41),(12 636.6 ± 672.37) yuans vs.(8532.20 ± 350.56) yuans,and 80.49% (33/41) vs.65.85% (27/41); P<0.05].Conclusions As compared with open surgery,mini-invasive percutaneous nephrolithotomy has shorter surgical duration and postoperative hospital stay,higher rate of calculi clearance,quicker recovery,less blood loss,and fewer complications,though it has higher total medical cost.It is a safe,effective way to treat complex renal calculi.%目的 比较、分析微创经皮肾镜取石术与开放手术治疗复杂性肾结石的临床疗效.方法 选择2006年3月至2011年3月于我院接受手术治疗的82例复杂性肾结石患者,按治疗方法分为微创经皮肾镜取石组41例和开放手术组41例.比较两组在手术时间、术中出血量、并发症发生率、术后住院时间、总治疗费用及结石清除率方面的差异.结果 微创经皮肾镜取石组手术时间[(110±21) min vs.(178±33) min]、术中出血量[(96.25±12.34) ml vs.(176.56±11

  6. Surgically assisted rapid maxillary expansion in adults.

    Science.gov (United States)

    Pogrel, M A; Kaban, L B; Vargervik, K; Baumrind, S

    1992-01-01

    Twelve adults with maxillary width discrepancy of greater than 5 mm were treated by surgically assisted rapid maxillary expansion. The procedure consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopedic device postoperatively. Mean palatal expansion of 7.5 mm (range of 6 to 13 mm), measured in the first molar region, was achieved within 3 weeks in all patients. Expansion remained stable during the 12-month study period, with a mean relapse for the entire group of 0.88 +/- 0.48 mm. Morbidity was limited to mild postoperative discomfort. The results of this preliminary study indicated that surgically assisted rapid maxillary expansion is a safe, simple, and reliable procedure for achieving a permanent increase in skeletal maxillary width in adults. Further study is necessary to document the three-dimensional movements of the maxillary segments and long-term stability of the skeletal and dental changes.

  7. EuroSCORE models in a cohort of patients with valvular heart disease and a high prevalence of rheumatic fever submitted to surgical procedures.

    Directory of Open Access Journals (Sweden)

    Ricardo Casalino

    Full Text Available Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery.Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC curve analysis.The mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery. Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70-0.81 for the additive EuroSCORE, 0.76 (95% CI 0.70-0.81 for the logistic EuroSCORE and 0.81 (95% CI 0.76-0.86 for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II.In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.

  8. Tratamento cirúrgico da fibrilação atrial: procedimento do "labirinto": experiência inicial Surgical treatment of atrial fibrillation with "maze" procedure: initial experience

    Directory of Open Access Journals (Sweden)

    Adib D Jatene

    1992-06-01

    complicações infecciosas. Os pacientes restantes obtiveram alta hospitalar sem drogas antiarrítmicas. Em um período de um a dez meses (M = 5,4, os pacientes estão assintomáticos e o Holter mostra presença de ritmo atrial irregular permanente (com FC média de 70 a 80 bpm com condução AV preservada; o ecodoppler mostra presença de contração atrial eficiente. Não houve recorrências de FA e nenhum dos pacientes. Em conclusão, podemos admitir que, a curto prazo, a técnica do "labirinto" na FA em reumáticos restaurou a contração atrial organizada e controlou a FC. Assim, pode contribuir para redução de fenômenos trombo-embólicos. Maior número de pacientes deve ser observado durante tempo prolongado para avaliação da eficácia do procedimento.The "maze" procedure for surgical treatment of chronic atrial fibrillation (AF described by Cox was performed in 9 patients from July 91 to May 92; 7 were female and the ages range from 37 to 63y (51,4y. Eight patients had surgical rheumatic valve disfunction (mitral stenosis in 6; mitral double disfunction in 2 being 1 with associated tricuspid regurgitation and 1 had recurrent paroxicistic AF with no valve disfunction. Surgical treatment was performed following the technique described by Cox and the surgery was completed with 6 mitral comissurotomies and 2 mitral valve replacements. Three patients had left atrial thrombosis. There were no immediate deaths and 1 patient died in the 45th day with infeccious complications. The first patient required reoperation for bleeding review. Second and 3rd patients presented transitory atrial tachycardia in 3rd and 5th day, controlled with intravenous amiodarone. No other complications were observed. In a mean follow up period of 5,4m (1 to 10 m, all patients were in regular atrial rhythm without antiarrhythmic drugs. Effective atrial contraction was demonstrated by ECHO in all patients and no one returned to AF. In conclusion, this initial follow up showed good results in

  9. CONDUCTO ALVEOLAR INFERIOR. CORRELATO ANATOMO-IMAGENOLOGICO E IMPLICANCIA EN LOS PROCEDIMIENTOS QUIRURGICOS DE MANDIBULA. Inferior alveolar canal. Imaginological anatomical correlation and implication in jaw surgical procedures

    Directory of Open Access Journals (Sweden)

    Andrés C Limardo

    2016-03-01

    Full Text Available Introducción: Las lesiones iatrogénicas del nervio dentario inferior son complicaciones documentadas de diversos procedimientos quirúrgicos en la mandíbula. Debido a ello se justifica una descripción más detallada con referencias morfométricas de dicho conducto, como así también una correlación con imágenes. Materiales y métodos: Se realizó un estudio descriptivo observacional con una muestra de 44 hemimandíbulas secas y 100 tomografías computadas de mandíbulas de pacientes al azar. Se realizaron mediciones del foramen mandibular y mentoniano con respecto a bordes mandibulares. Se hicieron cortes en la rama y el cuerpo con sus respectivas mediciones. Se utilizaron Tomografías Computadas Cone Beam 3D de 100 pacientes las cuales fueron procesadas por el programa Compudent Navigator 3D®. Utilizando este programa se pudieron realizar las mismas mediciones que en los preparados anatómicos, como así también la reconstrucción del conducto. En una segunda etapa se realizó una correlación entre los valores morfométricos del estudio anatómico y se comparó con los estudios por imágenes (TC con reconstrucción 3D Dental Scan. Resultados: Se expresaron en tablas con diversas variables. Discusión: Los textos clásicos de anatomía y los libros de cirugía de la especialidad describen en detalle el recorrido y las relaciones del CAI, y presentan datos morfométricos pero no lo hacen en poblaciones locales. Como conclusión podemos afirmar que, tomando como punto de partida la anatomía y correlacionándola con la imagenologia, podemos llegar a evitar lesiones del nervio alveolar inferior en el transcurso de diversos procedimientos realizados en la mandíbula. Introduction: Iatrogenic inferior alveolar nerve injuries are documented complications of different surgical procedures in the jaw. It should justify a more detailed description with morphometric references of the duct and a correlation with images. Materials and method: A

  10. Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations

    Directory of Open Access Journals (Sweden)

    Alexandre Pompeo

    2013-07-01

    Full Text Available Purpose To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL in the management of patients with indication for inguinal lymphadenectomy. Surgical Technique: VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly. A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. Results: A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. Conclusion: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.

  11. Surgical treatment of the accessory navicular syndrome with simple excision%单纯副舟骨切除术治疗足副舟骨疼痛综合征疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴超群; 张远金

    2011-01-01

    Objective To observe and evaluate the clinical efficacy of surgical treatment for the accessory navicular syndrome with improved surgical treatment of Vice Kinder. Methods 27 patients ( 33 feet ) were treated with of Vice Kinder operation. The foot was immobilized with cast or brace in inversion position and no weight bearing for 2 weeks. Follow-up evaluation of patients were done with symptomatic relief and recovery activities. Results The hospital stay was 2-5 days and no wound infection occurred. The average clinical follow-up was 3 to 19 months. The excellent results in 27 feet and good in 6 feet. Conclusions Surgical treatment of congenital accessory navicular syndrome with simple excision has the advantages of less invasion to the posterior tibial tendon and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results.%目的 观察及评价单纯副舟骨切除术治疗足副舟骨疼痛综合征的临床疗效.方法 对27例足副舟骨疼痛综合征患者33足采用单纯副舟骨切除术治疗,术后佩戴内翻位支具2周扶双拐不负重活动.随访评估患者症状缓解程度及活动恢复情况.结果 患者住院时间2~5 d,无切口感染.27例均获随访,时间3~19个月.症状完全消失27足,症状大部分缓解6足.结论 单纯副舟骨切除术治疗足副舟骨疼痛综合征,对胫后肌腱损伤小,不干扰足底内侧纵弓,住院时间短,术后无须长期制动,临床效果好.

  12. Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures.

    Science.gov (United States)

    Bohl, Daniel D; Russo, Glenn S; Basques, Bryce A; Golinvaux, Nicholas S; Fu, Michael C; Long, William D; Grauer, Jonathan N

    2014-12-03

    There has been an increasing use of national databases to conduct orthopaedic research. Questions regarding the validity and consistency of these studies have not been fully addressed. The purpose of this study was to test for similarity in reported measures between two national databases commonly used for orthopaedic research. A retrospective cohort study of patients undergoing lumbar spinal fusion procedures during 2009 to 2011 was performed in two national databases: the Nationwide Inpatient Sample and the National Surgical Quality Improvement Program. Demographic characteristics, comorbidities, and inpatient adverse events were directly compared between databases. The total numbers of patients included were 144,098 from the Nationwide Inpatient Sample and 8434 from the National Surgical Quality Improvement Program. There were only small differences in demographic characteristics between the two databases. There were large differences between databases in the rates at which specific comorbidities were documented. Non-morbid obesity was documented at rates of 9.33% in the Nationwide Inpatient Sample and 36.93% in the National Surgical Quality Improvement Program (relative risk, 0.25; p databases in the rates at which specific inpatient adverse events were documented. Sepsis was documented at rates of 0.38% in the Nationwide Inpatient Sample and 0.81% in the National Surgical Quality Improvement Program (relative risk, 0.47; p database studies become more prevalent in orthopaedic surgery, authors, reviewers, and readers should view these studies with caution. This study shows that two commonly used databases can identify demographically similar patients undergoing a common orthopaedic procedure; however, the databases document markedly different rates of comorbidities and inpatient adverse events. The differences are likely the result of the very different mechanisms through which the databases collect their comorbidity and adverse event data. Findings highlight

  13. Comparison of surgical procedures for vascular and airway anastomoses that utilize a modified non-suture external cuff technique for experimental lung transplantation in rats.

    Science.gov (United States)

    Mizobuchi, Teruaki; Sekine, Yasuo; Yasufuku, Kazuhiro; Fujisawa, Takehiko; Wilkes, David S

    2004-07-01

    Lung transplantation in rats is technically difficult and results may vary. The non-suture cuff technique (non-suture [NS]), which involves using a cuff for anastomoses of vessels and airways, is commonly utilized to perform transplant procedures. However, the standard bronchial cuff may occlude the lumen, resulting in diminished graft survival. In contrast, the non-suture cuff technique for vascular anastomoses with bronchial suturing (bronchial suture [BS]), although more technically difficult, is known to have prolonged bronchial patency. We developed a "modified" NS technique that uses a larger and longer cuff for anastomoses and compared the efficacy of this procedure to the BS technique for lung transplantation. The BS procedure was performed in 146 transplant procedures. The modified NS procedure, which uses a larger cuff than the standard NS procedure, was performed in 113 procedures. Although total ischemic times were comparable, the total operation time in the NS group was significantly shorter than in the BS group (p technique is widely acknowledged to provide prolonged patency of bronchial anastomosis, graft survival in the NS group was observed up 17 months post-transplant. These data show that the NS technique, which is less technically difficult, results in shorter operative times compared with the BS procedure, and results in durable anastomoses of lung grafts.

  14. Fast and simple procedure for fractionation of zinc in soil using an ultrasound probe and FAAS detection. Validation of the analytical method and evaluation of the uncertainty budget.

    Science.gov (United States)

    Leśniewska, Barbara; Kisielewska, Katarzyna; Wiater, Józefa; Godlewska-Żyłkiewicz, Beata

    2016-01-01

    A new fast method for determination of mobile zinc fractions in soil is proposed in this work. The three-stage modified BCR procedure used for fractionation of zinc in soil was accelerated by using ultrasounds. The working parameters of an ultrasound probe, a power and a time of sonication, were optimized in order to acquire the content of analyte in soil extracts obtained by ultrasound-assisted sequential extraction (USE) consistent with that obtained by conventional modified Community Bureau of Reference (BCR) procedure. The content of zinc in extracts was determined by flame atomic absorption spectrometry. The developed USE procedure allowed for shortening the total extraction time from 48 h to 27 min in comparison to conventional modified BCR procedure. The method was fully validated, and the uncertainty budget was evaluated. The trueness and reproducibility of the developed method was confirmed by analysis of certified reference material of lake sediment BCR-701. The applicability of the procedure for fast, low costs and reliable determination of mobile zinc fraction in soil, which may be useful for assessing of anthropogenic impacts on natural resources and environmental monitoring purposes, was proved by analysis of different types of soil collected from Podlaskie Province (Poland).

  15. Development of a simple proton nuclear magnetic resonance-based procedure to estimate the approximate distribution coefficient at physiological pH (logD7.4)

    DEFF Research Database (Denmark)

    Stéen, E Johanna L; Nyberg, Nils; Lehel, Szabolcs

    2017-01-01

    In drug discovery, lipophilicity is a key parameter for drug optimization. Lipophilicity determinations can be both work and time consuming, especially for non-UV active compounds. Herein, an improved and simple 1H NMR-based method is described to estimate the lipophilicity at physiological pH (l...

  16. SURGICAL OUTCOME OF TRIPLE PROCEDURE AS PENETRATING KERATOPLASTY WITH EXTRACAPSULAR CATARACT EXTRACTION WITH POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION IN PATIENTS WITH BOTH CENTRAL CORNEAL OPACITY AND ADVANCED CATARACT AT RURAL SET UP

    Directory of Open Access Journals (Sweden)

    Shubhangi Nigwekar, Kishor Badhe, Neeta Misra, Surekha Bangal

    2015-10-01

    Full Text Available Purpose: To study the surgical outcome of triple procedure as penetrating keratoplasty (PKP with conventional extra capsular cataract extraction (ECCE with posterior chamber intraocular lens (PCIOL implantation in patients with both central corneal opacity and advanced cataract at rural set up. Introduction: When corneal opacity and cataract present together then well-established and effective triple procedure is indicated. Prognosis for a clear graft is good in triple, as graft endothelium does not touch the hard nucleus which may occur in two steps or sequential surgery. It provides faster visual rehabilitation. Being single step procedure it reduces patient’s hospital stay, postoperative care and follows up visits. Methodology: In this hospital based observational , three years longitudinal study, we studied the surgical outcome of relatively rare one step triple procedure as PKP with conventional ECCE with PCIOL implantation in sulcus or in bag, in patients with both central corneal opacity and advanced cataract at rural set up. The outcome measures included graft clarity on slit lamp, postoperative unaided visual acuity with Snellen’s chart and the occurrence of postoperative complications after taking IEC permission and informed written consent in local language from study patients. Results: Out of 13 study patients mean age was 61.15yrs (Range50-80yrs. Follow up range was 9-34 months. At final follow up 9 patients (69.23% had clear grafts and 61.52% patients gained visual acuity >6/24. Graft failure was the most common post operative complication in 30.76% followed by Posterior capsular opacification (PCO in 15.38% patients which was treated well with YAG laser capsulotomy. Conclusion: Triple procedure gives good results in respect to graft clarity, unaided vision, and faster rehabilitation.

  17. Preventing surgical site infection. Where now?

    LENUS (Irish Health Repository)

    Humphreys, H

    2009-12-01

    Surgical site infection (SSI) is increasingly recognised as a measure of the quality of patient care by surgeons, infection control practitioners, health planners and the public. There is increasing pressure to compare SSI rates between surgeons, institutions and countries. For this to be meaningful, data must be standardised and must include post-discharge surveillance (PDS) as many superficial SSIs do not present to the original institution. Further work is required to determine the best method of conducting PDS. In 2008 two important documents on SSI were published from the Society for Healthcare Epidemiology of America\\/The Infectious Disease Society of America and the National Institute for Health and Clincal Excellence, UK. Both emphasise key aspects during the preoperative, operative and postoperative phases of patient care. In addition to effective interventions known to be important for some time, e.g. not shaving the surgical site until the day of the procedure, there is increasing emphasis on physiological parameters, e.g. blood glucose concentrations, oxygen tensions and body temperature. Laparoscopic procedures are increasingly associated with reduced SSI rates, and the screening and decontamination of meticillin-resistant Staphylococcus aureus carriers is effective for certain surgical procedures but has to be balanced by cost and the risk of mupirocin resistance. Finally, there is a need to convert theory into practice by the rigorous application of SSI healthcare bundles. Recent studies suggest that, with a multidisciplinary approach, simple measures can be effective in reducing SSI rates.

  18. Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over three years

    OpenAIRE

    2011-01-01

    Abstract Objectives: To evaluate the extent of bone fill over three years following surgical treatment of peri-implantitis with bone grafting with or without a membrane. Material & Methods: In a non-submerged wound healing mode, 15 subjects with 27 implants were treated with a bone substitute (Algipore?) alone, and 17 subjects with 29 implants were treated with the bone substitute and a resorbable membrane (Osseoquest?). Implants with radiographic bone loss ?1.8 mm following the...

  19. Clear & Simple

    Science.gov (United States)

    ... Cultural Respect Language Access Talking to Your Doctor Research Underway Plain Language Clear & Simple What is Clear & Simple? Clear & Simple ... schedule? A: Pretesting need not be an elaborate, time-consuming research project and depends on: How quickly you work, ...

  20. A Simple Laparoscopic Procedure to Restore a Normal Vaginal Length After Colpohysterectomy With Large Upper Colpectomy for Cervical and/or Vaginal Neoplasia.

    Science.gov (United States)

    Leblanc, Eric; Bresson, Lucie; Merlot, Benjamin; Puga, Marco; Kridelka, Frederic; Tsunoda, Audrey; Narducci, Fabrice

    2016-01-01

    Colpohysterectomy is sometimes associated with a large upper colpectomy resulting in a shortened vagina, potentially impacting sexual function. We report on a preliminary experience of a laparoscopic colpoplasty to restore a normal vaginal length. Patients with shortened vaginas after a laparoscopic colpohysterectomy were considered for a laparoscopic modified Davydov's procedure to create a new vaginal vault using the peritoneum of the rectum and bladder. From 2010 to 2014, 8 patients were offered this procedure, after informed preoperative consent. Indications were 2 extensive recurrent vaginal intraepithelial neoplasias grade 3 and 6 radical hysterectomies for cervical cancer. Mean vaginal length before surgery was 3.8 cm (standard deviation, 1.6). Median operative time was 50 minutes (range, 45-90). Blood loss was minimal (50-100 mL). No perioperative complications occurred. Median vaginal length at discharge was 11.3 cm (range, 9-13). Sexual intercourse could be resumed around 10 weeks after surgery. At a median follow-up of 33.8 months (range, 2.4-51.3), 6 patients remained sexually active but 2 had stopped. Although this experience is small, this laparoscopic modified Davydov's procedure seems to be an effective procedure, adaptable to each patient's anatomy. If the initial postoperative regular self-dilatation is carefully observed, vaginal patency is durably restored and enables normal sexual function.

  1. A rapid and simple DNA extraction procedure to detect Salmonella spp. and Listeria monocytogenes from fresh produce using real-time PCR

    Science.gov (United States)

    DNA isolation procedures significantly influence the outcome of PCR-based detection of human pathogens. Unlike clinical samples, DNA isolation from food samples such as fresh and fresh-cut produce has remained a formidable task and has hampered the sensitivity and accuracy of molecular methods. We...

  2. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  3. [Endoscopic percutaneous gastrostomy. A non-surgical method of enteral alimentation in ORL patients unable to feed orally].

    Science.gov (United States)

    Girodet, J; Vedrenne, J B; Salmon, R J; Rodriguez, J; Esteve, M; Guillaume, A; Brugere, J

    1988-01-01

    Since surgical gastrostomy is not a risk-free operation in debilitated patients, a method of endoscopic percutaneous gastrostomy (EPG) is proposed. A thread is passed percutaneously into the gastric cavity and brought to the exterior through the mouth during fibroscopy. This thread allows removal of a gastrostomy tube by simple traction. Used in 18 patients with ENT cancer the EPG was simple to perform, postoperative complications being minor in 3 cases and serious in one patient. In the absence of any obstacle in the pharyngeal channel preventing the passage of a fibroscope, EPG is a simple procedure and is therefore an alternative to surgical gastrostomy.

  4. Crown lengthening: a surgical flap approach.

    Science.gov (United States)

    Lundergan, W; Hughes, W R

    1996-09-01

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

  5. Development of a simple extraction and clean-up procedure for determination of organochlorine pesticides in soil using gas chromatography-tandem mass spectrometry.

    Science.gov (United States)

    Rashid, A; Nawaz, S; Barker, H; Ahmad, I; Ashraf, M

    2010-04-23

    A procedure based on QuEChERS extraction and a simultaneous liquid-liquid partition clean-up was developed. The procedure involved extraction of hydrated soil samples using acetonitrile and clean-up by liquid-liquid partition into n-hexane. The hexane extracts produced were clean and suitable for determination using gas chromatography-tandem mass spectrometry (GC-MS/MS). The method was validated by analysis of soil samples, spiked at five levels between 1 and 200 microg kg(-1). The recovery values were generally between 70 and 100% and the relative standard deviation values (%RSDs) were at or below 20%. The procedure was validated for determination of 19 organochlorine (OC) pesticides. These were hexachlorobenzene (HCB), alpha-HCH, beta-HCH, gamma-HCH, heptachlor, heptachlor epoxide (trans), aldrin, dieldrin, chlordane (trans), chlordane (cis), oxychlordane, alpha-endosulfan, beta-endosulfan, endosulfan sulfate, endrin, p,p'-DDT, o,p'-DDT, p,p'-DDD and p,p'-DDE. The method achieved low limits of detection (LOD; typically 0.3 microg kg(-1)) and low limits of quantification (LOQ; typically 1.0 microg kg(-1)). The method performance was also assessed using five fortified soil samples with different physico-chemical properties and the method performance was consistent for the different types of soil samples. The proposed method was compared with an established procedure based on Soxtec extraction. This comparison was carried out using six soil samples collected from regions of Pakistan with a history of intensive pesticide use. The results of this comparison showed that the two procedures produced results with good agreement. The proposed method produced cleaner extracts and therefore led to lower limits of quantification. The proposed method was less time consuming and safer to use. The six samples tested during this comparison showed that soils from cotton growing regions contained a number of persistent OC residues at relatively low levels (<10 microg kg(-1)). These

  6. New method to discriminate between cathepsin B and cathepsin L in crude extracts from fish muscle based on a simple acidification procedure

    DEFF Research Database (Denmark)

    Godiksen, Helene; Nielsen, Henrik Hauch

    2007-01-01

    A new and simple method to distinguish between cathepsin B and cathepsin L in crude extracts of herring (Clupea harengus) muscle has been established. An acid treatment of crude extracts (exposed to pH 3 for 5 min) activated a latent form of cathepsin L and inactivated cathepsin B. Furthermore......). Cathepsin B activity is measured in neutral extract using the specific cathepsin B substrate Z-Arg-Arg-MCA and cathepsin L activity is measured in acid-treated extract with Z-Phe-Arg-MCA as substrate. The specific cathepsin B inhibitor, CA-074, did not inhibit the Z-Arg-Arg-MCA significantly without...

  7. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25 cmH₂O: prospective, blind, and randomised study.

    Science.gov (United States)

    Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH₂O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH₂O, L group) and high (at 60 cmH₂O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH₂O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

  8. Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 cmH2O: Prospective, Blind, and Randomised Study

    Directory of Open Access Journals (Sweden)

    Joo-Eun Kang

    2014-01-01

    Full Text Available To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA manufacturers recommend maximum cuff pressures not exceeding 60 cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH2O, L group and high (at 60 cmH2O, H group LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU (postoperative day 1, POD 1 and 24 hours after discharge from PACU (postoperative day 2, POD 2. All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2 were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

  9. Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 cmH2O: Prospective, Blind, and Randomised Study

    Science.gov (United States)

    Kang, Joo-Eun; Choi, Jae Won; Son, Il Soon

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH2O, L group) and high (at 60 cmH2O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334. PMID:24778598

  10. Head-camera video recordings of trauma core competency procedures can evaluate surgical resident's technical performance as well as colocated evaluators.

    Science.gov (United States)

    Mackenzie, Colin F; Pasley, Jason; Garofalo, Evan; Shackelford, Stacy; Chen, Hegang; Longinaker, Nyaradzo; Granite, Guinevere; Pugh, Kristy; Hagegeorge, George; Tisherman, Samuel A

    2017-07-01

    Unbiased evaluation of trauma core competency procedures is necessary to determine if residency and predeployment training courses are useful. We tested whether a previously validated individual procedure score (IPS) for individual procedure vascular exposure and fasciotomy (FAS) performance skills could discriminate training status by comparing IPS of evaluators colocated with surgeons to blind video evaluations. Performance of axillary artery (AA), brachial artery (BA), and femoral artery (FA) vascular exposures and lower extremity FAS on fresh cadavers by 40 PGY-2 to PGY-6 residents was video-recorded from head-mounted cameras. Two colocated trained evaluators assessed IPS before and after training. One surgeon in each pretraining tertile of IPS for each procedure was randomly identified for blind video review. The same 12 surgeons were video-recorded repeating the procedures less than 4 weeks after training. Five evaluators independently reviewed all 96 randomly arranged deidentified videos. Inter-rater reliability/consistency, intraclass correlation coefficients were compared by colocated versus video review of IPS, and errors. Study methodology and bias were judged by Medical Education Research Study Quality Instrument and the Quality Assessment of Diagnostic Accuracy Studies criteria. There were no differences (p ≥ 0.5) in IPS for AA, FA, FAS, whether evaluators were colocated or reviewed video recordings. Evaluator consistency was 0.29 (BA) - 0.77 (FA). Video and colocated evaluators were in total agreement (p = 1.0) for error recognition. Intraclass correlation coefficient was 0.73 to 0.92, dependent on procedure. Correlations video versus colocated evaluations were 0.5 to 0.9. Except for BA, blinded video evaluators discriminated (p competency. Prognostic study, level II.

  11. Surgical sentinel lymph node biopsy in early breast cancer. Could it be avoided by performing a preoperative staging procedure? A pilot study.

    Science.gov (United States)

    Testori, Alberto; Meroni, Stefano; Moscovici, Oana Codrina; Magnoni, Paola; Malerba, Paolo; Chiti, Arturo; Rahal, Daoud; Travaglini, Roberto; Cariboni, Umberto; Alloisio, Marco; Orefice, Sergio

    2012-09-01

    The aim of this pilot trial was to study the feasibility of sentinel node percutaneous preoperative gamma probe-guided biopsy as a valid preoperative method of assessment of nodal status compared to surgical sentinel lymph node biopsy. This prospective study enrolled 10 consecutive patients without evidence of axillary lymph node metastases at preoperative imaging. All patients underwent sentinel node occult lesion localization (SNOLL) using radiotracer intradermic injection that detected a "hot spot" corresponding to the sentinel node in all cases. Gamma probe over the skin detection with subsequent ultrasonographically guided needle biopsy of the sentinel node were performed. The percutaneous needle core histopathological diagnosis was compared to the results of the surgical biopsy. Preoperative sentinel node identification was successful in all patients. The combination of preoperative gamma probe sentinel node detection and ultrasound-guided biopsy could represent a valid alternative to intraoperative sentinel node biopsy in clinically and ultrasonographically negative axillary nodes, resulting in shorter duration of surgery and lower intraoperative risks.

  12. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures

    Directory of Open Access Journals (Sweden)

    Samit Kumar Khutia

    2012-01-01

    Full Text Available Background: Paediatric patients often present with different painful conditions that require immediate surgical interventions. Despite a plethora of articles on the ketamine-propofol combination, comprehensive evidence regarding the suitable sedoanalgesia regime is lacking due to heterogeneity in study designs. Methods: This prospective, randomized, double-blind, active-controlled trial was conducted in 100 children, of age 3-14 years, American Society of Anesthesiologist physical status IE-IIE, posted for emergency short surgical procedures. Patients were randomly allocated to receive either 2 mL of normal saline (pre-induction plus calculated volume of drug from the 11 mL of ketamine-propofol solution for induction (group PK, n=50 or fentanyl 1.5 μg/kg diluted to 2 mL with normal saline (pre-induction plus calculated volume of drug from the 11 mL of propofol solution for induction (group PF, n=50. In both the groups, the initial bolus propofol 1 mg/kg i.v. (assuming the syringes contained only propofol, for simplicity was followed by adjusted infusion to achieve a Ramsay Sedation Scale score of six. Mean arterial pressure (MAP was the primary outcome measurement. Results: Data from 48 patients in group PK and 44 patients in group PF were available for analysis. Hypotension was found in seven patients (14.6% in group PK compared with 17 (38.6% patients in group PF (P=0.009. Intraoperative MAP was significantly lower in group PF than group PK when compared with baseline. Conclusion: The combination of low-dose ketamine and propofol is more effective and a safer sedoanalgesia regimen than the propofol-fentanyl combination in paediatric emergency short surgical procedures in terms of haemodynamic stability and lesser incidence of apnoea.

  13. The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus - lessons from projects funded by the World Diabetes Foundation

    DEFF Research Database (Denmark)

    Nielsen, Karoline Kragelund; de Courten, Maximilian; Kapur, Anil

    2012-01-01

    and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective...... analysed using content analysis. Results: The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during...

  14. [The surgical treatment of an aneurysm of the celiac trunk and hepatic artery].

    Science.gov (United States)

    Rodríguez-Camarero, S J; Menéndez, A I; Rodero, J I; Alvarez, J L; Cermeño, B; Viana, M M

    1993-01-01

    We report a case of splenic aneurysms with double location, at the celiac trunks and at the common hepatic artery, in the same patient that was treated by a surgical procedure. We also review literature about the hepatic aneurysms at the celiac trunks, with special attention on the aspects of etiology, natural evolutions and different surgical procedures available. It is remarkable on this kind of pathology that special attention should be paid in order to avoid the simple ligature-exclusion of the aneurysm, it involves realizing an endoaneurysmorrhaphy followed by an aorto-hepatic by-pass.

  15. Evaluation of a simple radionuclide procedure for left-to-right cardiac shunt measurement - correlation with earpiece densitometry and cardiac catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Ziada, G.; Hayat, N.; Jarrad, I.; Uthaman, B.; Abdel-Dayem, H.M.

    1986-08-01

    Measurement of shunts from systemic to pulmonary circulation using a simple radionuclide technique has been introduced at our department. A good bolus of the Technetium-99m sodium pertechnetate at a dose of 200 ..mu..Ci/kg body weight (minimal dose 2 mCi) was injected by way of a scalp vein needle connected to a three-way stopcock, thus permitting immediate flushing of the radioactive bolus dose with physiologic saline solution. An IGE-400A gamma camera with a low-energy, high-sensitivity parallel hole collimator was used. The data were stored for analysis on a Star computer at a rate of 4 frames/second for a 40-second period. Twenty-three patients (aged 3-33 years) underwent first pass radionuclide angiography and cardiac catheterization to estimate the degree of systemic-to-pulmonary shunting (QP/QS) ratio). In 15 of these patients, another non-invasive method, earpiece densitometry (EPD), was done to determine the size of the shunt qualitatively. Fifteen healthy volunteers submitted to first pass studies comprised our control group. Out of the 23 patients with shunts, 15 had simple intra-cardiac septal defects (atrial or ventricular) or patent ductus arteriosus, and 8 had valvular lesions plus shunts. Compared with the oximetry data, EPD resulted in misclassification of 5 out of 15 patients in that left-to-right shunts were interpreted as moderate in 4, i.e. QP/QS 2:1, when in fact they were smaller. The correlation coefficient value of the first pass method for simple defect is r=0.89 (A=0.41 and B=0.85), for combined lesions it is r=0.94 (A=0.1 and B=1.1). The mean value for QP:QS in 15 normal subjects is 1.06:1 (SD=+- 0.05). We conclude that first pass radionuclide angiography is a non-invasive and reliable method for determining QP/QS ratios. Unlike cardiac catheterization, it can be performed rapidly on an out-patient basis. (orig./TRV).

  16. Quantitative multi-element mapping of ancient glass using a simple and robust LA-ICP-MS rastering procedure in combination with image analysis.

    Science.gov (United States)

    Selih, Vid S; van Elteren, Johannes T

    2011-08-01

    The surface of two glass artefacts in mosaic style, probably fragments of conglomerate glass bowls dating back two millennia, was investigated by laser ablation-inductively coupled plasma mass spectrometry (LA-ICP-MS). By rastering with the laser beam over a selected area of the surface of the glass artefacts, elemental oxide maps were generated. Quantification of the elemental oxides in the maps was achieved using a so-called sum normalization procedure, summating the elements-54 in total-as their oxides to 100% (w/w), without using an internal standard and applying only one external standard (NIST SRM glass 610). This results in a robust mapping procedure which automatically corrects for drift and defocusing issues. Sum normalization was applied to each pixel in the map separately and required a custom source code to process all the data in the tens of thousands of pixels to generate the elemental oxide concentration maps. The digital element maps generated upon rastering of the two glass artefacts are very compelling and are an excellent entry point to gain detailed insight into their fabrication and provenance using image analysis software for retrieval of localized elemental oxide concentrations and correlations.

  17. A single simple procedure for dewaxing, hydration and heat-induced epitope retrieval (HIER for immunohistochemistry in formalin fixed paraffin-embedded tissue

    Directory of Open Access Journals (Sweden)

    I.M.S. Paulsen

    2015-11-01

    Full Text Available Heat-induced epitope retrieval (HIER is widely used for immunohistochemistry on formalin fixed paraffin-embedded tissue and includes temperatures well above the melting point of paraffin. We therefore tested whether traditional xylene-based removal of paraffin is required on sections from paraffin-embedded tissue, when HIER is performed by vigorous boiling in 10 mM Tris/0.5 mM EGTA-buffer (pH=9. Immunohistochemical results using HIER with or without prior dewaxing in xylene were evaluated using 7 primary antibodies targeting proteins located in the cytosol, intracellular vesicles and plasma membrane. No effect of omitting prior dewaxing was observed on staining pattern. Semiquantitative analysis did not show HIER to influence the intensity of labelling consistently. Consequently, quantification of immune labelling intensity using fluorescent secondary antibodies was performed at 5 dilutions of primary antibody with and without prior dewaxing in xylene. No effect of omitting prior dewaxing on signal intensity was detectable indicating similar immunoreactivity in dewaxed and non-dewaxed sections. The intensity of staining the nucleus with the DNA-stain ToPro3 was similarly unaffected by omission of dewaxing in xylene. In conclusion, the HIER procedure described and tested can be used as a single procedure enabling dewaxing, hydration and epitope retrieval for immunohistochemistry in formalin fixed paraffin-embedded tissue.

  18. Optimal Surgical Management Using a Classic Blalock-Taussig Shunt for an Infected Pseudoaneurysm After a Modified Blalock-Taussig Shunt Procedure.

    Science.gov (United States)

    Okada, Noritaka; Murayama, Hiroomi; Hasegawa, Hiroki

    2016-05-01

    We present 2 cases of a 3-month-old girl and boy who were diagnosed with an infected pseudoaneurysm 2 months after undergoing left-sided modified Blalock-Taussig shunt (mBTS) operations for pulmonary atresia. Because the shunts in both cases were nearly obstructed, they underwent a 2-stage surgical approach: classic BTS operations through a right thoracotomy to establish sufficient pulmonary flow and infected graft removal through a median sternotomy after close observation of the state of the aneurysms. By utilizing autologous tissue from a different thoracic entry, both patients were successfully managed and recovered without any recurrence of infection. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Stina Öberg

    2016-01-01

    Full Text Available A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video.

  20. Evaluation of medical residents exposed to X-ray during surgical procedures; Avaliacao dos medicos residentes expostos aos raios-X durante procedimentos cirurgicos

    Energy Technology Data Exchange (ETDEWEB)

    Alabarse, F.G.; Leal, R.; Amador, G.B.; Bacelar, A. [Hospital de Clinicas de Porto Alegre, RS (Brazil). Fisica Medica. Servico de Engenharia Biomedica; Westphal, M.; Furtado, A.P.A. [Hospital de Clinicas de Porto Alegre, RS (Brazil). Fisica Medica. Servico de Radiologia]. E-mail: abacelar@hcpa.ufrgs.br

    2001-07-01

    This work present some evaluations in relation to the Medical Resident that work with X-rays during surgery procedures. The objective is discovery what the staff that make more use of this kind of radiation during their procedures and evaluate the relation with their respective doses. The information was toke during the activities that make some use of X-rays. This information was connected with the respective dose of Medical Resident. The results is that the worker of Medical Resident is the worker that are most in exposure in a surgery unit. The staff that use X-rays with more frequency and have the biggest time in exposure is Orthopedy and Traumathology. The highest dose that they received were of 22,72 mSv, in a Resident of the Urology group. (author)

  1. Impact of the introduction of drug eluting stents on clinical outcomes in patients undergoing percutaneous and surgical coronary artery revascularisation procedures in Western Australia

    OpenAIRE

    Sanfilippo, Frank M; Rankin, Jamie M.; Hobbs, Michael ST; Nguyen, Michael; Knuiman, Matthew W; Berg, Patricia; Whitford, Eric G; Hendriks, Randall; Hockings, Bernard E; Muhlmann, Michael; Newman, Mark; Larbalestier, Robert; Gilfillan, Ian; Briffa, Thomas G

    2013-01-01

    Background Increasing rates of percutaneous coronary intervention (PCI) and decreasing rates of coronary artery bypass graft (CABG) surgery followed the introduction of drug eluting stents in Western Australia in 2002. We assessed the impact of these changes on one-year outcomes for the total population of patients undergoing coronary artery revascularisation procedures (CARP) in Western Australia between 2000-2004. Methods Clinical and linked administrative data (inpatient admissions and dea...

  2. Case report of surgical treatment of abnormal atrial flutter (incisional atrial tachycardia in the patient after mitral valve replacement and radiofrequency modification of Maze procedure

    Directory of Open Access Journals (Sweden)

    Revishvili А. Sh.

    2012-12-01

    Conclusion. This type of tachycardia following after an atrial fibrillation surgery may be considered as a failing transmural myocardial damage during the procedure. The catheter method can be used succesfully unless there are no effects of antiarrhythmic therapy. The catheter method enables not only to verify the disconnection between the left atrial pulmonary veins and left atrium myocardium but also to perform the ablation in zones of the atrial myocardium that are anatomic substrates of post surgery tachyarrhythmias.

  3. Analysis of surgical intervention populations using generic surgical process models.

    Science.gov (United States)

    Neumuth, Thomas; Jannin, Pierre; Schlomberg, Juliane; Meixensberger, Jürgen; Wiedemann, Peter; Burgert, Oliver

    2011-01-01

    According to differences in patient characteristics, surgical performance, or used surgical technological resources, surgical interventions have high variability. No methods for the generation and comparison of statistical 'mean' surgical procedures are available. The convenience of these models is to provide increased evidence for clinical, technical, and administrative decision-making. Based on several measurements of patient individual surgical treatments, we present a method of how to calculate a statistical 'mean' intervention model, called generic Surgical Process Model (gSPM), from a number of interventions. In a proof-of-concept study, we show how statistical 'mean' procedure courses can be computed and how differences between several of these models can be quantified. Patient individual surgical treatments of 102 cataract interventions from eye surgery were allocated to an ambulatory or inpatient sample, and the gSPMs for each of the samples were computed. Both treatment strategies are exemplary compared for the interventional phase Capsulorhexis. Statistical differences between the gSPMs of ambulatory and inpatient procedures of performance times for surgical activities and activity sequences were identified. Furthermore, the work flow that corresponds to the general recommended clinical treatment was recovered out of the individual Surgical Process Models. The computation of gSPMs is a new approach in medical engineering and medical informatics. It supports increased evidence, e.g. for the application of alternative surgical strategies, investments for surgical technology, optimization protocols, or surgical education. Furthermore, this may be applicable in more technical research fields, as well, such as the development of surgical workflow management systems for the operating room of the future.

  4. Robotic simple prostatectomy: A consideration for large prostate adenomas

    Directory of Open Access Journals (Sweden)

    Joshua B. Nething

    2014-12-01

    Full Text Available Background: The management of benign prostatic hyperplasia (BPH has changed considerably over the last several decades. First line treatment of BPH and lower urinary tract symptoms (LUTS with medical therapy has created a population of men with much larger prostate glands, many of whom require surgical intervention. Patients with prostate glands greater than 80 to 100 grams may be better managed surgically with a retropubic prostatectomy. We explore our experience with robotic assisted simple prostatectomy and review the relevant literature. Database: The database reviewed includes our experience with seven patients undergoing robotic simple prostatectomy, and a comprehensive review of the previously published series of this procedure. In addition, the literature pertaining to a pure laparoscopic approach to simple prostatectomy is reviewed. Conclusion: Robotic experience and training has become a standard in resident training programs; while classic transurethral resection is being performed less for large prostate glands. The robotic approach to simple prostatectomy provides an excellent option for surgical treatment of very large prostate glands, providing patients acceptable results in terms of operative time, estimated blood loss, hospital stay and duration of Foley catheter.

  5. The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus – lessons from projects funded by the World Diabetes Foundation

    Directory of Open Access Journals (Sweden)

    Maximilian de Courten

    2012-07-01

    Full Text Available Background: To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM, its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective: This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design: A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results: The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-screening, difficulties with reaching women for testing in

  6. Férula quirúrgica intermedia en cirugía ortognática bimaxilar: Un método simple de obtención Intermediate surgical splint in orthognathic bimaxillary surgery: A simple method for obtaining it

    Directory of Open Access Journals (Sweden)

    J.V. Pascual Gil

    2004-12-01

    Full Text Available La utilización de la férula quirúrgica intermedia (FQI en las intervenciones de cirugía ortognática bimaxilar es un procedimiento habitual. La utilidad, ayuda y confianza que aporta es indiscutible. Sin embargo, el procedimiento clásico de obtención de la FQI es complejo. Proponemos simplificar la fabricación de la FQI sin renunciar a su precisión y fiabilidad. Debemos cuestionar algunos conceptos del método de obtención de esta férula y reflexionar sobre el siguiente concepto básico: la dimensión vertical craneomandibular preoperatoria es igual a la dimensión vertical craneomandibular postoperatoria con la férula en posición. Para confeccionarla se ha diseñado un nuevo dispositivo denominado: Posicionador del maxilar.The employment of the intermediate surgical splint in bimaxillary orthognatic surgery is a common procedure. The utility, aid and confidence which are provided are inquestionable. Anyway the classic procedure of attainment of the splint is complex. We propose to simplify the manufacturing of the splint without renouncing to it´s accuracy and reliability. We must question some concepts about the attainment method of this splint and consider the following basic concept: the vertical preoperatory craneomandibular dimension is the same as the vertical postoperatory craneomandibular dimension with the splint in position. To manufacture it we have designed a new device called: Maxillary Placet.

  7. Retalho em ilha de tubarão: uma técnica cirúrgica reconstrutiva de defeitos localizados na área nasal alar/perialar. Um procedimento simples Shark island pedicle flap for repairing of basal cell carcinoma localized in nasal ala-perialar region: a simple procedure

    Directory of Open Access Journals (Sweden)

    Marisa C André

    2011-08-01

    Full Text Available O Carcinoma Basocelular é a neoplasia cutânea mais frequente. Os autores descrevem uma técnica realizada unicamente num tempo operatório para correção de defeitos na asa do nariz após excisão tumoral. Esta técnica simples permite a correção cirúrgica de defeitos nesta localização possibilitando a reconstrução da anatomia local e a preservação das unidades cosméticas, sem a necessidade de enxertoBasal Cell Carcinoma is the most common skin cancer. We describe a single-staged technique for correction of nasal ala defect after the excision of a basal cell carcinoma. This technique allows correction of surgical defects of the ala rebuilding the original anatomy, maintaining cosmetic units, without need for a graft

  8. Occurrence of selected trace metals and their oral bioaccessibility in urban soils of kindergartens and parks in Bratislava (Slovak Republic) as evaluated by simple in vitro digestion procedure.

    Science.gov (United States)

    Hiller, Edgar; Mihaljevič, Martin; Filová, Lenka; Lachká, Lucia; Jurkovič, Ľubomír; Kulikova, Tatsiana; Fajčíková, Katarína; Šimurková, Mária; Tatarková, Veronika

    2017-10-01

    A total of eighty surface soil samples were collected from public kindergartens and urban parks in the city of Bratislava, and the bioaccessibilities, non-carcinogenic and carcinogenic health risks to children, and lead isotopic composition. The mean metal concentrations in urban soils (0.29, 36.1, 0.13, 30.9 and 113mg/kg for Cd, Cu, Hg, Pb and Zn, respectively) were about two times higher compared with background soil concentrations. The order of bioaccessible metal fractions determined by Simple Bioaccessibility Extraction Test was: Pb (59.9%) > Cu (43.8%) > Cd (40.8%) > Zn (33.6%) > Hg (12.8%). Variations in the bioaccessible metal fractions were mainly related to the total metal concentrations in urban soils. A relatively wide range of lead isotopic ratios in urban soils (1.1598-1.2088 for (206)Pb/(207)Pb isotopic ratio) indicated a combination of anthropogenic and geogenic sources of metals in the soils. Lower values of (206)Pb/(207)Pb isotopic ratio in the city centre and similar spatial distribution of total metal concentrations, together with their increasing total concentrations in soils towards the city centre, showed that traffic and coal combustion in former times were likely the major sources of soil contamination. The non-carcinogenic and carcinogenic health risks to children due to exposure to metals in kindergarten and urban park soils were low, with hazard index and cancer risk values below the threshold values at all studied sites. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Simple machines

    CERN Document Server

    Graybill, George

    2007-01-01

    Just how simple are simple machines? With our ready-to-use resource, they are simple to teach and easy to learn! Chocked full of information and activities, we begin with a look at force, motion and work, and examples of simple machines in daily life are given. With this background, we move on to different kinds of simple machines including: Levers, Inclined Planes, Wedges, Screws, Pulleys, and Wheels and Axles. An exploration of some compound machines follows, such as the can opener. Our resource is a real time-saver as all the reading passages, student activities are provided. Presented in s

  10. Ligation device of Circumcision Versus Conventional surgical procedures:Comparison of clinical effectiveness%成人包皮套扎术与环切术的疗效比较

    Institute of Scientific and Technical Information of China (English)

    翁海兵; 钱声华(通讯作者); 沈银奎; 孙小春

    2013-01-01

    目的:对比分析成人包皮套扎术和传统手术的疗效。方法:包皮环切术180例,按时间分为包皮套扎术组(90例)和传统手术组(90例),比较手术时间、术中失血量、疼痛评分及术后外观满意度、愈合时间等。结果:手术均顺利,一次性包皮套扎术组手术时间5~15(平均10)分钟,包皮过长者无出血,包茎者剪开背侧时少许出血,内板较均匀一致,内板长度6~10(平均8)mm,内板两侧相差1~3(平均1.5)mm,细带完全保留,愈合时间术后2~3周;传统手术组手术时间20~35(平均30)分钟;内板长度4~15(平均9)mm,两侧内板相差2~9(平均3.5)mm,愈合时间术后7~10(平均8)天,均有统计学意义。结论:一次性包皮环切套扎器行包皮环切术是对传统包皮环切术的简化和改进,具有手术时间短、术中出血量少、疼痛轻、术后外观满意度高。患者易于接受等优点。%Objective:to compare the efficacy and complications of the ligation device of circumcision with conventional surgical procedures. Methods:A total of 180 patients, 140 with redundant prepuce and 40 with phimosis were randomly assigned to receive the ligation device of circumcision (n=90) and conventional surgical procedures (n=90). Comparisons were made between the two groups in the surgical duration, blood loss, pain score, the wounds healed, as wel as postoperative complications satisfaction with the penile appearance, and the quality of sexual life. Results:The surgical duration ,blood loss were 5~15(average 10)min ,0.8~4.4(average 2,60)ml in the ligation device group as compared with 20~35(average 30)min, 8~15(average 11.5)ml in the conventional surgery group. The wounds healed were 2~3weeks after circumcision, with wel-smoothed incision and good cosmetic results. as compared with7~10(average 8)days. Conclusion: Compared with the conventional surgical procedures, the ligation device of

  11. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  12. The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts—A Review of a Surgical Technique

    Directory of Open Access Journals (Sweden)

    Christopher Riben

    2012-01-01

    Full Text Available Background. Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation. Aim. To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique. Methods. The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles. Results. A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies. Conclusion. All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed.

  13. A study of the influence on diabetes of free and conjugated bisphenol A concentrations in urine: Development of a simple microextraction procedure using gas chromatography-mass spectrometry.

    Science.gov (United States)

    Pastor-Belda, Marta; Bastida, David; Campillo, Natalia; Pérez-Cárceles, María D; Motas, Miguel; Viñas, Pilar

    2016-09-10

    The association between bisphenol A (BPA) exposure and adult health status is examined by measuring the urinary BPA concentration using a miniaturized technique based on dispersive liquid-liquid microextraction (DLLME) in combination with gas chromatography-mass spectrometry (GC-MS). Both the free bioactive and the glucuronide conjugated forms of BPA were measured, the glucuronide form usually being predominant. The main analogs of BPA, including bisphenol Z (BPZ), bisphenol F (BPF) and biphenol (BP) were also determined. Several parameters affecting enzymatic hydrolysis, derivatization by in-situ acetylation and the DLLME stages were carefully optimized by means of multivariate designs. DLLME parameters were 2mL urine, 1mL acetone and 100μL chloroform, and hydrolysis was performed using β-glucuronidase and sulfatase at pH 5. No matrix effect was observed and quantification was carried out by aqueous calibration with a surrogate standard. Detection limits were in the range 0.01-0.04ngmL(-1). The intraday and interday precisions were lower than 11% in terms of relative standard deviation. Satisfactory values for all compounds were obtained in recovery studies (92-117%) at two concentration levels. Other bisphenols (BPF, BPZ and BP) were not detected in the urine samples, while BPA was the only bisphenol detected in the free form (creatinine adjusted) at concentration levels ranging from the detection limit to 15.9ngg(-1), and total BPA was detected at concentrations ranging from 0.46 to 24.5ngg(-1) levels. A comparison of the BPA content for both groups of patients revealed that slightly higher mean values were obtained for both free BPA and total BPA for diabetic patients, than for non-diabetic patients. However, a statistical comparison of the contents of BPA revealed that there were no significant differences. The procedure was validated using a certified reference material. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Rapid detection of Pneumocystis carinii in bronchoalveolar lavage specimens from human immunodeficiency virus-infected patients: use of a simple DNA extraction procedure and nested PCR.

    Science.gov (United States)

    Rabodonirina, M; Raffenot, D; Cotte, L; Boibieux, A; Mayençon, M; Bayle, G; Persat, F; Rabatel, F; Trepo, C; Peyramond, D; Piens, M A

    1997-11-01

    We report on the development of a rapid nested PCR protocol for the detection of Pneumocystis carinii DNA in bronchoalveolar lavage (BAL) specimens in which the protocol included the use of a commercially available DNA extraction kit (GeneReleaser). GeneReleaser enabled us to obtain amplification-ready DNA within 20 min without requiring the purification of the DNA. The nested PCR was performed with the primers pAZ102-E, pAZ102-H, and pAZ102-L2 (A. E. Wakefield, F. J. Pixley, S. Banerji, K. Sinclair, R. F. Miller, E. R. Moxon, and J. M. Hopkin, Lancet 336:451-453, 1990.). Results were obtained in about 4 h with the adoption of denaturation, annealing, and extension steps shortened to 20 seconds. The sensitivity of the nested PCR was tested with a P. carinii cyst suspension and was found to be less than one cyst (one to eight nuclei). The detection limit was the same with the use of GeneReleaser or proteinase K-phenol chloroform for DNA extraction. The nested PCR assay was prospectively compared with staining with Giemsa and methenamine silver stains for the detection of P. carinii in 127 BAL samples from 105 human immunodeficiency virus-infected patients investigated for acute respiratory illness. Twenty-five BAL specimens (20%) were positive by staining and the nested PCR and 25 (20%) were negative by staining and positive by the nested PCR. These 25 BAL specimens with conflicting results were obtained from 23 patients, 82% of whom were receiving prophylactic therapy against P. carinii pneumonia (PCP). Only two patients were diagnosed with possible PCP. The final diagnosis was not PCP for 20 patients who were considered to be colonized or to have a low level of infection. This colonization is not of clinical importance but is of epidemiological importance. Our rapid, simple, and sensitive amplification protocol may be performed in clinical laboratories for the routine diagnosis of PCP with BAL specimens.

  15. Tratamento híbrido com endoprótese não recoberta nas dissecções agudas da aorta tipo A New surgical strategy for acute type A aortic dissection: hybrid procedure

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2007-12-01

    Full Text Available O tratamento da dissecção aguda da aorta tipo A de Stanford, com a utilização de um novo dispositivo (stent de aorta não recoberto em associação à interposição de tubo supracoronariano para a substituição da aorta ascendente e hemiarco permitem que o arco aórtico e porção da aorta descendente sejam tratados, sem acrescentar complexidade ao procedimento operatório, nem prolongar o tempo de isquemia cerebral ou sistêmica.The new surgical strategy to treat patients with acute type A aortic dissection, the hybrid procedure with an uncovered aortic stent, allows surgeons to treat the aortic arch and the proximal descending aorta, besides the ascending segment, without extension of cerebral or systemic ischemia.

  16. Incisão periauricular para operações da glândula parótida Periauricular incision for surgical procedures on the parotid gland

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2010-12-01

    Full Text Available RACIONAL: As incisões mais comuns para parotidectomia consistem em abertura pré ou periauricular prolongadas para a região submandibular ou cervical. Elas podem acompanhar-se de cicatrizes imperfeitas, provocando deformidades cutâneas locais. OBJETIVO: Avaliar o tratamento de afecções cirúrgicas parotídeas através de incisão periauricular apenas. MÉTODO: Foram estudados 39 pacientes consecutivos com moléstias da parótida. Adenoma pleomórfico (20 casos foi a afecção mais encontrada, seguida por outros tumores benignos (9 casos, carcinomas (5 casos, cisto parotídeo (3 casos e parotidite crônica (2 casos. Todas as parotidectomias foram realizadas através de incisão periauricular. Em presença de carcinoma, a linfadenectomia cervical foi conduzida por meio de incisão cervical transversa supra-hióidea homolateral. RESULTADO: A remoção da afecção parotídea foi possível em todos os casos sem incisão cutânea complementar. Todas as cicatrizes tiveram bom resultado estético e, após seis meses, elas estavam quase imperceptíveis. Os pacientes revelaram satisfação com o resultado da operação. Fraqueza facial temporária ocorreu em 28 operações. Desconforto auricular transitório foi registrado em 22 pacientes. Todos tiveram hipoestesia da região operada, que perdurou por até seis meses. As complicações encontradas neste trabalho estão descritas na literatura como esperadas em parotidectomia, independentemente do tipo de incisão. CONCLUSÃO: A incisão periauricular é opção boa e estética para abordagem cirúrgica da glândula parótida.BACKGROUND: The most common incisions for parotidectomy consist of opening or pre periauricular extended to the submandibular or cervical region. They can accompany themselves ragged scars, causing local skin deformities. AIM: The purpose of this study was to evaluate the treatment of parotid surgical diseases using periauricular incision. METHOD: Thirty nine patients with

  17. Index of consciousness and bispectral index values are interchangeable during normotension and hypotension but not during non pulsatile flow state during cardiac surgical procedures: a prospective study.

    Science.gov (United States)

    Chakravarthy, Murali; Holla, Srinivasa; Jawali, Vivek

    2010-04-01

    Awareness under anesthesia is an avoidable complication during general anesthesia. Anesthetic depth monitors assist anesthesiologists in providing appropriate levels of anesthesia. Index of consciousness monitoring is a recently introduced monitor in the array of anesthesia depth monitors. The objective of this study was to assess the interchangeability of bispectral index, which is already in clinical use and the recently introduced index of consciousness techniques. The other objective was to assess this interchangeability during normotension, hypotension and during pulseless state in patients undergoing coronary artery bypass graft surgery. This study is a prospective observational study, conducted in a tertiary referral hospital. Fifteen cardiac surgical patients undergoing off pump and conventional coronary artery bypass under cardiopulmonary bypass participated in the study. Bispectral index and index of consciousness monitoring were carried out simultaneously during various stages of consciousness, and assessed for interchangeability. Bland Altman plotting and 'mountain plot' were used to assess the interchangeability. Eleven in the cohort underwent off pump and the rest (n = 4) conventional coronary artery bypass surgery under cardiopulmonary bypass. A set of 887 data were obtained during the study period. The data were classified as those obtained during normotension, hypotension and pulseless state during cardiopulmonary bypass. 732 sets of data were obtained during normotension, 84 during hypotension and 71 during cardiopulmonary bypass. Overall interchangeability was good, suggested by low bias (0.96), high precision (0.54), r value of 0.7 and P value of consciousness values may be interchangeable. The interchangeability is better appreciated during normotension and hypotension but not during non pulsatile state of cardiopulmonary bypass.

  18. Effectiveness of cyanoacrylate microbial sealant in the reduction of surgical site infection in gynecologic oncology procedures: A phase III single institution prospective randomized trial.

    Science.gov (United States)

    Thomas, Eric D; Nugent, Elizabeth K; MacAllister, Matthew C; Moxley, Katherine M; Landrum, Lisa; L Walker, Joan; McMeekin, D S; Mannel, Robert S; McGwin, Gerald; Moore, Kathleen N

    2017-01-01

    Surgery is a cornerstone for patients with gynecologic malignancies. Surgical site infections (SSI) remain a source of post-operative morbidity. Consequences range from escalated costs, delay in adjuvant therapy, and increased morbidity. Our primary objective was to evaluate the effectiveness of a cyanoacrylate microbial sealant (CMS) to reduce post-operative SSI following laparotomy for suspected gynecologic malignancy. Patients were randomized using a 1:1 allocation to receive either standard skin preparation or standard preparation with CMS and stratified by BMI. Patients were followed for 6weeks for SSI. Demographic data was collected through the EMR. Associations between SSI, use of CMS, and clinicopathologic factors were explored using descriptive statistics, chi-square and multivariate analysis. 300 patients underwent randomization. Median age of the cohort was 58. Arms were matched and there was no difference in rate of medical comorbidities. Mean BMI was 38.8kg/m(2) in patients randomized to BMI≥30 and 26.3kg/m(2) randomized to BMISurgical characteristics for the entire cohort: 66% malignancy, 91% clean-contaminated, 21% bowel surgery, 25% transfusion. Seventy-six (25%) patients developed a SSI: 43 patients (28%) treated with CMS, compared to 33 (21%) patients treated without CMS (p=0.18). Multivariate model demonstrated that BMI≥30 (psurgical-site complications in up to 30% of cases. The addition of CMS alone does not appear to reduce risk of overall SSI. Additional risk-reducing strategies including use of antimicrobial agents and optimization of modifiable risk factors prior to surgery should be explored as pathways for reducing this significant post-operative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Institution of The Steiros Algorithm(®) Outpatient Surgical Protocol reduced orthopedic surgical site infections (SSI) rates.

    Science.gov (United States)

    Watson, Paul A; Watson, Luke; Torress-Cook, Alfonso

    2012-01-01

    Control of surgical site infections (SSI) is imperative for the safety of our patients. As orthopedic surgeons we strive to have the lowest infection rate possible for all our surgical procedures. this study evaluates the effects of a simple outpatient peri-operative patient cleaning protocol (The Steiros Algorithm(®) Outpatient Surgery Protocol) on SSI rates. We retrospectively reviewed the hospital's infection rate database for all procedures from July 2005 until February 2011 performed by one general orthopedic surgeon (PAW) within one hospital system. The Steiros Algorithm(®) Outpatient Surgery Protocol was instituted on January 1(st), 2009. We calculated and compared the deep and superficial SSI rate for orthopedic surgeries performed before and after the Outpatient Protocol was instituted. All patients had a minimum of one-year follow-up data. Lowest previously published estimated costs for SSI were used for a cost analysis ($17,708). The July 1(st), 2005 through December 31(st), 2008 SSI rate was 1.0% (13/1292). From January 1(st), 2009 through February 28(th), 2011 the SSI rate was zero (0/875). the SSI rates decreased 100%. Due to the reduction in SSI, the hospital saved a minimum of $154,059 over a two year period. In this retrospective review, the Steiros Algorithm(®) Outpatient Surgery Protocol dramatically reduced the overall SSI rate to zero and saved money. We believe this is a simple, effective protocol that can be used for all orthopedic surgical procedures.

  20. Impact of oxidative stress on early postoperative knee function and muscle injury biochemical markers: Is it possible to create an ischemic preconditioning effect in sequential ischemic surgical procedures?

    Science.gov (United States)

    Aktaş, Erdem; Atay, Çiğdem; Deveci, Mehmet Ali; Arıkan, Murat; Toğral, Güray; Yıldırım, Ahmet

    2015-01-01

    Simultaneous bilateral total knee arthroplasty (TKA) with prolonged tourniquet time has the potential to trigger ischemia-reperfusion injury, which can adversely affect knee function. Studies suggest that the magnitude of injury is less if it occurs following an ischemic event which takes place in another part of the body, known as ischemic preconditioning (IPC). The purpose of this study was to investigate the impact of oxidative stress on muscle injury and knee function and to elucidate if potential IPC effect can attenuate ischemia-reperfusion injury metabolites and prevent poor functional outcomes in single-stage bilateral TKA. Thirty patients who underwent single-stage bilateral TKA under tourniquet were enrolled in the study. All procedures were initiated from the right limb. Upon completion of the procedure, the left tourniquet was inflated 20 minutes after the first tourniquet was deflated. The tourniquet time was noted. Pre- and postoperative levels of malondialdehyde (MDH), creatine kinase (CK), and lactate dehydrogenase (LDH) were evaluated. Knee function was assessed postoperatively at 1 month using WOMAC score. Postoperative levels of MDH, CK, and LDH were significantly increased in both extremities compared to preoperative levels. Serum MDH, CK, and LDH levels were not found to be correlated with tourniquet time for either extremity. Compared to the left extremity, the right extremity revealed increased postoperative oxidative stress, which was indicated by elevated serum MDH, CK, and LDH levels. Although tourniquet time and postoperative serum MDH, CK, and LDH levels were not found to be correlated with WOMAC index in either knee, the average change in WOMAC score at 1 month postoperatively was found to be higher in the left knee compared to the right. The biochemical and functional outcomes can be attributed to potential IPC effect. During bilateral TKA, a 20-minute interval between tourniquets can create IPC effect and attenuate the magnitude of