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Sample records for surgical technique reduces

  1. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis.

    Science.gov (United States)

    Chen, Hua-Biao; Wan, Qi; Xu, Qi-Feng; Chen, Yi; Bai, Bo

    2016-04-25

    Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes. We compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups. MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal

  2. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis

    OpenAIRE

    Chen, Hua-Biao; Wan, Qi; Xu, Qi-Feng; Chen, Yi; Bai, Bo

    2016-01-01

    Background Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM...

  3. Journal of Surgical Technique and Case Report

    African Journals Online (AJOL)

    The aim of Journal of Surgical Technique and Case Report is to advance surgical knowledge and practice by promoting the reporting of innovative and reproducible surgical techniques ... Anterior palatal island advancement flap for bone graft coverage: technical note · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  4. Changes in urological surgical techniques

    Directory of Open Access Journals (Sweden)

    Oktay Üçer

    2010-06-01

    Full Text Available Recently, laparoscopic and afterwards robotic techniques have constituted most of urologic surgery procedures. Open surgery may give place to robotic surgery due to possible widespread use of robots in the future. Studies, that compare these two techniques are usually designed about radical prostatectomy, since it is the most common operation performed by using these techniques. In literature,robotic surgery seems more advantageous than other techniques but the most important disadvantage of this technique is cost-effective problems. In present review,history of open, laparoscopic and robotic surgery, and comparison of advantages, disadvantages and cost of these techniques have been discussed with literature.

  5. Problems associated with basic oral surgical techniques

    International Nuclear Information System (INIS)

    Kapatkin, A.S.; Marretta, S.M.; Schloss, A.J.

    1990-01-01

    The veterinarian must be able to diagnose several types of dental problems. History, physical examination, clinical pathology, and radiography are important in making an accurate diagnosis. Basic oral surgery includes various extraction techniques and management of their associated complications. Knowledge of dental anatomy and proper surgical technique can make an extraction curative rather than a frustrating procedure with multiple complications

  6. Coblation versus other surgical techniques for tonsillectomy.

    Science.gov (United States)

    Pynnonen, Melissa; Brinkmeier, Jennifer V; Thorne, Marc C; Chong, Lee Yee; Burton, Martin J

    2017-08-22

    Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven. To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost. The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2017, Issue 3); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 April 2017. Randomised controlled trials (RCTs) of children and adults undergoing tonsillectomy with coblation compared with any other surgical technique. This review is limited to trials of extracapsular (traditional) tonsillectomy and excludes trials of intracapsular tonsil removal (tonsillotomy). We used the standard Cochrane methods. Our primary outcomes were: patient-reported pain using a validated pain scale at postoperative days 1, 3 and 7; intraoperative blood loss; primary postoperative bleeding (within 24 hours) and secondary postoperative bleeding (more than 24 hours after surgery). Secondary outcomes were: time until resumption of normal diet, time until resumption of normal activity, duration of surgery and adverse effects including blood transfusion and the need for reoperation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included 29 studies, with a total of 2561 participants. All studies had moderate or high risk of bias. Sixteen studies used an adequate randomisation technique, however the inability to mask the surgical teams and/or provide adequate methods to mitigate the risk of bias put nearly all studies at moderate or high risk of

  7. Journal of Surgical Technique and Case Report: Editorial Policies

    African Journals Online (AJOL)

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

  8. Standardization of surgical techniques used in facial bone contouring.

    Science.gov (United States)

    Lee, Tae Sung

    2015-12-01

    Since the introduction of facial bone contouring surgery for cosmetic purposes, various surgical methods have been used to improve the aesthetics of facial contours. In general, by standardizing the surgical techniques, it is possible to decrease complication rates and achieve more predictable surgical outcomes, thereby increasing patient satisfaction. The technical strategies used by the author to standardize facial bone contouring procedures are introduced here. The author uses various pre-manufactured surgical tools and hardware for facial bone contouring. During a reduction malarplasty or genioplasty procedure, double-bladed reciprocating saws and pre-bent titanium plates customized for the zygomatic body, arch and chin are used. Various guarded oscillating saws are used for mandibular angloplasty. The use of double-bladed saws and pre-bent plates to perform reduction malarplasty reduces the chances of post-operative asymmetry or under- or overcorrection of the zygoma contours due to technical faults. Inferior alveolar nerve injury and post-operative jawline asymmetry or irregularity can be reduced by using a guarded saw during mandibular angloplasty. For genioplasty, final placement of the chin in accordance with preoperative quantitative analysis can be easily performed with pre-bent plates, and a double-bladed saw allows more procedural accuracy during osteotomies. Efforts by the surgeon to avoid unintentional faults are key to achieving satisfactory results and reducing the incidence of complications. The surgical techniques described in this study in conjunction with various in-house surgical tools and modified hardware can be used to standardize techniques to achieve aesthetically gratifying outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Ahmed glaucoma valve implant: surgical technique and complications

    Directory of Open Access Journals (Sweden)

    Riva I

    2017-02-01

    Full Text Available Ivano Riva,1 Gloria Roberti,1 Francesco Oddone,1 Anastasios GP Konstas,2 Luciano Quaranta3 1IRCCS “Fondazione GB Bietti per l’Oftalmologia”, Rome, Italy; 21st University Department of Ophthalmology, Glaucoma Unit, AHEPA Hospital, Thessaloniki, Greece; 3Department of Medical and Surgical Specialties, Section of Ophthalmology, University of Brescia, Brescia, Italy Abstract: Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications. Keywords: glaucoma, surgical technique, glaucoma drainage devices, Ahmed glaucoma valve, complications

  10. Review of Surgical Techniques of Experimental Renal Transplantation in Rats.

    Science.gov (United States)

    Shrestha, Badri; Haylor, John

    2017-08-01

    Microvascular surgical techniques of renal transplant in rats have evolved over the past 5 decades to achieve successful rat renal transplant; these modifications have included surgical techniques to address the anatomic variations in the renal blood vessels and those to reduce ischemic and operation durations. Here, we review the surgical techniques of renal transplant in rats and evaluate the advantages and disadvantages of individual techniques of vascular and ureteric anastomoses. For this review, we performed a systematic literature search using relevant medical subject heading terms and included appropriate publications in the review. Since the first description of a rat model of renal transplant by Bernard Fisher and his colleagues in 1965, which used end-to-side anastomosis between the renal vein and renal artery to the recipient inferior vena cava and aorta, several vascular and ureteric anastomosis techniques have been modified. Vascular anastomosis techniques now include end-to-end anastomosis, use of donor aortic and inferior vena cava conduits, sleeve and cuff anastomoses, and application of fibrin glue. Likewise, restoration of the urinary tract can now be achieved by direct anastomosis of the donor ureter to the recipient bladder, end-to-end anastomosis between the donor and recipient ureters, and donor bladder cuff to the recipient bladder. There are advantages and disadvantages attributable to individual techniques. The range of vascular and ureteric anastomosis techniques that has emerged reflects the need for mastering more than one technique to suit the vascular anatomy of individual animals and to reduce operating time for achieving successful outcomes after renal transplant.

  11. Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.

    Science.gov (United States)

    Ionna, Franco; Amantea, Massimiliano; Mastrangelo, Filiberto; Ballini, Andrea; Maglione, Maria Grazia; Aversa, Corrado; De Cecio, Rossella; Russo, Daniela; Marrelli, Massimo; Tatullo, Marco

    2016-07-01

    Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

  12. Finger replantation: surgical technique and indications.

    Science.gov (United States)

    Barbary, S; Dap, F; Dautel, G

    2013-12-01

    In this article, we discuss the surgical technique of finger replantation in detail, distinguishing particularities of technique in cases of thumb amputation, children fingertip replantation, ring finger avulsion, and very distal replantations. We emphasize the principles of bone shortening, the spare part concept, the special importance of nerve sutures and the use of vein graft in case of avulsion or crushing. However, even if finger replantation is now a routine procedure, a clear distinction should be made between revascularization and functional success. The indications for finger replantation are then detailed in the second part of this paper. The absolute indications for replantation are thumb, multiple fingers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Fingertip amputations distal to the insertion of the Flexor digitorum superficialis (FDS) are also a good indication. Other cases are more controversial because of the poor functional outcome, especially for the index finger, which is often functionally excluded. Copyright © 2013. Published by Elsevier SAS.

  13. Evolving Educational Techniques in Surgical Training.

    Science.gov (United States)

    Evans, Charity H; Schenarts, Kimberly D

    2016-02-01

    Training competent and professional surgeons efficiently and effectively requires innovation and modernization of educational methods. Today's medical learner is quite adept at using multiple platforms to gain information, providing surgical educators with numerous innovative avenues to promote learning. With the growth of technology, and the restriction of work hours in surgical education, there has been an increase in use of simulation, including virtual reality, robotics, telemedicine, and gaming. The use of simulation has shifted the learning of basic surgical skills to the laboratory, reserving limited time in the operating room for the acquisition of complex surgical skills". Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Ahmed glaucoma valve implant: surgical technique and complications.

    Science.gov (United States)

    Riva, Ivano; Roberti, Gloria; Oddone, Francesco; Konstas, Anastasios Gp; Quaranta, Luciano

    2017-01-01

    Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications.

  15. Computer-Assisted Technique for Surgical Tooth Extraction

    Directory of Open Access Journals (Sweden)

    Hosamuddin Hamza

    2016-01-01

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

  16. New techniques in dental surgical CT

    International Nuclear Information System (INIS)

    Rabin, D.N.; Rabin, H.; Sakowicz, B.A.; Rabin, M.A.; Rabin, S.I.; Schwartz, A.

    1991-01-01

    This paper demonstrates how CT can be used with dental software to evaluate prosthetic failure and for planning dental implants when a stent is used. The Food and Drug Administration issued a safety alert for proplast-coated temporomandibular joint prostheses. Prosthetic failure occurs with migration, fragmentation, or bone erosion. Sagittal CT requiring a special head holder can instead be performed with reformatted sagittal images. The technique of dental implant CT changes when a dental stent is used to provide more accurate implant anchorage and planning. Images must be parallel to the occlusal plane. We will demonstrate these techniques and present their rationale

  17. Double gloving to reduce surgical cross-infection.

    Science.gov (United States)

    Tanner, J; Parkinson, H

    2006-07-19

    The invasive nature of surgery, with its increased exposure to blood, means that during surgery there is a high risk of transfer of pathogens. Pathogens can be transferred through contact between surgical patients and the surgical team, resulting in post-operative or blood borne infections in patients or blood borne infections in the surgical team. Both patients and the surgical team need to be protected from this risk. This risk can be reduced by implementing protective barriers such as wearing surgical gloves. Wearing two pairs of surgical gloves, triple gloves, glove liners or cloth outer gloves, as opposed to one pair, is considered to provide an additional barrier and further reduce the risk of contamination. The primary objective of this review was to determine if additional glove protection reduces the number of surgical site or blood borne infections in patients or the surgical team. The secondary objective was to determine if additional glove protection reduces the number of perforations to the innermost pair of surgical gloves. The innermost gloves (next to skin) compared with the outermost gloves are considered to be the last barrier between the patient and the surgical team. We searched the Cochrane Wounds Group Specialised Register (January 2006), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library Issue 4, 2005). We also contacted glove manufacturing companies and professional organisations. Randomised controlled trials involving: single gloving, double gloving, triple gloving, glove liners, knitted outer gloves, steel weave outer gloves and perforation indicator systems. Both authors independently assessed the relevance and quality of each trial. Data was extracted by one author and cross checked for accuracy by the second author. Two trials were found which addressed the primary outcome, namely, surgical site infections in patients. Both trials reported no infections. Thirty one randomised controlled trials

  18. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  19. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-28

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  20. The surgical correction of buried penis: a new technique

    NARCIS (Netherlands)

    Boemers, T. M.; de Jong, T. P.

    1995-01-01

    We report a new surgical technique for the correction of buried penis. The study comprised 10 boys with buried penis. The technique consisted of resection of abnormal dartos attachments, unfurling of the prepuce and correction of the deficient shaft skin by reapproximation of the preputial skin

  1. Evolution of surgical techniques for a progressive risk reduction.

    Science.gov (United States)

    Amato, Bruno; Santoro, Mario; Izzo, Raffaele; Servillo, Giuseppe; Compagna, Rita; Di Domenico, Lorenza; Di Nardo, Veronica; Giugliano, Giuseppe

    2017-07-18

    Advanced age is a strong predictor of high perioperative mortality in surgical patients and patients aged 75 years and older have an elevated surgical risk, much higher than that of younger patients. Progressive advances in surgical techniques now make it possible to treat high-risk surgical patients with minimally invasive procedures. Endovascular techniques have revolutionized the treatment of several vascular diseases, in particular carotid stenosis, aortic pathologies, and severely incapacitating intermittent claudication or critical limb ischemia. The main advantages of the endovascular approach are the low complication rate, high rate of technical success and a good clinical outcome. Biliary stenting has improved the clinical status of severely ill patients with bile duct stricture before major surgery, and represents a good palliative therapy in the case of malignant biliary obstruction.

  2. Surgical techniques for lumbo-sacral fusion.

    Science.gov (United States)

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Reducing healthcare costs facilitated by surgical auditing: a systematic review.

    Science.gov (United States)

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

    2015-07-01

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

  4. Treatment of unicameral bone cyst: surgical technique.

    Science.gov (United States)

    Hou, Hsien-Yang; Wu, Karl; Wang, Chen-Ti; Chang, Shun-Min; Lin, Wei-Hsin; Yang, Rong-Sen

    2011-03-01

    There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 ± 2.3 months compared with 23.4 ± 14.9, 12.2 ± 8.5, and 6.6 ± 4.3 months in Groups 1, 2, and 3, respectively. This new

  5. [Composite digital allotransplants: surgical technique and different applications].

    Science.gov (United States)

    Casoli, V; Rousvoal, A; Zirak, C; Bakhach, J; Guimberteau, J-C

    2007-10-01

    Microsurgery and human allotransplantation progress as well as the improvement of immunosuppressive drugs actually allow the development of the composite tissue allotransplantation. One of the latest challenges in plastic surgery is to restore the anatomic and functional structures using similar tissues. Composite tissue allotransplantation will probably reach this goal. Our work is to find new surgical techniques for the reconstruction of the osteotendinous apparatus of the long digits. In this paper, we will demonstrate the surgical technique to harvest the allotransplant and its modulation in the reconstruction of various digital defects.

  6. Through Knee Amputation: Technique Modifications and Surgical Outcomes

    Directory of Open Access Journals (Sweden)

    Frank P Albino

    2014-09-01

    Full Text Available BackgroundKnee disarticulations (KD are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center.MethodsA retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A. between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified.ResultsBetween 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%, arterial thrombosis (35%, and trauma (9%. Postoperative complications included superficial cellulitis (13%, soft tissue infection (4%, and flap ischemia (4% necessitating one case of surgical debridement (4% and four trans-femoral amputations (9%. 9 (22% patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01.ConclusionsKnee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

  7. Surgical implantation techniques for electronic tags in fish

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-01-01

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

  8. Some Observations on Veterinary Undergraduate Training in Surgical Techniques.

    Science.gov (United States)

    Whittick, William G.

    1978-01-01

    The undergraduate surgery course of the Faculty of Veterinary Medicine and Animal Science, Universiti Pertanian Malaysia, is described with focus on its experential method of teaching surgical techniques. Also discussed are the benefits of veterinary school cooperation with a large city Society for the Prevention of Cruelty to Animals (SPCA). (JMD)

  9. Nonpenetrating glaucoma surgery with goniosynechiolysis ab interno: a surgical technique.

    Science.gov (United States)

    Mirshahi, A; Scharioth, G B

    2009-01-01

    To present a surgical technique for treatment of peripheral anterior synechiae (PAS or goniosynechiae) at the operative field during nonpenetrating glaucoma surgery. After usual preparation of a superficial and a deep scleral flap with externalization of the Schlemm's canal and peeling the juxtacanalicular trabecular meshwork, the goniosynechia is transected by a spatula introduced to the anterior chamber through a paracentesis. A Descemet's window provides full visual control at the peripheral cornea at the basis of the superficial scleral flap. With this surgical technique, selective treatment of goniosynechiae is possible exactly at the area where creation of low outflow resistance is intended by the surgeon during nonpenetrating glaucoma surgery. This technique enables the surgeon to perform nonpenetrating glaucoma surgery even in the presence of peripheral anterior synechiae.

  10. Surgical techniques for treatment of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Carlos Édder de Mello Cardoso Lima

    2015-12-01

    Full Text Available Gastroesophageal reflux is one of the most frequently gastrointestinal tract diseases currently found, having a great impact on the patient's quality of life. Purpose: to analyze the main surgical techniques used in the treatment of this pathology, their indications, advantages and disadvantages. Methods: this is a literature review. Thirteen articles published between 1998 and 2013 in the Lilacs, Bireme e Scielo databases, addressing different surgical techniques for the treatment of gastroesophageal reflux were selected. Results: Five hundred and thirty-eight total fundoplications and 466 partial fundoplications were performed. Conclusion: The findings of this review show that total fundoplication is the most commonly used technique in the treatment of gastroesophageal reflux disease.

  11. Restoring accommodation: surgical technique and preliminary evaluation in rabbits

    Science.gov (United States)

    Tahi, Hassan; Chapon, Pascal F.; Hamaoui, Marie; Lee, William E.; Holden, Brien; Parel, Jean-Marie A.

    1999-06-01

    Purpose. To evaluate an innovative surgical technique for phaco-ersatz, a cataract surgery designed to restore accommodation. Techniques for very small capsulorhexis as well as the refilling procedure were developed. This study evaluates the feasibility and reproducibility of the surgical technique. Methods. The right eye of 8 NZW rabbits (~ 2 Kg) were operated following the ARVO Statements for the Use of Animals in Ophthalmic and Vision Research. The surgery is begun by making a small peripheral capsulorhexis of about 1 mm using. The lens content is then removed. The lens is then refilled with a novel in situ polymerizable gel and the corneal incision is closed using one 10/0 Nylon interrupted stitch. Results. The capsulorhexis technique was succesfully performed and reproducible in all animals. The average size of the capsulorhexis opening was 1. 2 mm (+/-0.14). Lens material removal and refilling of the capsular bag with an in situ polymerizable material was also performed in each trial study. Conclusion. This surgical technique seemed feasible and reproducible.

  12. [Intestinal stomas--indications, stoma types, surgical technique].

    Science.gov (United States)

    Renzulli, P; Candinas, D

    2007-09-01

    The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

  13. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

    Directory of Open Access Journals (Sweden)

    Mladenović Marko

    2015-01-01

    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  14. An innovative surgical technique for treating penile incarceration injury caused by heavy metallic ring

    Directory of Open Access Journals (Sweden)

    S J Baruah

    2009-01-01

    Full Text Available Penile incarceration injury by heavy metallic ring is a rare genital injury. A man may place metal object for erotic or autoerotic purposes, for masturbation or increasing erection, and due to psychiatric disturbances are some of the reasons for a penile incarceration injury. The incarcerating injury results in reduced blood flow distal to the injury, leading to edema, ischemia, and sometimes gangrene. These injuries are divided into five grades and their treatment options are divided into four groups. Surgical techniques are reserved for the advanced grades (Grades IV and V. We describe an innovative surgical technique, which can be adopted in Grades II and III injuries.

  15. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  16. THD Doppler procedure for hemorrhoids: the surgical technique

    OpenAIRE

    Ratto, C.

    2013-01-01

    Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called “dearterialization”) can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called “mucopexy”) can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Followi...

  17. The Kock pouch reconsidered: an alternative surgical technique.

    Science.gov (United States)

    Crawshaw, Alison; Williams, Julia; Woodhouse, Fran

    The psychological impact stoma surgery can have on an individual is well documented within the literature (White and Hunt, 1997; Borwell, 2009; Williams, 2005; Brown, 2005). For many years, surgeons have explored and developed innovations in surgical techniques, in particular restorative procedures with a view of preventing permanent stoma formation; ileal anal pouch (IAP) now being the surgical procedure of choice for treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, high morbidity rates are associated with pouch longevity (Castillo et al 2005; Nessar and Wu, 2012) and once removed can lead to a high-output ileostomy with risks of electrolyte imbalance and malabsorption. This then creates the dilemma of whether the Kock pouch (KP) should be offered as a surgical option. This article offers a historical perspective of the KP and its place in the surgical management of UC and FAP. This article also presents results from a recent audit funded by the Ileostomy Association (IA), highlighting how patients manage their KP and the importance of maintaining bowel control and being free of an incontinent stoma as a means of coming to terms with their condition.

  18. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    Science.gov (United States)

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  19. Surgical techniques and radiological findings of meniscus allograft transplantation.

    Science.gov (United States)

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. ACL Surgical Technique — Staying Out of Trouble

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    Predescu Vlad

    2016-11-01

    Full Text Available The incidence of ACL tear and reconstruction has increased over time, and failure of ACL reconstruction is not perfectly defined among surgeons. Atraumatic failure of ACL surgery represents approximately 70% of causes, and occurs in diagnostic errors, technical errors and problems of ACL graft integrations. Regarding surgical technique, we should answer certain questions about our choice of surgery, tunnel position, graft type, graft suture, tensioning the graft, and how we deal with certain incidents or intraoperative accidents. The purpose of this article is to review the current information and trends of ACL reconstruction, and presents some tips and tricks we use in our current practice.

  1. Selection of oncoplastic surgical technique in Asian breast cancer patients

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    Eui Sun Shin

    2018-01-01

    Full Text Available Background Oncoplastic surgery is being increasingly performed in Korean women; however, unlike Westerners, Korean women usually have small to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors should be considered to determine the optimal surgical method. Methods A total of 108 patients who underwent oncoplastic surgery from January 2013 to December 2016 were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD flap transposition, and reduction oncoplasty, to restore the breast volume and symmetry. Results The mean weight of the tumor specimens was 40.46 g, and the ratio of the tumor specimen weight to breast volume was 0.12 g/mL in the patients who underwent glandular tissue reshaping (n=59. The corresponding values were 101.47 g and 0.14 g/mL, respectively, in the patients who underwent reduction oncoplasty (n=17, and 82.54 g and 0.20 g/mL, respectively, in those treated with an LD flap (n=32. Glandular tissue reshaping was mostly performed in the upper outer quadrant, and LD flap transposition was mostly performed in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusions We report satisfactory outcomes of oncoplastic surgical procedures in Korean patients. The results regarding specimen weight and the tumor-to-breast ratio of Asian patients will be a helpful reference point for determining the most appropriate oncoplastic surgical technique.

  2. A new plastic surgical technique for adult congenital webbed penis

    Science.gov (United States)

    Chen, Yue-bing; Ding, Xian-fan; Luo, Chong; Yu, Shi-cheng; Yu, Yan-lan; Chen, Bi-de; Zhang, Zhi-gen; Li, Gong-hui

    2012-01-01

    Objective: To introduce a novel surgical technique for correction of adult congenital webbed penis. Methods: From March 2010 to December 2011, 12 patients (age range: 14–23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. Results: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. Conclusions: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results. PMID:22949367

  3. Tailor-made Surgical Guide Reduces Incidence of Outliers of Cup Placement.

    Science.gov (United States)

    Hananouchi, Takehito; Saito, Masanobu; Koyama, Tsuyoshi; Sugano, Nobuhiko; Yoshikawa, Hideki

    2010-04-01

    Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10 degrees from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques. Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  4. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. THD Doppler procedure for hemorrhoids: the surgical technique.

    Science.gov (United States)

    Ratto, C

    2014-03-01

    Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called "mucopexy") can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Following adequate clinical assessment, patients undergo THD under general or spinal anesthesia, in either the lithotomy or the prone position. In all patients, distal Doppler-guided dearterialization is performed, providing the selective ligation of hemorrhoidal arteries identified by Doppler. In patients with hemorrhoidal/muco-hemorrhoidal prolapse, the mucopexy is performed with a continuous suture including the redundant and prolapsing mucosa and submucosa. The description of the surgical procedure is complemented by an accompanying video (see supplementary material). In long-term follow-up, there is resolution of symptoms in the vast majority of patients. The most common complication is transient tenesmus, which sometimes can result in rectal discomfort or pain. Rectal bleeding occurs in a very limited number of patients. Neither fecal incontinence nor chronic pain should occur. Anorectal physiology parameters should be unaltered, and anal sphincters should not be injured by following this procedure. When accurately performed and for the correct indications, THD is a safe procedure and one of the most effective treatments for hemorrhoidal disease.

  6. Rehabilitation with 4 zygomatic implants with a new surgical protocol using ultrasonic technique.

    Science.gov (United States)

    Mozzati, Marco; Mortellaro, Carmen; Arata, Valentina; Gallesio, Giorgia; Previgliano, Valter

    2015-05-01

    When the residual bone crest cannot allow the placement of standard implants, the treatment for complete arch rehabilitation of severely atrophic maxillae can be performed with 4 zygomatic implants (ZIs) and immediate function with predictable results in terms of aesthetics, function, and comfort for the patient. However, even if ZIs' rehabilitations showed a good success rate, this surgery is difficult and need a skillful operator. Complications in this kind of rehabilitation are not uncommon; the main difficulties can be related to the reduced surgical visibility and instrument control in a critical anatomic area. All the surgical protocols described in the literature used drilling techniques. Furthermore, the use of ultrasonic instruments in implant surgery compared with drilling instruments have shown advantages in many aspects of surgical procedures, tissues management, enhancement of control, surgical visualization, and healing. The aim of this study was to report on the preliminary experience using ultrasound technique for ZIs surgery in terms of safety and technical improvement. Ten consecutive patients with severely atrophic maxilla have been treated with 4 ZIs and immediate complete arch acrylic resin provisional prostheses. The patients were followed up from 30 to 32 months evaluating implant success, prosthetic success, and patient satisfaction with a questionnaire. No implants were lost during the study period, with a 100% implant and prosthetic success rate. Within the limitations of this preliminary study, these data indicate that ultrasonic implant site preparation for ZIs can be a good alternative to the drilling technique and an improvement for the surgeon.

  7. Healthcare technology: physician collaboration in reducing the surgical cost.

    Science.gov (United States)

    Olson, Steven A; Obremskey, William T; Bozic, Kevin J

    2013-06-01

    The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

  8. Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection.

    Science.gov (United States)

    Manivannan, Bhavani; Gowda, Deepak; Bulagonda, Pradeep; Rao, Abhishek; Raman, Sai Suguna; Natarajan, Shanmuga Vadivoo

    2018-04-01

    We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aortic valve (MVR/AVR) cardiac operations, with a relative risk (RR) ratio of 0.19 (95% confidence interval [CI] 0.12-0.31) and 0.08 (95% CI 0.03-0.22), respectively. The SSI rate was inversely correlated with the rate of compliance with pre-operative (r = -0.738; p = 0.037), peri-operative (r = - 0.802; p = 0.017), and post-operative (r = -0.762; p = 0.028) care bundles. Implementation of the Surveillance of SSI, Auditing, and Feedback bundle had a profound beneficial effect on the SSI rate, thereby reducing healthcare costs and improving patient quality of life.

  9. [Minimally invasive surgical therapy of gynecomastia: liposuction and exeresis technique].

    Science.gov (United States)

    Voigt, M; Walgenbach, K J; Andree, C; Bannasch, H; Looden, Z; Stark, G B

    2001-10-01

    A number of techniques are available for the correction of gynecomastia. Nonscarring sparing methods are preferred, and the minimally invasive technique is to use liposuction for the gland and the fatty tissue exclusively. In this retrospective study we present our experience with a combination of liposuction and subsequent resection of the remaining gland. Sixty-two patients (112 breasts) were surgically treated for gynecomastia from January 1996 and September 2000. From 1996 to 1997 all patients suffering from gynecomastia grade Simon I-II were treated by the method described by Rosenberg and Stark, which is exclusively suction of the fatty and glandular tissue. In a retrospective chart study a high recurrence rate was found in these patients. Subsequently we changed our technique to liposuction of the fatty tissue followed by sharp excision of the glandular tissue through the incision made for the liposuction cannula in the submammary fold. Suction alone was not sufficient to remove the glandular tissue; the rate of recurrence after suction was 35%. When sharp resection of the glandular tissue was carried out after the liposuction the recurrence rate dropped to under 10%. In total our complication rate was 50% including minor sequelae. The most frequent complication was unacceptable scarring of the nipple-areola complex. Hypesthesia of the nipple-areola occurred in 13.4% of the patients. The combination of liposuction and resection of the glandular tissue is a minimally invasive correction that can be used in all cases of gynecomastia grade Simon I-II.

  10. Reducing surgical nurses' aseptic practice-related stress.

    Science.gov (United States)

    Aholaakko, Teija-Kaisa

    2011-12-01

    This paper aims to explore aseptic practice-related stress in surgery. The objectives are to define stress-related factors and the means to reduce the stress. Occupational stress is related to personal characteristics: job satisfaction and physiological and psychological well-being. The stress symptoms are often classified as part of a negative mood. Nurses have expressed stress when deadening their conscience to external demands with co-workers or internal working role-related demands. Surgery nurses expect fair division of work and compliance with rules. The hospital management, technology and the medical profession, instead of the needs of the patient, are recognised as a danger in the development of surgery nurses' role. A qualitative stimulated recall interview was performed in the surgery of the university hospital. Thirty-one operations were videotaped, and 31 nurses interviewed during videotape stimulation. The 1306 text pages were transcripted and analysed by a qualitative membership categorisation device analysis. The analysis revealed aseptic practice-related stress which constructed a sixteen level category. The membership categorisation identified connections between qualitatively attributed personnel and seven stress factors: working experience; time; equipment; person; patient; working morals and power. Final analysis revealed nurses reducing aseptic practice-related stress by safe, peaceful, competent and relative means. The aseptic practice-related stress varied from positive motivating feelings to exhaustion. The stress was experienced by medical and nursing co-workers and reduced by means which varied according to expertise and co-workers. This study showed needs for both the shared multiprofessional documentation of aseptic practice and better adherence to recommendations. Constructive means are useful when solving conflicts and replacing person-related aseptic practice with evidence-based. They may support nurses' professional growth, reduce

  11. Surgical techniques for the atomic bomb survivors of thyroid cancer

    International Nuclear Information System (INIS)

    Takeichi, Nobuo; Dohi, Kiyohiko; Noso, Yoshihiro

    2016-01-01

    As for proper surgical techniques for radiation-induced thyroid carcinogenesis, this paper explains with a focus on the Hiroshima University cases, with an addition of the cases of Radiation Effects Research Foundation and Takeichi Clinic. The definitive diagnosis of thyroid cancer is usually carried out by echo-guided aspiration biopsy cytology, but Takeichi Clinic faces the surgery by preparing 'thyroid - cervical lymph node map' by combining this technique with CT and MRI. As the surgery examples at Hiroshima University, 259 cases during 1955-1972 and 363 cases during 1965-1982 were taken up, and the survival rate and cancer death rate classified by tissue types for 10 years after the initial operations were shown in a table. Dead patients were mostly the surgery cases of senior persons of 60 years in age or older, and the death rate for surgery cases of the persons of 19 years old or younger was only 1.9% at 6 cases. Higher cancer death rate was seen in the cases of papillary cancer of more than 5 cm in size, where extra glandular infiltration could not be curated or cut out, and 64/318 cases of patients had a recurrence of cancer at thyroid gland. The mortality rate up to 20 years after the surgery of atomic bomb survivors was not significantly different from that of non-victims. Information on the multicentric cancerous focuses and microscopic cancer in the thyroid gland, as well as the tissue types and high risk of cancer death were described from the cases of Hiroshima University and Takeichi Clinic. The thyroid cancer of radiation exposure victims often results in papillary cancer, and the following are described related with this: (1) selection of ablation method, (2) method to protect the parathyroid tissue, and (3) method to prevent damage to the recurrent laryngeal nerve and superior laryngeal nerve. The surgical procedure to perform the neck outside area lymph node dissection due to the quasi-subtotal or quasi-complete removal of the thyroid gland is

  12. Employing innovative techniques to reduce inspection times

    International Nuclear Information System (INIS)

    Heumueller, R.; Guse, G.; Dirauf, F.; Fischer, E.

    1997-01-01

    Shorter inspection periods mean lower revision costs and less tight revision schedules, but must not detract from the quality of inspection findings. This requirement imposes upon the company performing the inspection the need for top achievements both in quality management and in the use of innovative techniques. Flexible equipment systems and inspection techniques adapted to specific purposes are able to reduce inspection times in many inspection jobs. As part of a complete system designed to reduce inspection times, the new Saphir (Siemens Alok Phased Array Integrated Reliable UT-System) inspection equipment system is the core of most of the recent innovations. Being an integrated inspection equipment system, it is able to handle conventional US probes as well as arrays and phased arrays. It is open for further matching to specific inspection and administrative requirements and developments, and it may be incorporated in the network of an integrated system with a database. A technological leap in probe design in the past few years has allowed controllable wave fields to be generated which are in no way inferior to those of conventional probes with fixed angles of incidence. In this way, a number of inspection techniques can be implemented with a single probe. This reduces inspection times, setup and retooling times, and doses. Typical examples already used in practice are the LLT (longitudinal-longitudinal-transverse waves) technique and the integration of inspections for longitudinal and transverse defects in a single run. In the near future, surfaces with complicated curvatures will be inspected by novel modular robot systems consisting of individual modules of linear axes and rotational axes. (orig.) [de

  13. [Endoscopic calcaneoplasty (ECP) in Haglund's syndrome. Indication, surgical technique, surgical findings and results].

    Science.gov (United States)

    Jerosch, J; Sokkar, S; Dücker, M; Donner, A

    2012-06-01

    Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months. According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia. ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the

  14. Surgical treatment of gynecomastia: mastectomy compared to liposuction technique.

    Science.gov (United States)

    Song, Yan-Ni; Wang, Yan-Bo; Huang, Rui; He, Xiao-Guang; Zhang, Jin-Feng; Zhang, Guo-Qiang; Ren, Yan-Lv; Pang, Jian-Hua; Pang, Da

    2014-09-01

    Gynecomastia is a benign enlargement of the male breast. Yet enlarged breasts cause anxiety, embarrassment, psychosocial discomfort, and fear of breast cancer. The aim of this study was to assess the experience of gynecomastia patients undergoing mastectomy and liposuction surgery. Seven hundred thirty-three patients were analyzed for age, chief complaint, position, grade, operation approach, biopsy, and complication between mastectomy group and liposuction group, from 1990 to 2010. Four hundred two patients (436 breasts) were treated with mastectomy and 331 patients (386 breasts) were treated with liposuction techniques. Three hundred thirty (82%) patients complained of breast lump and lump with pain in mastectomy group, and 204 (61%) patients complained of enlargement breast and enlargement with pain in liposuction group (P liposuction acquired pathologic diagnosis through fine needle aspiration and/or core biopsy (P liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group. The surgical treatment of gynecomastia required an individual approach, depending on symptoms (lump or enlargement) and requirements of patients. Patients who chose mastectomy were looking for reassurance that their pathologic diagnosis was benign. The increase in the number of liposuction patients was reflected in our study because it was associated with superior esthetic results and few complications.

  15. Surgical techniques for the treatment of ankyloglossia in children: a case series

    Directory of Open Access Journals (Sweden)

    Marina Azevedo JUNQUEIRA

    2014-06-01

    Full Text Available This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  16. Comparison of two surgical techniques in large incisional hernias

    Directory of Open Access Journals (Sweden)

    Mustafa Sit

    2014-03-01

    Full Text Available Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report. Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011. Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus,which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get. Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall. J Clin Exp Invest 2014; 5 (1: 36-39

  17. Robotic partial nephrectomy for complex renal tumors: surgical technique.

    Science.gov (United States)

    Rogers, Craig G; Singh, Amar; Blatt, Adam M; Linehan, W Marston; Pinto, Peter A

    2008-03-01

    Laparoscopic partial nephrectomy requires advanced training to accomplish tumor resection and renal reconstruction while minimizing warm ischemia times. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery. We describe our technique, illustrated with video, of robotic partial nephrectomy for complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance was used to resect 14 tumors in eight patients (mean age: 50.3 yr; range: 30-68 yr). Three patients had hereditary kidney cancer. All patients had complex tumor features, including hilar tumors (n=5), endophytic tumors (n=4), and/or multiple tumors (n=3). Robotic partial nephrectomy procedures were performed successfully without complications. Hilar clamping was used with a mean warm ischemia time of 31 min (range: 24-45 min). Mean blood loss was 230 ml (range: 100-450 ml). Histopathology confirmed clear-cell renal cell carcinoma (n=3), hybrid oncocytic tumor (n=2), chromophobe renal cell carcinoma (n=2), and oncocytoma (n=1). All patients had negative surgical margins. Mean index tumor size was 3.6 cm (range: 2.6-6.4 cm). Mean hospital stay was 2.6 d. At 3-mo follow-up, no patients experienced a statistically significant change in serum creatinine or estimated glomerular filtration rate and there was no evidence of tumor recurrence. Robotic partial nephrectomy is safe and feasible for select patients with complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance may facilitate a minimally invasive, nephron-sparing approach for select patients with complex renal tumors who might otherwise require open surgery or total nephrectomy.

  18. Lengthening of fourth brachymetatarsia by three different surgical techniques.

    Science.gov (United States)

    Lee, W-C; Yoo, J H; Moon, J-S

    2009-11-01

    We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.

  19. Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation.

    Science.gov (United States)

    Anchieta, M V M; Salles, F A; Cassaro, B D; Quaresma, M M; Santos, B F O

    2016-10-01

    Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time. The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics-Materialise (Belgium)-software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press. The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material's exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon's discretion. This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.

  20. Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis.

    Science.gov (United States)

    John-Baptiste, A; Sowerby, L J; Chin, C J; Martin, J; Rotenberg, B W

    2016-01-01

    When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.

  1. Surgical Approaches to Chronic Pancreatitis: Indications and Techniques.

    Science.gov (United States)

    Dua, Monica M; Visser, Brendan C

    2017-07-01

    There are a number of surgical strategies for the treatment of chronic pancreatitis. The optimal intervention should provide effective pain relief, improve/maintain quality of life, preserve exocrine and endocrine function, and manage local complications. Pancreaticoduodenectomy was once the standard operation for patients with chronic pancreatitis; however, other procedures such as the duodenum-preserving pancreatic head resections and its variants have been introduced with good long-term results. Pancreatic duct drainage via a lateral pancreaticojejunostomy continues to be effective in ameliorating symptoms and expediting return to normal lifestyle in many patients. This review summarizes operative indications and gives an overview of the different surgical strategies in treating chronic pancreatitis.

  2. A new technique in the surgical treatment of Hangman's fractures: Neurospinal Academy (NSA) technique.

    Science.gov (United States)

    Dalbayrak, Sedat; Yaman, Onur; Yılmaz, Mesut

    2013-07-01

    Treatment of Hangman's fractures is still controversial. Hangman's fractures Type II and IIA are usually treated with surgical procedures. This study aims at describing the Neurospinal Academy (NSA) technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Hangman II and IIA patient are treated with NSA technique. Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. In Hangman's fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.

  3. A new technique in the surgical treatment of Hangman′s fractures: Neurospinal Academy (NSA technique

    Directory of Open Access Journals (Sweden)

    Sedat Dalbayrak

    2013-01-01

    Full Text Available Context: Treatment of Hangman′s fractures is still controversial. Hangman′s fractures Type II and IIA are usually treated with surgical procedures. Aim: This study aims at describing the Neurospinal Academy (NSA technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. Settings and Design: NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Materials and Methods: Hangman II and IIA patient are treated with NSA technique. Result: Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. Conclusions: In Hangman′s fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.

  4. How do you tell whether a change in surgical technique leads to a change in outcome?

    Science.gov (United States)

    Vickers, Andrew J; Cronin, Angel M; Masterson, Timothy A; Eastham, James A

    2010-04-01

    Surgeons routinely evaluate and modify their surgical technique to improve patient outcome. It is also common for surgeons to analyze results before and after a change in technique to determine whether the change led to better results. Simple comparison of results before and after surgical modification may be confounded by the surgical learning curve. We developed a statistical method applicable to analyzing before/after surgical studies. We used simulation studies to compare different statistical analyses of before/after studies. We evaluated a simple 2-group comparison of results before and after the modification by the chi-square test and a novel bootstrap method that adjusts for the surgical learning curve. In the presence of the learning curve a simple 2-group comparison almost always showed an ineffective surgical modification to be of benefit. When the surgical modification was harmful, leading to a 10% decrease in the success rate, 2-group comparison nonetheless showed a statistically significant improvement in outcome about 80% of the time. The bootstrap method had only moderate power but did not show that ineffective surgical modifications were beneficial more than would be expected by chance. Simplistic approaches to the analysis of before/after surgical studies may lead to grossly erroneous results under the surgical learning curve. A straightforward alternative statistical method allows investigators to separate the effects of the learning curve from those of the surgical modification. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Surgical techniques and curative effect of carotid endarterectomy for carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Min HAN

    2014-02-01

    Full Text Available Objective To investigate the surgical techniques of carotid endarterectomy (CEA for treating carotid artery stenosis, in order to improve the surgical efficacy and reduce intraoperative adverse events and complications after operation. Methods Retrospective analysis was carried out on surgical data of 53 cases who were performed CEA from October 2010 to October 2013 in Department of Neurosurgery in Tianjin Huanhu Hospital. There were 39 males and 14 females, aged from 40 to 78 years old and mean age (60.34 ± 8.92 years old; the course of disease was from 2 d to 4 years. Twenty-six cases were diagnosed as right carotid stenosis, 15 cases left carotid stenosis and 12 cases double-sided carotid stenosis. Among all of those cases, 35 cases were diagnosed as moderate stenosis (30%-69%, 16 cases severe stenosis (70%-99% , and 2 cases complete occlusion. Results Among 53 patients, 50 patients underwent CEA; 2 cases underwent CEA and aneurysm clipping; one case underwent stent removal surgery and CEA because restenosis was found after carotid artery stenting (CAS. Postoperative neck CTA and fMRI showed good morphology of carotid artery, fluent blood flow and improved cerebral perfusion after operation. All of those patients were followed up for 3 to 24 months. One case died of myocardial infarction; 2 cases appeared skin numbness on the operating side of the neck, and the symptom disappeared 3 months later; one case appeared hoarseness after operation; 3 cases experienced mild transient ischemic attack (TIA and the symptom disappeared 2 months later. No case of stroke was found. Conclusions CEA is a safe and effective surgical approach to treat carotid stenosis. Correct and reasonable choices of the surgical indications and skilled surgical technique are the key to ensure the success of operation and to improve efficacy of the therapy. doi:10.3969/j.issn.1672-6731.2014.02.006Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v14n2a6

  6. Pre-operative antibiotic use reduces surgical site infection.

    Science.gov (United States)

    Toor, Asad Ali; Farooka, Muhammad Waris; Ayyaz, Mahmood; Sarwar, Hassan; Malik, Awais Amjad; Shabbir, Faisal

    2015-07-01

    To assess the efficacy of World Health Organisation Surgical Safety Checklist as a simple, reliable and effective tool to ensure appropriate administration of intravenous antibiotics. The prospective interventional study was conducted in three phases at Mayo Hospital, Lahore, from May 2011 to January 2012. The first phase comprised baseline data collection, followed by implementation of World Health Organisation Surgical Safety Checklist, and finally post-implementation data collection. The duration of each phase was 3 months. Primary end points were discharge from hospital, 30 days or death of the patient. Of the 613 patients in the study, 303(49.4%) were in the pre-implementation phase and 310(50.5%) in post-implementation phase. Adherence of optimal administration of antibiotic increased from 114(37.6%) to 282(91%) (poperative infection fell from 99(32.7%) to 47(15.2%) (psite infection by more than half. Hospital stay was shortened by 1.3 days on average which results in considerable reduction in morbidity, mortality and costs.

  7. Improved compliance with the World Health Organization Surgical Safety Checklist is associated with reduced surgical specimen labelling errors.

    Science.gov (United States)

    Martis, Walston R; Hannam, Jacqueline A; Lee, Tracey; Merry, Alan F; Mitchell, Simon J

    2016-09-09

    A new approach to administering the surgical safety checklist (SSC) at our institution using wall-mounted charts for each SSC domain coupled with migrated leadership among operating room (OR) sub-teams, led to improved compliance with the Sign Out domain. Since surgical specimens are reviewed at Sign Out, we aimed to quantify any related change in surgical specimen labelling errors. Prospectively maintained error logs for surgical specimens sent to pathology were examined for the six months before and after introduction of the new SSC administration paradigm. We recorded errors made in the labelling or completion of the specimen pot and on the specimen laboratory request form. Total error rates were calculated from the number of errors divided by total number of specimens. Rates from the two periods were compared using a chi square test. There were 19 errors in 4,760 specimens (rate 3.99/1,000) and eight errors in 5,065 specimens (rate 1.58/1,000) before and after the change in SSC administration paradigm (P=0.0225). Improved compliance with administering the Sign Out domain of the SSC can reduce surgical specimen errors. This finding provides further evidence that OR teams should optimise compliance with the SSC.

  8. Sacroiliac screw fixation: A mini review of surgical technique

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2014-01-01

    Full Text Available The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.

  9. Grantee Spotlight: Marvella Ford, Ph.D. - Reducing Barriers to Surgical Cancer Care among African Am

    Science.gov (United States)

    Drs. Marvella E. Ford and Nestor F. Esnaola were awarded a five-year NIH/NIMHD R01 grant to evaluate a patient navigation intervention to reduce barriers to surgical cancer care and improving surgical resection rates in African Americans with lung cancer.

  10. Surgical attenuation of congenital portosystemic shunts in dogs. Techniques, complications and prognosis

    NARCIS (Netherlands)

    Kummeling, A.|info:eu-repo/dai/nl/304828793

    2009-01-01

    The general aim of this thesis was to identify factors associated with outcome after surgical attenuation of congenital portosystemic shunts (CPSS) in dogs and to clarify underlying mechanisms of postoperative recovery in this disease. Two surgical techniques used for CPSS attenuation, ligation and

  11. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    intraoperative surgical methods applied to minimize incidence or severity of SP after LC. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, nonsignificant or significant effect on incidence or severity of SP. RESULTS: A total of 31...... papers where included in the review. Seven, 8, and 12 papers investigated the effect of drains, abdominal wall lift (AWL), and low-pressure pneumoperitoneum respectively. Four papers investigated drain suction, active gas aspiration, low insufflation flow or N(2)O insufflation respectively...

  12. A ferromagnetic surgical system reduces phrenic nerve injury in redo congenital cardiac surgery.

    Science.gov (United States)

    Shinkawa, Takeshi; Holloway, Jessica; Tang, Xinyu; Gossett, Jeffrey M; Imamura, Michiaki

    2017-05-01

    A ferromagnetic surgical system (FMwand®) is a new type of dissection device expected to reduce the risk of adjacent tissue damage. We reviewed 426 congenital cardiac operations with cardiopulmonary bypass through redo sternotomy to assess if this device prevented phrenic nerve injury. The ferromagnetic surgical system was used in 203 operations (47.7%) with regular electrocautery and scissors. The preoperative and operative details were similar between the operations with or without the ferromagnetic surgical system. The incidence of phrenic nerve injury was significantly lower with the ferromagnetic surgical system (0% vs 2.7%, P = 0.031). A logistic regression model showed that the use of the ferromagnetic surgical system was significantly associated with reduced odds of phrenic nerve injury (P < 0.001). © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. Surgical techniques for quantitative nutrient digestion and absorbtion studies in the pig

    DEFF Research Database (Denmark)

    Jørgensen, Henry; Serena, Anja; Theil, Peter Kappel

    2010-01-01

    Surgical techniques allow quantitative measurement of nutrient digestion and absorption in pigs. The present paper presents our updated techniques for anaesthesia and surgery. The surgery technique of catheterization of the portal vein, mesenteric vein and mesenteric artery, as well as the fitting...

  14. Safety and surgical techniques of C1 lateral mass screws

    International Nuclear Information System (INIS)

    Kubo, Shinichiro; Kuroki, Hiroshi; Hanado, Shoji; Hamanaka, Hideaki; Inomata, Naoki; Kuroki, Shuji; Chosa, Etsuo

    2010-01-01

    The objectives of this study were to evaluate the proper insertion techniques of C1 lateral mass screws. Eighteen consecutive patients were examined after upper cervical fusion using twenty-nine C1 lateral mass screws. Screws were placed by three different techniques; Goel's technique (4), Tan's technique (20), Notching technique (5). Pre and post-operative CT scans with multiplanar reconstruction were used to detect cortical breaches and direction of screws. No transverse foramen and vertebral groove violation was found in CT scans. Three had breached superior articular facet of the atlas. However, the range of motion (R.O.M) of atlanto-occipital joints had not changed postoperatively. Theses screws were inserted with Tan's technique and two of three were directed medially. It is feasible to safely insert C1 lateral mass screws when correct insertion point and direction are considered preoperatively. However, care should be taken because screws can violate the atlanto-occipital joint especially with Tan's technique. (author)

  15. Application of minimally invasive technique in surgical treatment of pancreatic diseases

    Directory of Open Access Journals (Sweden)

    ZHANG Yixi

    2015-05-01

    Full Text Available In recent years, with the rapid development of minimally invasive concept, from laparoscopic operation to three-dimension laparoscopic technique and to robotic surgical system, treatment modalities have changed a lot. Pancreatic diseases, including multiple lesions, have different prognoses. An appropriate surgical procedure should be selected while ensuring the radical treatment of disease, so as to minimize the injury to patients and the impairment of organ function. Minimally invasive technique is of great significance in the surgical treatment of pancreatic diseases.

  16. PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION

    Science.gov (United States)

    NISHIMI, ALEXANDRE YUKIO; ARBEX, DEMETRIO SIMÃO; MARTINS, DIOGO LUCAS CAMPOS; GUSMÃO, CARLOS VINICIUS BUARQUE DE; BONGIOVANNI, ROBERTO RANGEL; PASCARELLI, LUCIANO

    2016-01-01

    ABSTRACT Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion. PMID:28149190

  17. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections.

    Science.gov (United States)

    Cannon, Jamie A; Altom, Laura K; Deierhoi, Rhiannon J; Morris, Melanie; Richman, Joshua S; Vick, Catherine C; Itani, Kamal M F; Hawn, Mary T

    2012-11-01

    Surgical site infection is a major cause of morbidity after colorectal resections. Despite evidence that preoperative oral antibiotics with mechanical bowel preparation reduce surgical site infection rates, the use of oral antibiotics is decreasing. Currently, the administration of oral antibiotics is controversial and considered ineffective without mechanical bowel preparation. The aim of this study is to examine the use of mechanical bowel preparation and oral antibiotics and their relationship to surgical site infection rates in a colorectal Surgical Care Improvement Project cohort. This retrospective study used Veterans Affairs Surgical Quality Improvement Program preoperative risk and surgical site infection outcome data linked to Veterans Affairs Surgical Care Improvement Project and Pharmacy Benefits Management data. Univariate and multivariable models were performed to identify factors associated with surgical site infection within 30 days of surgery. This study was conducted in 112 Veterans Affairs hospitals. Included were 9940 patients who underwent elective colorectal resections from 2005 to 2009. The primary outcome measured was the incidence of surgical site infection. Patients receiving oral antibiotics had significantly lower surgical site infection rates. Those receiving no bowel preparation had similar surgical site infection rates to those who had mechanical bowel preparation only (18.1% vs 20%). Those receiving oral antibiotics alone had an surgical site infection rate of 8.3%, and those receiving oral antibiotics plus mechanical bowel preparation had a rate of 9.2%. In adjusted analysis, the use of oral antibiotics alone was associated with a 67% decrease in surgical site infection occurrence (OR=0.33, 95% CI 0.21-0.50). Oral antibiotics plus mechanical bowel preparation was associated with a 57% decrease in surgical site infection occurrence (OR=0.43, 95% CI 0.34-0.55). Timely administration of parenteral antibiotics (Surgical Care Improvement

  18. Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention.

    Science.gov (United States)

    Hastie, Graham; Soufi, Mazen; Wilson, James; Roy, Bibhas

    2018-03-01

    We aimed to assess the effectiveness of PRP injections in lateral epicondylitis of the elbow as it was felt after PRP introduction the numbers of patients requiring surgery for had reduced. We conducted a retrospective review of cases from the 1 st January 2008 to 31st December 2015. The numbers of patients undergoing surgical release and the numbers of patients requiring PRP injections were recorded each year and the numbers of patients requiring surgery was compared pre and post PRP injection to ascertain if PRP introduction reduced surgical intervention. Prior to PRP, a yearly mean of 12.75 patients underwent surgery, since PRP this reduced to 4.25 patients, P lateral epicondylitis of the elbow, not only a safe but also very effective tool in reducing symptoms and have shown it has reduced the need for surgical intervention in this difficult cohort of patients.

  19. Assessing suturing techniques using a virtual reality surgical simulator.

    Science.gov (United States)

    Kazemi, Hamed; Rappel, James K; Poston, Timothy; Hai Lim, Beng; Burdet, Etienne; Leong Teo, Chee

    2010-09-01

    Advantages of virtual-reality simulators surgical skill assessment and training include more training time, no risk to patient, repeatable difficulty level, reliable feedback, without the resource demands, and ethical issues of animal-based training. We tested this for a key subtask and showed a strong link between skill in the simulator and in reality. Suturing performance was assessed for four groups of participants, including experienced surgeons and naive subjects, on a custom-made virtual-reality simulator. Each subject tried the experiment 30 times using five different types of needles to perform a standardized suture placement task. Traditional metrics of performance as well as new metrics enabled by our system were proposed, and the data indicate difference between trained and untrained performance. In all traditional parameters such as time, number of attempts, and motion quantity, the medical surgeons outperformed the other three groups, though differences were not significant. However, motion smoothness, penetration and exit angles, tear size areas, and orientation change were statistically significant in the trained group when compared with untrained group. This suggests that these parameters can be used in virtual microsurgery training.

  20. What matters after sleeve gastrectomy: patient characteristics or surgical technique?

    Science.gov (United States)

    Dhar, Vikrom K; Hanseman, Dennis J; Watkins, Brad M; Paquette, Ian M; Shah, Shimul A; Thompson, Jonathan R

    2018-03-01

    The impact of operative technique on outcomes in laparoscopic sleeve gastrectomy has been explored previously; however, the relative importance of patient characteristics remains unknown. Our aim was to characterize national variability in operative technique for laparoscopic sleeve gastrectomy and determine whether patient-specific factors are more critical to predicting outcomes. We queried the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for laparoscopic sleeve gastrostomies performed in 2015 (n = 88,845). Logistic regression models were used to determine predictors of postoperative outcomes. In 2015, >460 variations of laparoscopic sleeve gastrectomy were performed based on combinations of bougie size, distance from the pylorus, use of staple line reinforcement, and oversewing of the staple line. Despite such substantial variability, technique variants were not predictive of outcomes, including perioperative morbidity, leak, or bleeding (all P ≥ .05). Instead, preoperative patient characteristics were found to be more predictive of these outcomes after laparoscopic sleeve gastrectomy. Only history of gastroesophageal disease (odds ratio 1.44, 95% confidence interval 1.08-1.91, P < .01) was associated with leak. Considerable variability exists in technique among surgeons nationally, but patient characteristics are more predictive of adverse outcomes after laparoscopic sleeve gastrectomy. Bundled payments and reimbursement policies should account for patient-specific factors in addition to current accreditation and volume thresholds when deciding risk-adjustment strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. Gauze Impregnated With Quaternary Ammonium Salt Reduces Bacterial Colonization of Surgical Drains After Breast Reconstruction.

    Science.gov (United States)

    Strong, Amy L; Wolfe, Emily T; Shank, Nina; Chaffin, Abigail E; Jansen, David A

    2018-06-01

    Surgical site infection after breast reconstruction is associated with increased length of hospital stay, readmission rates, cost, morbidity, and mortality. Identifying methods to reduce surgical site infection without the use of antibiotics may be beneficial at reducing antimicrobial resistance, reserving the use of antibiotics for more severe cases. Quaternary ammonium salts have previously been shown to be a safe and effective antimicrobial agent in the setting of in vitro and in vivo animal experiments. A retrospective study was conducted to investigate the antimicrobial properties of a quaternary ammonium salt, 3-trimethoxysilyl propyldimethyloctadecyl ammonium chloride (QAS-3PAC; Bio-spear), at reducing surgical drain site colonization and infection after breast reconstruction (deep inferior epigastric perforator flap reconstruction or tissue expander placement). Twenty patients were enrolled, with 14 surgical drains covered with nonimpregnated gauze and 17 surgical drains covered with QAS-3PAC impregnated gauze, for the purposes of investigating bacterial colonization. Antibiotic sensitivity analysis was also conducted when bacterial cultures were positive. The overall incidence of bacterial colonization of surgical drains was lower in the treatment group compared with the control group (17.6% vs 64.3%, respectively; P = 0.008). QAS-3PAC impregnated gauze reduced the incidence of bacterial colonization of surgical drains during the first (0.0% vs 33.3%) and second (33.3% vs 87.5%; P = 0.04) postoperative week. Furthermore, no enhanced antibiotic resistance was noted on drains treated with QAS-3PAC impregnated gauze. The results of this study suggest that QAS-3PAC impregnated gauze applied over surgical drains may be an effective method for reducing the incidence of bacterial colonization.

  2. Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series

    Directory of Open Access Journals (Sweden)

    Mayra Elena Hernández Carrazco

    2014-07-01

    Full Text Available Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications

  3. Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits.

    Science.gov (United States)

    Shrestha, Badri Man; Haylor, John

    2017-11-15

    Rat models of renal transplant are used to investigate immunologic processes and responses to therapeutic agents before their translation into routine clinical practice. In this study, we have described details of rat surgical anatomy and our experiences with the microvascular surgical technique relevant to renal transplant by employing donor inferior vena cava and aortic conduits. For this study, 175 rats (151 Lewis and 24 Fisher) were used to establish the Fisher-Lewis rat model of chronic allograft injury at our institution. Anatomic and technical details were recorded during the period of training and establishment of the model. A final group of 12 transplanted rats were studied for an average duration of 51 weeks for the Lewis-to-Lewis isografts (5 rats) and 42 weeks for the Fisher-to-Lewis allografts (7 rats). Functional measurements and histology confirmed the diagnosis of chronic allograft injury. Mastering the anatomic details and microvascular surgical techniques can lead to the successful establishment of an experimental renal transplant model.

  4. A novel single-step surgical technique for vestibular deepening using laser in conjunction with periodontal flap surgery

    Directory of Open Access Journals (Sweden)

    Ashu Bhardwaj

    2016-01-01

    Full Text Available Moderate-to-severe chronic periodontitis results in clinical loss of attachment, reduced width of attached gingiva (AG, periodontal pockets beyond mucogingival junction (MGJ, gingival recession, loss of alveolar bone, and decreased vestibular depth (VD. The encroachment of frenal and muscle attachments on marginal gingiva increases the rate of progression of periodontal pockets, prevents healing, and causes their recurrence after therapy. Loss of VD and AG associated with continuous progression of pocket formation and bone loss requires two-stage surgical procedures. In this article, one-stage surgical procedure is being described for the first time, to treat the periodontal pockets extending beyond the MGJ by periodontal flap surgery along with vestibular deepening with diode laser to increase the AG. One-step surgical technique is illustrated whereby pocket therapy with reconstruction of lost periodontal tissues can be done along with gingival augmentation by vestibular deepening.

  5. A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds

    OpenAIRE

    Dohmen, Pascal M.; Konertz, Wolfgang

    2007-01-01

    Surgical site infections are a mean topic in cardiac surgery, leading to a prolonged hospitalization, and substantially increased morbidity and mortality. One source of pathogens is the endogenous flora of the patient?s skin, which can contaminate the surgical site. A number of preoperative skin care strategies are performed to reduce bacterial contamination like preoperative antiseptic showering, hair removal, antisepsis of the skin, adhesive barrier drapes, and antimicrobial prophylaxis. Fu...

  6. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    Science.gov (United States)

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  7. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    OpenAIRE

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations.

  8. Innovation in surgical technology and techniques: Challenges and ethical issues.

    Science.gov (United States)

    Geiger, James D; Hirschl, Ronald B

    2015-06-01

    The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

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

  10. Pectus bar removal: surgical technique and strategy to avoid complications.

    Science.gov (United States)

    Park, Hyung Joo; Kim, Kyung Soo

    2016-01-01

    Pectus bar removal is the final stage of the procedure for minimally invasive repair of pectus excavatum. Based on our experience with one of the largest scale data, we would like to address the important issues in pectus bar removal, such as appropriate duration of bar maintenance, techniques for bar removal, and strategies to avoid complications. Between September 1999 and August 2015, we operated on 2,553 patients with pectus excavatum and carinatum using pectus bars for a minimally invasive approach. Among them, 1,821 patients (71.3%) underwent pectus bar removal as a final stage of pectus deformity repair, and their data were analyzed retrospectively to identify the outcomes and adverse effects of the pectus bar removal procedure. The mean age of the patients was 9.13 years (range, 16 months to 44 years) and the male to female ratio was 3.55. The study is approved by the Institutional Review Board (IRB), the ethical committee of Seoul St. Mary's Hospital. The IRB has exempted the informed consent from every patient in this study due to this is a retrospective chart review without revealing any patients' personal data. Our technique involved straightening of the bar in a supine position. The overall mean duration of pectus bar maintenance was 2.57 years (range, 4 months to 14 years). The mean duration was 2.02 years (range, 4 months to 7 years) for children under 12 years, 2.99 years (range, 7 months to 9 years) for teenagers aged 12-20 years, and 3.53 years (range, 3 months to 14 years) for adults over 20 years. Forty-eight patients (2.6%) underwent bar removal more than 5 years after bar insertion and 58 patients (3.2%) underwent bar removal earlier than initially planned. The most common adverse reaction after bar removal was wound seroma including infection (43 patients, 2.36%). Recurrence after bar removal occurred in nine patients (0.49%), and seven of these required redo repair (0.38%). Pectus bar removal is a safe and straightforward procedure with a

  11. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty.

    Science.gov (United States)

    Zywiel, Michael G; Daley, Jacqueline A; Delanois, Ronald E; Naziri, Qais; Johnson, Aaron J; Mont, Michael A

    2011-07-01

    Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient's native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. All adult reconstruction surgeons at a single institution were approached to voluntarily provide patients with chlorhexidine gluconate-impregnated cloths and a printed sheet instructing their use the night before and morning of surgery. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections. Overall, the advance pre-operative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone. These findings were maintained when patients were stratified by surgical infection risk category. No surgical site infections occurred in the 136 patients who completed the protocol as compared to 21 infections in 711 procedures (3.0%) performed in patients who did not. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only.

  12. Column-Oriented Storage Techniques for MapReduce

    OpenAIRE

    Floratou, Avrilia; Patel, Jignesh; Shekita, Eugene; Tata, Sandeep

    2011-01-01

    Users of MapReduce often run into performance problems when they scale up their workloads. Many of the problems they encounter can be overcome by applying techniques learned from over three decades of research on parallel DBMSs. However, translating these techniques to a MapReduce implementation such as Hadoop presents unique challenges that can lead to new design choices. This paper describes how column-oriented storage techniques can be incorporated in Hadoop in a way that preserves its pop...

  13. Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view

    Directory of Open Access Journals (Sweden)

    Xavier Cathelineau

    2010-04-01

    Full Text Available PURPOSE: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view. MATERIALS AND METHODS: We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy. RESULTS: LRP nuances were reassessed by surgical teams in order to verify possible weaknesses in their performance. Our basic approach was to carefully study the anatomy and pioneer open surgery descriptions in order to standardized and master a technique. The learning curve is presented in terms of an objective evaluation of outcomes for cancer control and functional results. In terms of technique-outcomes, there are several key elements in radical prostatectomy, such as dorsal vein control-apex exposure and nerve sparing with particular implications in oncological and functional results. Major variations among the surgical teams' performance and follow-up prevented objective comparisons in radical prostatectomy. The remarkable evolution of LRP needs to be supported by comprehensive results. CONCLUSIONS: Radical prostatectomy is a complex surgical operation with difficult objectives. Surgical technique should be standardized in order to allow an adequate and reliable performance in all settings, keeping in mind that cancer control remains the primary objective. Reassessing anatomy and a return to basics in surgical technique is the means to improve outcomes and overcome the difficult task of the learning curve, especially in minimally access urological surgery.

  14. Novel Surgical Technique for Bone Marrow Lesion — Case Report

    Directory of Open Access Journals (Sweden)

    Fodor Pal

    2016-11-01

    Full Text Available Introduction: Bone marrow lesions (BMLs are commonly described as magnetic resonance imaging (MRI findings associated with stress injuries or trauma. The presence of BMLs closely correlates with pain and rapid joint deterioration. Case presentation: A 51-year-old healthy man presented to our clinic with severe knee pain due to BMLs. After 3 months of conservative treatment, arthroscopy and subchondroplasty (SCP of the medial femoral condyle was performed. The IKDC (International Knee Documentation Committee score improved from 39.9 to 66.7 at 6 months, and to 87.4 at 1 year after surgery. The KOOS (Knee Injury and Osteoarthritis Outcome score improved from 38.5 to 77.7 at 6 months, and to 92.6 at 1 year after surgery. The Tegner Lysholm score improved from 23 to 80 at 6 months, and to 95 at 1 year after surgery. Conclusion: SCP may provide a viable approach to reduce pain associated with BML, with minimal risk of significant complications.

  15. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique.

    Science.gov (United States)

    Hoag, Nathan; Gani, Johan; Chee, Justin

    2016-07-01

    To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula.

  16. Evaluation of primary and secondary stability of titanium implants using different surgical techniques.

    Science.gov (United States)

    Tabassum, Afsheen; Meijer, Gert J; Walboomers, X Frank; Jansen, John A

    2014-04-01

    To investigate the influence of different surgical techniques on the primary and secondary implant stability using trabecular bone of goats as an implantation model. In the iliac crest of eight goats, 48 cylindrical-screw-type implants with a diameter of 4.2 mm (Dyna(®) ; Bergen op Zoom, the Netherlands) were installed, using three different surgical techniques: (i) 5% undersized, using a final drill diameter of 4 mm; (ii) 15% undersized, using a final drill diameter of 3.6 mm; and (iii) 25% undersized, using a final drill diameter of 3.2 mm. Peak insertion torque values were measured by a Digital(®) (MARK-10 Corporation, New York, NY, USA) torque gauge instrument during placement. At 3 weeks after implantation, removal torque was measured. Histomorphometrically, the peri-implant bone volume was measured in three zones; the inner zone (0-500 μm), the middle zone (500-1000 μm) and the outer zone (1000-1500 μm). Evaluation of the obtained data demonstrated no statistically significant difference between different surgical techniques regarding removal torque values. With respect to the percentage peri-implant bone volume (%BV), also no significant difference could be observed between all three applied surgical techniques for both the inner, middle and outer zone. However, irrespective of the surgical technique, it was noticed that the %BV was significantly higher for the inner zone as compared to middle and outer zone (P < 0.05) around the implant. At 3 weeks after implant installation, independent of the used undersized surgical technique, the %BV in the inner zone (0-500 μm) peri-implant area was improved due to both condensation of the surrounding bone as also the translocation of host bone particles along the implant surface. Surprisingly, no mechanical beneficial effect of the 25% undersized surgical technique could be observed as compared to the 5% or 15% undersized surgical technique to improve primary or secondary implant stability. © 2013

  17. Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions.

    Science.gov (United States)

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

    2016-04-01

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

  18. Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques.

    Science.gov (United States)

    Horbach, Sophie E R; Bouman, Mark-Bram; Smit, Jan Maerten; Özer, Müjde; Buncamper, Marlon E; Mullender, Margriet G

    2015-06-01

    Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared. With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders. A PubMed and EMBASE search for relevant publications (1995-present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients. Main outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL). Twenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization. The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data. © 2015 International Society for

  19. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

    International Nuclear Information System (INIS)

    Hollingsworth, Caroline L.; Rice, Henry E.

    2010-01-01

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  20. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hollingsworth, Caroline L. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States); Rice, Henry E. [Duke University Medical Center, Department of Surgery, Durham, NC (United States)

    2010-07-15

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  1. SURGICAL TECHNIQUE

    African Journals Online (AJOL)

    We describe a simple form of posterior spinal surgery for patients with tuberculous ... malnutrition and other concomitant diseases tuberculosis (T B) of ... Positioning: We use the prone position with hip and .... can fracture, get absorbed or slip.

  2. Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Nobuaki Fujikuni

    2011-12-01

    Full Text Available Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

  3. Posterior Segment Intraocular Foreign Body: Extraction Surgical Techniques, Timing, and Indications for Vitrectomy

    Directory of Open Access Journals (Sweden)

    Dante A. Guevara-Villarreal

    2016-01-01

    Full Text Available Ocular penetrating injury with Intraocular Foreign Body (IOFB is a common form of ocular injury. Several techniques to remove IOFB have been reported by different authors. The aim of this publication is to review different timing and surgical techniques related to the extraction of IOFB. Material and Methods. A PubMed search on “Extraction of Intraocular Foreign Body,” “Timing for Surgery Intraocular Foreign Body,” and “Surgical Technique Intraocular Foreign Body” was made. Results. Potential advantages of immediate and delayed IOFB removal have been reported with different results. Several techniques to remove IOFB have been reported by different authors with good results. Conclusion. The most important factor at the time to perform IOFB extraction is the experience of the surgeon.

  4. Comparative study of 2 surgical techniques for castration of guinea pigs (Cavia porcellus).

    Science.gov (United States)

    Guilmette, Josée; Langlois, Isabelle; Hélie, Pierre; El Warrak, Alexander de Oliveira

    2015-10-01

    The objective of this study was to compare 2 surgical approaches (scrotal or abdominal) for castration of guinea pigs and to investigate post-operative infection rates with either technique. Forty-eight guinea pigs were castrated by scrotal or abdominal technique after being randomly assigned to 1 of 2 groups (n = 24). Individuals were either castrated by an experienced exotic animal surgeon (n = 12) or by an experienced small animal surgeon (n = 12). Surgical wounds were evaluated daily before euthanasia for histological evaluation 2 wks after surgery. Post-operative infection rate was significantly higher in the scrotal group than in the abdominal group, with a higher rate for the experienced small animal surgeon. Castration of guinea pigs with the abdominal technique is significantly faster and has a significantly lower post-operative infection rate than the scrotal technique.

  5. Use of segregation techniques to reduce stored low level waste

    International Nuclear Information System (INIS)

    Nascimento Viana, R.; Vianna Mariano, N.; Antonio do Amaral, M.

    2000-01-01

    This paper describes the use of segregation techniques in reducing the stored Low Level Waste on Intermediate Waste Repository 1, at Angra Nuclear Power Plant Site, from 1701 to 425 drums of compacted waste. (author)

  6. The Suprameatal Approach: A Safe Alternative Surgical Technique for Cochlear Implantation

    NARCIS (Netherlands)

    Postelmans, Job T. F.; Tange, Rinze A.; Stokroos, Robert J.; Grolman, Wilko

    2010-01-01

    Objective: To report on surgical complications arising post-operatively in 104 patients undergoing cochlear implantation surgery using the suprameatal approach (SMA). Second, to examine the advantages and disadvantages of the SMA technique compared with the classic mastoidectomy using the posterior

  7. A method of handing down surgical clipping technique for cerebral aneurysm

    International Nuclear Information System (INIS)

    Idei, Masaru; Yamane, Kanji; Okita, Shinji; Kumano, Kiyoshi; Nakae, Ryuta

    2009-01-01

    Meticulous clipping techniques are essential to obtain good results. Recently, the introduction of intravascular surgery for cerebral aneurysms has decreased the number of the direct clipping surgeries. And the increasing number of the lawsuits against doctors further discourages young surgeons from attempting clipping. As a result, young neurosurgeons, have less experience performing clipping. Therefore, we must learn clipping techniques from expert neurosurgeons under the limitation of having fewer opportunities to perform clipping surgery. In this paper, I present my experiences and discuss ways to obtain techniques for clipping surgery. I performed surgical clipping in 19 cases, 12 unruptured and 7 ruptured aneurysms, 7 males and 12 females aged from 36 to 79 years old (mean 61.9 years). Postoperatively, there were no symptomatic complications, but there were 2 asymptomatic infarctions that were revealed on CT scan. Intraoperative premature rupture occurred in 1 patient with a ruptured aneurysm. Techniques of manipulation with micro-forceps, suction and spatula are required for successful clipping. Off-the-job training of dissecting chicken wing arteries and rat abdominal aortas and vena cavas is useful. Moreover, actual experiences of surgical operations are essential. Surgical experiences raise the motivation of young neurosurgeons and encourage them to train more. We believe that this benign cycle contributes to meticulous surgical skills. (author)

  8. Evaluation of primary and secondary stability of titanium implants using different surgical techniques

    NARCIS (Netherlands)

    Tabassum, A.; Meijer, G.J.; Walboomers, X.F.; Jansen, J.A.

    2014-01-01

    OBJECTIVE: To investigate the influence of different surgical techniques on the primary and secondary implant stability using trabecular bone of goats as an implantation model. MATERIAL AND METHODS: In the iliac crest of eight goats, 48 cylindrical-screw-type implants with a diameter of 4.2 mm

  9. Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques

    NARCIS (Netherlands)

    Horbach, S.E.R.; Bouman, M.B.; Smit, J.M.; Özer, M.; Buncamper, M.E.; Mullender, M.G.

    2015-01-01

    Introduction: Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most

  10. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer

    NARCIS (Netherlands)

    Haverkamp, L.; Seesing, M. F J; Ruurda, J. P.; Boone, J.; van Hillegersberg, R.

    The aim of this study was to evaluate the worldwide trends in surgical techniques for esophageal cancer surgery by comparing it to our survey from 2007. In addition, new questions were added for gastroesophageal junction (GEJ) cancer. An international survey on surgery of esophageal and GEJ cancer

  11. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses

    OpenAIRE

    PATRICIA B CARROLL; WERVISTON DEFARIA; CARLOS GANDIA; MARIANA BERHO; EVANGELOS MISIAKOS; ANDREAS G TZAKIS

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was ...

  12. Comparison of two surgical techniques for creating an acute myocardial infarct in rats

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Achcar Capriglione

    2014-12-01

    Full Text Available Objective: To perform a comparative assessment of two surgical techniques that are used creating an acute myocardial infarc by occluding the left anterior descending coronary artery in order to generate rats with a left ventricular ejection fraction of less than 40%. Methods: The study was completely randomized and comprised 89 halothane-anaesthetised rats, which were divided into three groups. The control group (SHAM comprised fourteen rats, whose left anterior descending coronary artery was not occluded. Group 1 (G1: comprised by 35 endotracheally intubated and mechanically ventilated rats, whose left anterior descending coronary artery was occluded. Group 2 (G2: comprised 40 rats being manually ventilated using a nasal respirator whose left anterior descending coronary artery was occluded. Other differences between the two techniques include the method of performing the thoracotomy and removing the pericardium in order to expose the heart, and the use of different methods and suture types for closing the thorax. Seven days after surgery, the cardiac function of all surviving rats was determined by echocardiography. Results: No rats SHAM group had progressed to death or had left ventricular ejection fraction less than 40%. Nine of the 16 surviving G1 rats (56.3% and six of the 20 surviving G2 rats (30% had a left ventricular ejection fraction of less than 40%. Conclusion: The results indicate a tendency of the technique used in G1 to be better than in G2. This improvement is probably due to the greater duration of the open thorax, which reduces the pressure over time from the surgeon, allowing occlusion of left anterior descending coronary artery with higher accuracy.

  13. Prepubertal gonadectomy in cats: different surgical techniques and comparison with gonadectomy at traditional age.

    Science.gov (United States)

    Porters, N; Polis, I; Moons, C; Duchateau, L; Goethals, K; Huyghe, S; de Rooster, H

    2014-09-06

    Feasibility, surgical time and complications of different surgical techniques for prepubertal gonadectomy (PPG; 8-12 weeks of age) in cats were studied and compared to gonadectomy at traditional age (TAG; 6-8 months of age). Kittens were randomly assigned to PPG or TAG. Ovarian pedicle haemostasis for PPG was achieved by ligatures (n=47), vascular clips (n=50), bipolar electrocoagulation (n=50), or pedicle tie (n=50); for TAG (n=34) ligatures were used. In male cats, PPG consisted of closed castration by spermatic cord knot (n=92) or ligature (n=91) while TAG (n=34) was an open castration by spermatic cord knot. A linear (surgical time) and a logistic regression (complications) model were designed. Significance was set at 0.05. For female PPG, clips and coagulation were the fastest procedures; placement of ligatures was most time-consuming. In male PPG, knot placement was significantly faster than ligation. In both sexes, very few intraoperative or wound complications were observed, irrespective of the surgical technique used. Surgical times in females (ligatures) as well as in males (knot) were significantly shorter for PPG than for TAG. PPG was as safe as TAG, yet took less time to perform and did not result in a greater rate of postoperative complications. British Veterinary Association.

  14. Surgical myocardial revascularization in patients with reduced systolic left ventricular function.

    Science.gov (United States)

    Bruno, Piergiorgio; Iafrancesco, Mauro; Massetti, Massimo

    2018-04-20

    Surgical myocardial revascularization in patients with reduced left ventricular function has been a matter of debate for decades. Recently published 10-years extension follow-up of the STICH trial have conclusively demonstrated benefit of surgical myocardial revascularization in patients with significant coronary artery disease and low left ventricular ejection fraction. However, selection of patients for surgery remains challenging as well as decision to perform percutaneous rather than surgical revascularization in this class of patients. New evidence helped to clarify the role of preoperative patients' characteristics as risk factors for surgery and to identify those patients who may benefit the most from surgery. Focus of this review is to review epidemiology, aetiology and pathophysiology of coronary artery disease in patients with reduced left ventricular function, role of viability and results of observational and investigational studies on revascularization in patients with reduced left ventricular function with a particular emphasis on relative indication of coronary artery bypass grafting and percutaneous coronary intervention and the surgical implications of development of ischemic mitral regurgitation or ischemic left ventricular aneurysm.

  15. Techniques for Optimizing Surgical Scars, Part 2: Hypertrophic Scars and Keloids.

    Science.gov (United States)

    Potter, Kathryn; Konda, Sailesh; Ren, Vicky Zhen; Wang, Apphia Lihan; Srinivasan, Aditya; Chilukuri, Suneel

    2017-01-01

    Surgical management of benign or malignant cutaneous tumors may result in noticeable scars that are of great concern to patients, regardless of sex, age, or ethnicity. Techniques to optimize surgical scars are discussed in this three-part review. Part 2 focuses on scar revision for hypertrophic and keloids scars. Scar revision options for hypertrophic and keloid scars include corticosteroids, bleomycin, fluorouracil, verapamil, avotermin, hydrogel scaffold, nonablative fractional lasers, ablative and fractional ablative lasers, pulsed dye laser (PDL), flurandrenolide tape, imiquimod, onion extract, silicone, and scar massage.

  16. The first successful laparoscopic Whipple procedure at Hat Yai Hospital: surgical technique and a case report.

    Science.gov (United States)

    Khaimook, Araya; Borkird, Jumpot; Alapach, Sakda

    2010-09-01

    Whipple procedure is the most complex abdominal surgical procedure to treat periampullary carcinoma. With the benefit of minimally invasive approach, many institutes attempt to do Whipple procedure laparoscopically. However, only 146 cases of laparoscopic Whipple procedure have yet been reported in the literature worldwide between 1994 and 2008. The authors reported the first laparoscopic Whipple procedure at Hat Yai Hospital in December 2009. The patient was a 40-year-old, Thai-Muslim female, with the diagnosis of ampullary carcinoma. The operating time was 685 minutes. The patient was discharged on postoperative day 14 without serious complication. The surgical technique and postoperative progress of the patient were described.

  17. Useful surgical techniques for facial nerve preservation in tumorous intra-temporal lesions.

    Science.gov (United States)

    Kim, Jin; Moon, In Seok; Lee, Jong Dae; Shim, Dae Bo; Lee, Won-Sang

    2010-02-01

    The management of the facial nerve in tumorous temporal lesions is particularly challenging due to its complex anatomic location and potential postoperative complications, including permanent facial paralysis. The most important concern regarding surgical treatment of a tumorous temporal lesion is the inevitable facial paralysis caused by nerve injury during the tumor removal, especially in patients with minimal to no preoperative facial nerve dysfunction. We describe successful four cases in which various surgical techniques were developed for the preservation of the facial nerve in treatment of intratemporal tumorous lesions. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  18. Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique.

    Science.gov (United States)

    Canut Jordana, M Isabel; Pérez Formigó, Daniel; Abreu González, Rodrigo; Nadal Reus, Jeroni

    2010-11-11

    We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact. Complete ophthalmologic examination and optical coherence tomography (OCT) of the anterior segment were performed. Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control. Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively.

  19. Measurement of blood flow through surgical anastomosis using the radioactive microsphere technique

    Energy Technology Data Exchange (ETDEWEB)

    Hummel, S.J.; Delgado, G.; Butterfield, A.; Dritschilo, A.; Harbert, J.

    1985-10-01

    Two different radioactive microspheres ( U Ce and UWSc) were used to measure blood flow to an area of the large intestine in dogs before and after a surgical resection was performed with surgical staples. The healing of an anastomosis is theoretically related to the blood flow to the anastomotic site. Blood flow studies were conducted in three dogs using this technique. The average blood flow preoperatively was 0.558 mL/minute per gram and 1.04 mL/minute per gram postoperatively. These results indicate a statistically significant increase in blood flow at the anastomotic site six days after anastomosis when compared with the blood flow to the same area before any surgical procedures.

  20. Measurement of blood flow through surgical anastomosis using the radioactive microsphere technique

    International Nuclear Information System (INIS)

    Hummel, S.J.; Delgado, G.; Butterfield, A.; Dritschilo, A.; Harbert, J.

    1985-01-01

    Two different radioactive microspheres ( 141 Ce and 46 Sc) were used to measure blood flow to an area of the large intestine in dogs before and after a surgical resection was performed with surgical staples. The healing of an anastomosis is theoretically related to the blood flow to the anastomotic site. Blood flow studies were conducted in three dogs using this technique. The average blood flow preoperatively was 0.558 mL/minute per gram and 1.04 mL/minute per gram postoperatively. These results indicate a statistically significant increase in blood flow at the anastomotic site six days after anastomosis when compared with the blood flow to the same area before any surgical procedures

  1. Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.

    Science.gov (United States)

    Yoshida, Kazumichi; Kurosaki, Yoshitaka; Funaki, Takeshi; Kikuchi, Takayuki; Ishii, Akira; Takahashi, Jun C; Takagi, Yasushi; Yamagata, Sen; Miyamoto, Susumu

    2014-01-01

    To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

    Directory of Open Access Journals (Sweden)

    Patrick Holweg

    2017-01-01

    Full Text Available Various surgical techniques have been described for the fixation of acromioclavicular (AC dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points, SPADI (0 points, and QuickDASH score (0 points. The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

  3. Priority of surgical treatment techniques of full cartilage defects of knee joint

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    Андрій Вікторович Літовченко

    2015-10-01

    Full Text Available Aim. Surgical treatment of chondromalacia of knee joint cartilage is an actual problem of the modern orthopedics because the means of conservative therapy can be realized at an initial stage only and almost exhausted at the further ones. Imperfections of palliative surgical techniques are the short-term clinical effect and pathogenetic baselessness because surgical procedure is not directed on reparation of cartilaginous tissue. For today there are a lot of transplantation techniques that are used for biological renewal of articular surface with formation of hyaline or at least hyaline-like cartilage. The deep forage of cartilage defect bottom to the medullary canal is a perspective and priority technique.Methods. The results of treatment of 61 patients with chondromalacia of knee joint of 3-4 degree according to R. Outerbridge are the base of the work. 20 patients of every group underwent microfracturization of cartilage defect bottom and subchondral forage of defect zone. 21 patients underwent the deep forage of defect zone of knee joint according to an offered technique.Result. The results of treatment with microfracturization, subchondral forage and deep forage of defect zone indicate the more strong clinical effect especially in the last clinical group where good and satisfactory results ratios in the term of observation 18 and 24 month remain stable.Conclusions. Deep forage of cartilage defects zone is the most adequate reparative technique of the surgical treatment of local knee joint cartilage defects. Owing to this procedure the number of cells of reparative chondrogenesis predecessors is realized

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

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    Jose M. Cabello

    2009-04-01

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

  5. Delayed surgical treatment for neglected or mal-reduced talar fractures.

    Science.gov (United States)

    Huang, Peng-Ju; Cheng, Yuh-Min

    2005-10-01

    From 1993 to 2002, we treated nine patients for neglected or mal-reduced talar fractures. Average patient age was 39 (20-64) years and average follow-up 53 months. The time interval between injury and index operation ranged from 4 weeks to 4 years. Surgical procedures included open reduction with or without bone grafting in six cases, open reduction combined with ankle fusion in one case, talar neck osteotomy in one case, and talar neck osteotomy combined with subtalar fusion in one case. All cases had solid bone union. One patient developed avascular necrosis of the talus needing subsequent ankle arthrodesis. In six patients, adjacent hindfoot arthrosis occurred. The overall AOFAS ankle-hindfoot score was in average 77.4. We conclude that in neglected and mal-reduced talar fractures, surgical treatment can lead to a favourable outcome if the hindfoot joints are not arthritic.

  6. Blocking Surgically Induced Lysyl Oxidase Activity Reduces the Risk of Lung Metastases

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    Chen Rachman-Tzemah

    2017-04-01

    Full Text Available Surgery remains the most successful curative treatment for cancer. However, some patients with early-stage disease who undergo surgery eventually succumb to distant metastasis. Here, we show that in response to surgery, the lungs become more vulnerable to metastasis due to extracellular matrix remodeling. Mice that undergo surgery or that are preconditioned with plasma from donor mice that underwent surgery succumb to lung metastases earlier than controls. Increased lysyl oxidase (LOX activity and expression, fibrillary collagen crosslinking, and focal adhesion signaling contribute to this effect, with the hypoxic surgical site serving as the source of LOX. Furthermore, the lungs of recipient mice injected with plasma from post-surgical colorectal cancer patients are more prone to metastatic seeding than mice injected with baseline plasma. Downregulation of LOX activity or levels reduces lung metastasis after surgery and increases survival, highlighting the potential of LOX inhibition in reducing the risk of metastasis following surgery.

  7. [Multiple colonic anastomoses in the surgical treatment of short bowel syndrome. A new technique].

    Science.gov (United States)

    Robledo-Ogazón, Felipe; Becerril-Martínez, Guillermo; Hernández-Saldaña, Víctor; Zavala-Aznar, Marí Luisa; Bojalil-Durán, Luis

    2008-01-01

    Some surgical pathologies eventually require intestinal resection. This may lead to an extended procedure such as leaving 30 cm of proximal jejunum and left and sigmoid colon. One of the most important consequences of this type of resection is "intestinal failure" or short bowel syndrome. This complex syndrome leads to different metabolic and water and acid/base imbalances, as well as nutritional and immunological challenges along with the problem accompanying an abdomen subjected to many surgical procedures and high mortality. Many surgical techniques have been developed to improve quality of life of patients. We designed a non-transplant surgical approach and performed the procedure on two patients with postoperative short bowel syndrome with work can be performed by a large number of surgeons. The procedure has a low morbimortality rate and offers the opportunity for better control of metabolic and acid/base balance, intestinal transit and proper nutrition. We consider that this technique offers a new alternative for the complex management required by patients with short bowel syndrome and facilitates their long-term nutritional control.

  8. A novel surgical method for total nail ablation: Use of triple flap technique

    Directory of Open Access Journals (Sweden)

    Berna Aksoy

    2017-11-01

    Full Text Available Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix. A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple flap technique which was composed of a main central advancement flap containing ventral toe skin and two side flaps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her first toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple flap technique is an effective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. 

  9. Supplemental Perioperative Oxygen to Reduce Surgical Site Infection after High Energy Fracture Surgery

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-12-1-0588 TITLE: Supplemental Perioperative Oxygen to Reduce Surgical Site Infection after High- Energy Fracture Surgery...High- Energy Fracture Surgery 5a. CONTRACT NUMBER W81XWH-12-1-0588 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Robert V. O’Toole, MD...14 4 1. INTRODUCTION: The overall scope of this project is to address the treatment of high- energy military fractures, which has

  10. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    Science.gov (United States)

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Use of artificial intelligence to analyze clinical database reduces workload on surgical house staff.

    Science.gov (United States)

    Grossi, E A; Steinberg, B M; LeBoutillier, M; Coppa, G F; Roses, D F

    1994-08-01

    The current quantity and diversity of hospital clinical, laboratory, and pharmacy records have resulted in a glut of information, which can be overwhelming to house staff. This study was performed to measure the impact of artificial intelligence analysis of such data on the junior surgical house staff's workload, time for direct patient care, and quality of life. A personal computer was interfaced with the hospital computerized patient data system. Artificial intelligence algorithms were applied to retrieve and condense laboratory values, microbiology reports, and medication orders. Unusual laboratory tests were reported without artificial intelligence filtering. A survey of 23 junior house staff showed a requirement for a total of 30.75 man-hours per day, an average of 184.5 minutes per service twice a day for five surgical services each with an average of 40.7 patients, to manually produce a report in contrast to a total of 3.4 man-hours, an average of 20.5 minutes on the same basis (88.9% reduction, p medical practice has created an explosion of information, which is a burden for surgical house staff. Artificial intelligence preprocessing of the hospital database information focuses attention, eliminates superfluous data, and significantly reduces surgical house staff clerical work, allowing more time for education, research, and patient care.

  12. National surgical mortality audit may be associated with reduced mortality after emergency admission.

    Science.gov (United States)

    Kiermeier, Andreas; Babidge, Wendy J; McCulloch, Glenn A J; Maddern, Guy J; Watters, David A; Aitken, R James

    2017-10-01

    The Western Australian Audit of Surgical Mortality was established in 2002. A 10-year analysis suggested it was the primary driver in the subsequent fall in surgeon-related mortality. Between 2004 and 2010 the Royal Australasian College of Surgeons established mortality audits in other states. The aim of this study was to examine national data from the Australian Institute of Health and Welfare (AIHW) to determine if a similar fall in mortality was observed across Australia. The AIHW collects procedure and outcome data for all surgical admissions. AIHW data from 2005/2006 to 2012/2013 was used to assess changes in surgical mortality. Over the 8 years surgical admissions increased by 23%, while mortality fell by 18% and the mortality per admission fell by 33% (P audit was associated with a sharp decline in perioperative mortality. In the absence of any influences from other changes in clinical governance or new quality programmes it is probable it had a causal effect. The reduced mortality was most evident in high-risk patients. This study adds to the evidence that national audits are associated with improved outcomes. © 2017 Royal Australasian College of Surgeons.

  13. Reversible hydronephrosis in the rat: a new surgical technique assessed by radioisotopic measurements

    International Nuclear Information System (INIS)

    Flam, T.; Venot, A.; Bariety, J.

    1984-01-01

    A new technique for experimental reversible hydronephrosis in the rat was developed. A noninvasive radioisotopic investigation, using Tc-99m dimercaptosuccinic acid, permitted sequential assessment of the separate renal function at different stages of the study. After 1 week of unilateral ureteral obstruction, reversibility was obtained by the removal of the obstructive device. Ten days after the obstruction release, the ipsilateral kidney had returned to 71 per cent of its preligation uptake value. Histological findings demonstrated the reversibility of the surgical obstruction

  14. Ontogeny of a surgical technique: Robotic kidney transplantation with regional hypothermia.

    Science.gov (United States)

    Sood, Akshay; McCulloch, Peter; Dahm, Philipp; Ahlawat, Rajesh; Jeong, Wooju; Bhandari, Mahendra; Menon, Mani

    2016-01-01

    Innovation is a hallmark of surgical practice. It is generally accepted that a new procedure will undergo technical changes during its evolution; however, quantitative accounts of the process are limited. Multiple groups, including our own, have recently described a minimally-invasive approach to conventional kidney transplantation (KT) operation. Unique to our experience is a structured development of the technique within the confines of a safe surgical innovation framework - the IDEAL framework (idea, development, exploration, assessment, long-term monitoring; stages 0-4). We here provide a first-hand narrative of the progress of robotic KT operation from preclinical trial to clinical application. Overall, 54 patients underwent robotic KT with regional hypothermia successfully. Major technical changes including selection of optimal patient position (flank vs. lithotomy), robotic instrumentation, vascular occlusion method (bulldog vs. tourniquet) and suture material (prolene vs. GoreTex) occurred early during the procedure development (IDEAL stage 0, preclinical). Minor technical changes such as utilization of the aortic punch for arteriotomy (case 3), use of barbed suture during ureteroneocystostomy (case 6) and extraperitonealization of the graft kidney (case 6) that increased the efficiency and safety of the procedure continued throughout procedure development (IDEAL stages 1-2, clinical stages). We demonstrate that a surgical technique evolves continually; although, the majority of technical alterations occur early in the life-cycle of the procedure. Development of a new technique within the confines a structured surgical innovation framework allows for evidence based progression of the technique and may minimize the risk of harm to the patient. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  15. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

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    Nathan Hoag

    2016-07-01

    Full Text Available Purpose: To present a novel modification of surgical technique to treat female urethral stricture (FUS by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods: We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results: The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions: This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula.

  16. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap.

    Science.gov (United States)

    Han, Dong-Seok; Jang, Hoon; Youn, Chang-Shik; Yuk, Seung-Mo

    2015-06-19

    Until recently, no single, universally accepted surgical method has existed for all types of concealed penis repairs. We describe a new surgical technique for repairing concealed penis by using an advanced musculocutaneous scrotal flap. From January 2010 to June 2014, we evaluated 12 patients (12-40 years old) with concealed penises who were surgically treated with an advanced musculocutaneous scrotal flap technique after degloving through a ventral approach. All the patients were scheduled for regular follow-up at 6, 12, and 24 weeks postoperatively. The satisfaction grade for penile size, morphology, and voiding status were evaluated using a questionnaire preoperatively and at all of the follow-ups. Information regarding complications was obtained during the postoperative hospital stay and at all follow-ups. The patients' satisfaction grades, which included the penile size, morphology, and voiding status, improved postoperatively compared to those preoperatively. All patients had penile lymphedema postoperatively; however, this disappeared within 6 weeks. There were no complications such as skin necrosis and contracture, voiding difficulty, or erectile dysfunction. Our advanced musculocutaneous scrotal flap technique for concealed penis repair is technically easy and safe. In addition, it provides a good cosmetic appearance, functional outcomes and excellent postoperative satisfaction grades. Lastly, it seems applicable in any type of concealed penis, including cases in which the ventral skin defect is difficult to cover.

  17. Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation

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    Perel Pablo

    2010-02-01

    Full Text Available Abstract Background The identification of safe and effective alternatives to blood transfusion is a public health priority. In sub-Saharan Africa, blood shortage is a cause of mortality and morbidity. Blood transfusion can also transmit viral infections. Giving tranexamic acid (TXA to bleeding surgical patients has been shown to reduce both the number of blood transfusions and the volume of blood transfused. The objective of this study is to investigate whether routinely administering TXA to bleeding elective surgical patients is cost effective by both averting deaths occurring from the shortage of blood, and by preventing infections from blood transfusions. Methods A decision tree was constructed to evaluate the cost-effectiveness of providing TXA compared with no TXA in patients with surgical bleeding in four African countries with different human immunodeficiency virus (HIV prevalence and blood donation rates (Kenya, South Africa, Tanzania and Botswana. The principal outcome measures were cost per life saved and cost per infection averted (HIV, Hepatitis B, Hepatitis C averted in 2007 International dollars ($. The probability of receiving a blood transfusion with and without TXA and the risk of blood borne viral infection were estimated. The impact of uncertainty in model parameters was explored using one-way deterministic sensitivity analyses. Probabilistic sensitivity analysis was performed using Monte Carlo simulation. Results The incremental cost per life saved is $87 for Kenya and $93 for Tanzania. In Botswana and South Africa, TXA administration is not life saving but is highly cost saving since fewer units of blood are transfused. Further, in Botswana the administration of TXA averts one case of HIV and four cases of Hepatitis B (HBV per 1,000 surgical patients. In South Africa, one case of HBV is averted per 1,000 surgical patients. Probabilistic sensitivity analyses confirmed the robustness of the model. Conclusion An economic

  18. Choice of a General Anesthesia Technique in the Surgical Treatment of Postinfarct Left Ventricular Aneurysms

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    N. A. Karpun

    2005-01-01

    Full Text Available Objective. To choose the optimum technique of general anesthesia in the surgical treatment of patients with postinfarct left ventricular aneurysms (PLVA.Materials and methods. Fifty-four patients operated on for PLVA were examined. They were divided into 4 groups according to the basic technique of general anesthesia: 1 intravenous anesthesia based on propofol and fentanyl; 2 inhalation sevoflurane anesthesia with fentanyl enhancement of the analgesic component; 3 inhalation isoflurane anesthesia with fentanyl enhancement of the analgesic component; 4 general anesthesia in combination with epidural blockade. Central hemodynamics was investigated by the thermodilution technique and the perioperative period was also studied.Results and discussion. None of the general anesthesia techniques affected the development of perioperative complications. However, with decreased myocardial reserves, high thoracic epidural anesthesia should be applied with caution as it causes a significant desympathization, which may lead to impairments of the autoregulatory mechanisms of coronary blood flow and aggravate existing contractile disorders. Intravenous and inhalation anesthesia techniques provide a fair hemodynamic stability at all stages of surgical treatment. Inhalation anesthesia has a number of advantages: less cost and the possibility of rapid activation of patients in the early postoperative period.

  19. "TuNa-saving" endoscopic medial maxillectomy: a surgical technique for maxillary inverted papilloma.

    Science.gov (United States)

    Pagella, Fabio; Pusateri, Alessandro; Matti, Elina; Avato, Irene; Zaccari, Dario; Emanuelli, Enzo; Volo, Tiziana; Cazzador, Diego; Citraro, Leonardo; Ricci, Giampiero; Tomacelli, Giovanni Leo

    2017-07-01

    The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.

  20. [Management of spinal metastasis by minimal invasive surgery technique: Surgical principles, indications: A literature review].

    Science.gov (United States)

    Toquart, A; Graillon, T; Mansouri, N; Adetchessi, T; Blondel, B; Fuentes, S

    2016-06-01

    Spinal metastasis are getting more frequent. This raises the question of pain and neurological complications, which worsen the functional and survival prognosis of this oncological population patients. The surgical treatment must be the most complete as possible: to decompress and stabilize without delaying the management of the oncological disease. Minimal invasive surgery techniques are by definition, less harmful on musculocutaneous plan than opened ones, with a comparable efficiency demonstrated in degenerative and traumatic surgery. So they seem to be applicable and appropriate to this patient population. We detailed different minimal invasive techniques proposed in the management of spinal metastasis. For this, we used our experience developed in degenerative and traumatic pathologies, and we also referred to many authors, establishing a literature review thanks to Pubmed, Embase. Thirty eight articles were selected and allowed us to describe different techniques: percutaneous methods such as vertebro-/kyphoplasty and osteosynthesis, as well as mini-opened surgery, through a posterior or anterior way. We propose a surgical approach using these minimal invasive techniques, first according to the predominant symptom (pain or neurologic failure), then characteristics of the lesions (number, topography, type…) and the deformity degree. Whatever the technique, the main goal is to stabilize and decompress, in order to maintain a good quality of life for these fragile patients, without delaying the medical management of the oncological disease. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Fixation of Hydroxyapatite-Coated Revision Implants Is Improved by the Surgical Technique of Cracking the Sclerotic Bone Rim

    Science.gov (United States)

    Elmengaard, Brian; Bechtold, Joan E.; Chen, Xinqian; Søballe, Kjeld

    2013-01-01

    Revision joint replacement has poorer outcomes that have been associated with poorer mechanical fixation. We investigate a new bone-sparing surgical technique that locally cracks the sclerotic bone rim formed during aseptic loosening. We inserted 16 hydroxyapatite-coated implants bilaterally in the distal femur of eight dogs, using a controlled weight-bearing experimental model that replicates important features of a typical revision setting. At 8 weeks, a control revision procedure and a crack revision procedure were performed on contralateral implants. The crack procedure used a splined tool to perform a systematic local perforation of the sclerotic bone rim of the revision cavity. After 4 weeks, the hydroxyapatite-coated implants were evaluated for mechanical fixation by a push-out test and for tissue distribution by histomorphometry. The cracking revision procedure resulted in significantly improved mechanical fixation, significantly more bone ongrowth and bone volume in the gap, and reduced fibrous tissue compared to the control revision procedure. The study demonstrates that the sclerotic bone rim prevents bone ingrowth and promotes fixation by fibrous tissue. The effect of the cracking technique may be due to improved access to the vascular compartment of the bone. The cracking technique is a simple surgical method that potentially can improve the fixation of revision implants in sclerotic regions important for obtaining the fixation critical for overall implant stability. PMID:19148940

  2. Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone.

    Science.gov (United States)

    Till, Sara R; Morgan, Daniel M; Bazzi, Ali A; Pearlman, Mark D; Abdelsattar, Zaid; Campbell, Darrell A; Uppal, Shitanshu

    2017-08-01

    Organisms that are isolated from vaginal cuff infections and pelvic abscesses after hysterectomy frequently include anaerobic vaginal flora. Metronidazole has outstanding coverage against nearly all anaerobic species, which is superior to both cefazolin and second-generation cephalosporins. Cefazolin plus metronidazole has been demonstrated to reduce infectious morbidity compared with either cefazolin or second-generation cephalosporins in other clean-contaminated procedures, which include both as colorectal surgery and cesarean delivery. The purpose of this study was to evaluate whether the combination of cefazolin plus metronidazole before hysterectomy was more effective in the prevention of surgical site infection than existing recommendations of cefazolin or second-generation cephalosporin. This was a retrospective cohort study of patients in the Michigan Surgical Quality Collaborative from July 2012 through February 2015. The primary outcome was surgical site infection. Patients who were >18 years old and who underwent abdominal, vaginal, laparoscopic, or robotic hysterectomy for benign or malignant indications were included if they received 1 of the following prophylactic antibiotic regimens: cefazolin, second-generation cephalosporin, or cefazolin plus metronidazole. Multivariate logistic regression modeling was performed to evaluate the independent effect of an antibiotic regimen, and propensity score matching was used to validate the findings. The study included 18,255 hysterectomies. The overall rate of surgical site infection was 1.8% (n=329). The unadjusted rate of surgical site infection was 1.8% (n=267) for cefazolin, 2.1% (n=49) for second-generation cephalosporin, and 1.4% (n=13) for cefazolin plus metronidazole. After adjustment for differences in patient and operative factors among the antibiotic cohorts, compared with cefazolin plus metronidazole, we found the risk of surgical site infection was significantly higher for patients who received

  3. Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

    Science.gov (United States)

    Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P

    2017-06-01

    Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX ® , Meshlab ® , Netfabb ® and Blender ® . Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Impact of robotic technique and surgical volume on the cost of radical prostatectomy.

    Science.gov (United States)

    Hyams, Elias S; Mullins, Jeffrey K; Pierorazio, Phillip M; Partin, Alan W; Allaf, Mohamad E; Matlaga, Brian R

    2013-03-01

    Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; Probotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to improve the cost-effectiveness of prostate cancer surgical therapy.

  5. Surgical treatment of gynecomastia with severe ptosis: periareolar incision and dermal double areolar pedicle technique.

    Science.gov (United States)

    Cannistra, Claudio; Piedimonte, Andrea; Albonico, Fiorella

    2009-11-01

    Gynecomastia is a morphostructural impairment of the mammary region in men caused by parenchymal hypertrophy or a cutaneous distortion of breast skin covering or both. The clinical classification introduced by Simon et al. in 1973 ranks gynecomastia in three degrees. Each subtype can be treated with a specific technique. This article describes an alternative surgical procedure for treating gynecomastia with severe ptosis(type III and type IIIb of Simon's classification). Fifty-eight patients were treated for gynecomastia in our Plastic Surgery Unit from 1996 to 2004. The cutaneous excess of periareolar skin is evaluated by a pinching test. A circular periareolar mark is traced corresponding to the cutaneous excess that has to be removed.Initially, liposuction of adipous tissue on the periphery of the mammary region is performed through two cutaneous 3-mm incisions at the 3 o'clock and 9 o'clock positions around the areola. After this, the liposuction incisions are enlarged from 10 o'clock to 8 o'clock and from 2 o'clockto 4 o'clock to create access for the mastectomy. This dissection creates a double dermal areolar pedicle. The new areolar position is fixed with a Benelli round block suture. A resolution of the morphologic deformity without evident scars after hair growth and a correction of the breast deformity has been observed in the 6-month follow-ups conducted for all the patients. We observed that the vascular-nervous net under the areola at 12 o'clock and 6 o'clock is very important, more so than the lateral pedicle, and the conservation of a double vascular-nervous pedicle reduces significantly the risk of areolar necrosis, especially in cases of gynecomastia type III and in cases where there is a high degree of breast malformation such as the tuberous breast.

  6. [The sural medial perforator flap: Anatomical bases, surgical technique and indications in head and neck reconstruction].

    Science.gov (United States)

    Struk, S; Schaff, J-B; Qassemyar, Q

    2018-04-01

    The medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery. We harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap. A total of 23 perforators with a diameter superior than 1mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3cm±2cm from the popliteal fossa and at 3.6cm±1cm from the median line of the calf. The mean pedicle length was 12.1cm±2.5cm. At its origin, the source artery diameter was 1.8mm±0.25mm and source veins diameters were 2.45mm±0.9mm in average. There was no complication in our clinical application. This study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. DOES INTRAVENOUS TRANEXAMIC ACID REDUCE BLOOD LOSS DURING SURGICALLY ASSISTED RAPID PALATAL EXPANSION?

    Directory of Open Access Journals (Sweden)

    Emine AKBAŞ

    2017-10-01

    Full Text Available Purpose: The purpose of this study was to evaluate the efficacy of tranexamic acid (TXA in reducing blood loss during surgically assisted rapid palatal expansion (SARPE procedure. Subjects and Methods: A total of 34 patients (12 male, 22 female who had been treated surgically under general anesthesia with SARPE including pterygoid disjunction for transverse maxillary deficiency (TMD were included in this study. The study group (n=17 received intravenous (IV TXA 10 mg/kg as a preoperative bolus; the control group (n=17 received normal saline solution. Preoperative and postoperative haemoglobin and haematocrit values, intraoperative blood loss, and any blood product transfusion were recorded. Results: Blood loss during SARPE was statistically significantly less in the study group than the control group (p=0.0001. Conclusion: Preoperative IV administration of TXA can effectively control blood loss during when SARPE with pterygoid disjunction is performed.

  8. The failure of retrograde autologous priming of the cardiopulmonary bypass circuit to reduce blood use after cardiac surgical procedures.

    Science.gov (United States)

    Murphy, Glenn S; Szokol, Joseph W; Nitsun, Martin; Alspach, David A; Avram, Michael J; Vender, Jeffery S; Votapka, Timothy V; Rosengart, Todd K

    2004-05-01

    Hemodilution during cardiopulmonary bypass (CPB) is a primary risk factor for blood transfusion in cardiac surgical patients. Priming of the CPB circuit with the patients' own blood (retrograde autologous priming, RAP) is a technique used to limit hemodilution and reduce transfusion requirements. We designed this study to examine the impact of RAP on perioperative blood product use. Using a retrospective cohort study design, the medical records of all patients undergoing CPB (excluding circulatory arrest cases) by a single surgeon were examined. Data were collected over a 24-mo period when RAP was routinely used as a blood conservation strategy (RAP group, n = 257). This group was compared with a cohort of patients during the 24 mo immediately preceding the introduction of RAP into clinical practice (no RAP group, n = 288). A small, statistically insignificant reduction in the percentage of patients receiving packed red blood cells was observed in the RAP group (44% versus 51% no RAP, P = 0.083). No differences were found between the groups in the number of units of packed red blood cells, platelets, or fresh frozen plasma transfused throughout the perioperative period. These results suggest that overall, RAP does not offer a clinically important benefit as a blood conservation technique. Priming of the cardiopulmonary bypass circuit with the patients' own blood (retrograde autologous priming) resulted in insignificant reductions in blood use in a large, unselected group of patients undergoing cardiac surgical procedures.

  9. Frequency of lingual nerve injury in mandibular third molar extraction: A comparison of two surgical techniques

    International Nuclear Information System (INIS)

    Shad, S.; Abbasi, M.M.

    2015-01-01

    Background: Surgical removal of impacted mandibular third molar is associated with a number of complications including postoperative bleeding, dry socket, postoperative infection, and injury to regional nerves. Lingual nerve damage is one of the main complications. To prevent this complication different techniques had been used. Lingual flap reflection is one of these procedures in which lingual soft tissue is reflected and retracted deliberately, the nerve is identified and is kept out of the surgical field. The objective of this study was to evaluate a surgical technique for third molar removal which is associated with minimum frequency of lingual nerve damage. Method: A randomized controlled trial was performed. A total of 380 patients with impacted mandibular third molars were included in this study. Each patient was allotted randomly by blocked randomization to group A where procedure was performed by reflection and retraction of lingual flap in addition to buccal flap and group B where procedure was performed by retraction of buccal flap only. Results: Lingual nerve damage occurred in 8.94 percentage in Group A in which lingual flap retraction was performed but damage was reversible. In group B, 2.63 percentage lingual nerve damage was observed and nature of damage was permanent. The difference was statistically significant (p=0.008). Conclusions: Lingual flap retraction poses 3.4 times increased risk of lingual nerve damage during extraction of mandibular third molar when lingual flap is retracted but the nature of damage is reversible. (author)

  10. Congenital completely buried penis in boys: anatomical basis and surgical technique.

    Science.gov (United States)

    Liu, Xing; He, Da-wei; Hua, Yi; Zhang, De-ying; Wei, Guang-hui

    2013-07-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Surgical correction of the congenital completely buried penis (CCBP) is a difficult challenge and there is no unanimous consensus about the surgical 'gold standard' and patient eligibility for surgery. In the present study, dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis. This abnormality can be successfully corrected by releasing the fundiform ligament and mobilising the scrotal skin to cover the length of the penile shaft. The study shows that the paucity and traction of the penile skin and an abnormal fundiform ligament are important anatomical defects in CCBP. Dorsal curve and severe shortage of penile skin in erectile conditions are the main indications for surgical correction. To present our experience of anatomical findings for congenital completely buried penis (CCBP), which has no unanimous consensus regarding the 'gold standard' for surgical correction and patient eligibility, by providing our surgical technique and illustrations. Between February 2006 and February 2011, 22 children with a median (range) age of 4.2 (2.5-5.8) years, with CCBP underwent surgical correction by one surgeon. Toilet training and photographs of morning erections by parents were advised before surgery. The abnormal anatomical structure of buried penis during the operation was observed. The technique consisted of the release of the fundiform ligament, fixation of the subcutaneous penile skin at the base of the degloved penis, penoscrotal Z-plasty and mobilisation of the penile and scrotal skin to cover the penile shaft. In reflex erectile conditions, CCBP presents varying degrees of dorsal curve and shortage of penile skin. Dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis in all patients. All wounds healed well and the cosmetic outcome was good at 6-month follow-up after the repair. The appearance of the dorsal curve in

  11. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.

    Science.gov (United States)

    Bouman, Mark-Bram; van Zeijl, Michiel C T; Buncamper, Marlon E; Meijerink, Wilhelmus J H J; van Bodegraven, Ad A; Mullender, Margriet G

    2014-07-01

    Vaginal (re)construction is essential for the psychological well-being of biological women with a dysfunctional vagina and male-to-female transgender women. However, the preferred method for vagina (re)construction with respect to functional as well as aesthetic outcomes is debated. Regarding intestinal vaginoplasty, despite the asserted advantages, the need for intestinal surgery and subsequent risk of diversion colitis are often-mentioned concerns. The outcomes of vaginal reconstructive surgery need to be appraised in order to improve understanding of pros and cons. To review literature on surgical techniques and clinical outcomes of intestinal vaginoplasty. Electronic databases and reference lists of published articles were searched for primary studies on intestinal vaginoplasty. Studies were included if these included at least five patients and had a minimal follow-up period of 1 year. No constraints were imposed with regard to patient age, indication for vaginoplasty, or applied surgical technique. Outcome measures were extracted and analyzed. Main outcome measures were surgical procedure, clinical outcomes, and outcomes concerning sexual health and quality of life. Twenty-one studies on intestinal vaginoplasty were included (including 894 patients in total). All studies had a retrospective design and were of low quality. Prevalence and severity of procedure-related complications were low. The main postoperative complication was introital stenosis, necessitating surgical correction in 4.1% of sigmoid-derived and 1.2% of ileum-derived vaginoplasties. Neither diversion colitis nor cancer was reported. Sexual satisfaction rate was high, but standardized questionnaires were rarely used. Quality of life was not reported. Based on evidence presently available, it seems that intestinal vaginoplasty is associated with low complication rates. To substantiate these findings and to obtain information about functional outcomes and quality of life, prospective studies

  12. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery.

    Science.gov (United States)

    Xu, D; Yin, Y; Hou, L; Dai, W

    2016-05-01

    Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX. SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.

  13. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  14. AN OVERVIEW OF REDUCED ORDER MODELING TECHNIQUES FOR SAFETY APPLICATIONS

    Energy Technology Data Exchange (ETDEWEB)

    Mandelli, D.; Alfonsi, A.; Talbot, P.; Wang, C.; Maljovec, D.; Smith, C.; Rabiti, C.; Cogliati, J.

    2016-10-01

    The RISMC project is developing new advanced simulation-based tools to perform Computational Risk Analysis (CRA) for the existing fleet of U.S. nuclear power plants (NPPs). These tools numerically model not only the thermal-hydraulic behavior of the reactors primary and secondary systems, but also external event temporal evolution and component/system ageing. Thus, this is not only a multi-physics problem being addressed, but also a multi-scale problem (both spatial, µm-mm-m, and temporal, seconds-hours-years). As part of the RISMC CRA approach, a large amount of computationally-expensive simulation runs may be required. An important aspect is that even though computational power is growing, the overall computational cost of a RISMC analysis using brute-force methods may be not viable for certain cases. A solution that is being evaluated to assist the computational issue is the use of reduced order modeling techniques. During the FY2015, we investigated and applied reduced order modeling techniques to decrease the RISMC analysis computational cost by decreasing the number of simulation runs; for this analysis improvement we used surrogate models instead of the actual simulation codes. This article focuses on the use of reduced order modeling techniques that can be applied to RISMC analyses in order to generate, analyze, and visualize data. In particular, we focus on surrogate models that approximate the simulation results but in a much faster time (microseconds instead of hours/days).

  15. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses

    Directory of Open Access Journals (Sweden)

    PATRICIA B CARROLL

    2006-01-01

    Full Text Available The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7 (25-32 kg were used. A segment of the right (n=5 or left (n=2 iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  16. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses.

    Science.gov (United States)

    Carroll, Patricia B; Defaria, Werviston; Gandia, Carlos; Berho, Mariana; Misiakos, Evangelos; Tzakis, Andreas G

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  17. Pigment dispersion syndrome associated with intraocular lens implantation: a new surgical technique

    Directory of Open Access Journals (Sweden)

    M Isabel Canut Jordana

    2010-11-01

    Full Text Available M Isabel Canut Jordana1, Daniel Pérez Formigó1, Rodrigo Abreu González2, Jeroni Nadal Reus11Barraquer Ophthalmology Centre, Barcelona, Spain; 2University Hospital of La Candelaria, Tenerife, SpainAims: We report the case of a myopic patient who, after intraocular lens transplant in the posterior chamber, suffered elevated intraocular pressure due to pigment dispersion, with recurrent episodes of blurred vision. The patient was treated with a new surgical technique that can avoid potential iridolenticular contact.Methods: Complete ophthalmologic examination and optical coherence tomography (OCT of the anterior segment were performed.Results: Contact between the pigmentary epithelium and the iris with an intraocular lens was revealed by utrasound biomicroscopy and OCT. In this case, Nd:YAG laser iridotomy and laser iridoplasty were not effective for iridolenticular separation and control of the pigment dispersion. We propose a new technique: stitches on the surface of the iris to obtain good iridolenticular separation and good intraocular pressure control.Conclusion: Stitches on the iris surface should be considered as optional therapy in pigmentary glaucoma secondary to intraocular lens implantation. This surgical technique can avoid potential iridolenticular contacts more definitively.Keywords: pigmentary glaucoma, intraocular lens, optical coherence tomography, laser

  18. Evaluation of different surgical techniques in the management of subluxated cataractous lens.

    Science.gov (United States)

    Aldakaf, A; Bakir, H; Almogahed, A; Carstocea, Benone

    2007-01-01

    To compare and evaluate the outcome of different surgical techniques in the management of subluxated cataractous lens. This retrospective study included 18 eyes of 18 patients with subluxated cataracts of varying etiology. Their preoperative examination maintain included: best corrected visual acuity (BCVA), thorough anterior segment examination, by slit -lamp especially for the degree and extent of subluxation and cataract, cornea, iris and the pupil for other abnormalities or other traumatic signs, presence or absence of vitreous in the anterior chamber, IOP and finally fundus examination. The patients were then divided into 3 groups each comprising 6 patients. The first group underwent ECCE with sulcus implantation PMMA IOL , the second and third groups underwent phacoemulsification with bag implanted Acrylic IOL but the third group underwent special techniques and precautions during surgery. Postoperatively, all patients were examined for BCVA, IOP, IOL positioning, pupil, fundus examination. Thirteen patients were males and five were females. The etiology of subluxation was traumatic in ten males and two female. The ages of the patients were between 11 and 62 years old the post operative follow up period ranged between 7 and 16 months. No major intraoperative complications were noted. In the 1st group 2 patients underwent AC automated vitrectomy, 3 in the 2nd group, 1 in the 3rd group. Three patients needed scleral fixation suture . Thirteen patients had well centered IOL and 4 had slight decentration not necessitating further intervention and one in the 2nd group had clinically significant decentration where IOL explanation, widening of the wound and re implantation of a wide 6.5mm optic PMMA IOL was done in the second post operative daily. Subluxated cataracts need special precautions in the chosen surgical technique to maintain a reasonable safety level intraoperatively and an acceptable surgical.

  19. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    International Nuclear Information System (INIS)

    Didier, Ryne A.; Vajtai, Petra L.; Hopkins, Katharine L.

    2015-01-01

    Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDI vol ). Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDI vol . Reduced CTDI vol was achieved primarily by reductions in effective tube current-time product (mAs eff ) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDI vol , size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Between groups A and B, mean CTDI vol was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDI vol and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. (orig.)

  20. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Didier, Ryne A. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Vajtai, Petra L. [Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States); Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Hopkins, Katharine L. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States)

    2014-07-05

    Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDI{sub vol}). Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDI{sub vol}. Reduced CTDI{sub vol} was achieved primarily by reductions in effective tube current-time product (mAs{sub eff}) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDI{sub vol}, size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Between groups A and B, mean CTDI{sub vol} was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDI{sub vol} and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. (orig.)

  1. Pylorus-preserving Whipple pancreaticoduodenectomy: Postoperative evaluation of a new surgical technique

    International Nuclear Information System (INIS)

    Trerotola, S.O.; Jones, B.; Crist, D.J.; Cameron, J.L.

    1988-01-01

    The pylorus-preserving Whipple pancreaticoduodenectomy is becoming an increasingly popular alternative to the standard Whipple operation in the surgical treatment of diseases of the periampullary region. Contrast radiography plays an important role in the postoperative evaluation of patients undergoing this operation. Although most radiologists are familiar with the postoperative anatomy and complications associated with the standard Whipple operation, the newer technique involves different postoperative anatomy and different complications and requires a different approach to examination. The procedure presents several new diagnostic pitfalls. These variables are presented from a described series of 50 patients undergoing this procedure for periampullary neoplasm or chronic pancreatitis

  2. Anomalous Systemic Artery to the Left Lower Lobe: Literature Review and a New Surgical Technique.

    Science.gov (United States)

    Miller, Jacob R; Lancaster, Timothy S; Abarbanell, Aaron M; Manning, Peter B; Eghtesady, Pirooz

    2018-05-01

    Anomalous systemic arterial supply to the basal segments of the left lower lobe without coexisting pulmonary artery connection is a rare anomaly. Most feel treatment is necessary; however, the ideal strategy is unclear. Treatments described include embolization, pulmonary resection, or anastomosis to the native pulmonary artery. We recently encountered an infant with this anomaly and present a literature review summarizing all recent reports. Additionally, we describe a novel surgical technique to create a tension-free anastomosis utilizing segmental aortic translocation that we employed in our patient due to a large distance between the anomalous vessel and native left pulmonary artery.

  3. Suture fixation of migrated septal occluder device to prevent further migration: a simple surgical technique

    Directory of Open Access Journals (Sweden)

    Mohite Prashant N

    2013-01-01

    Full Text Available Abstract As the use of percutaneous intervention is increasing for the closure of the atrial septal defect, the procedure related complications are also on rise, migration of the device being most common. The migrated devices with failed percutaneous retrieval must be removed surgically under cardiopulmonary bypass. During establishment of cardiopulmonary bypass, the handling of heart may cause further migration of the device into other chambers of heart which leads to difficulty in finding and retrieval of the device. The authors propose a simple and unique technique to prevent further migration of the septal occluder device.

  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. The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires.

    Science.gov (United States)

    VanCleave, Andrea M; Jones, James E; McGlothlin, James D; Saxen, Mark A; Sanders, Brian J; Vinson, LaQuia A

    2014-01-01

    In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P = .0005), audible pop (P = .0211), and flash (P = .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing surgical fire safety protocols toward making surgical fires the "never-events" they should be.

  6. Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives.

    Science.gov (United States)

    Loras, Carme; Mayor, Vicenç; Fernández-Bañares, Fernando; Esteve, Maria

    2018-03-12

    The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP). To carry out a calculation of the standard direct costs of AEP, and to make a financial comparison with their surgical alternatives. Calculation of the standard direct cost in carrying out each procedure. An endoscopist detailed the time, personnel, materials, consumables, recovery room time, stents, pathology and medication used. The cost of surgical procedures was the average cost recorded in the hospital. Thirty-eight AEP were analyzed. The technique showing lowest cost was gastroscopy + APC (€116.57), while that with greatest cost was ERCP with cholangioscopy + stent placement (€5083.65). Some 34.2% of the procedures registered average costs of €1000-2000. In 57% of cases, the endoscopic alternative was 2-5 times more cost-efficient than surgery, in 31% of cases indistinguishable or up to 1.4 times more costly. Standard direct cost of the majority of AEP is reported using a methodology that enables easy application in other centers. For the most part, endoscopic procedures are more cost-efficient than the corresponding surgical procedure. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  7. "A tree must be bent while it is young": teaching urological surgical techniques to schoolchildren.

    Science.gov (United States)

    Buntrock, Stefan

    2012-01-01

    Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as "doctor games 2.0" will doubtlessly begin to incorporate virtual laparoscopic techniques. To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. As part of EAU Urology Week 2010, 108 school children aged 15-19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were "video games," "children," and "surgical skills." Searches were performed without restriction for a certain period of time. In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology.

  8. Detour technique, Dipping technique, or IIeal bladder flap technique for surgical correction of uretero-ileal anastomotic stricture in orthotopic ileal neobladder

    Directory of Open Access Journals (Sweden)

    Mohamed Wishahi

    2015-08-01

    Full Text Available ABSTRACTBackground:Uretero-ileal anastomotic stricture (UIAS is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.Design and Participants:From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.Surgical procedures:Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.Results:Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3% underwent antegrade dilatation and insertion of double J.Conclusion:After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function.

  9. Virtual Surgical Planning for Correction of Delayed Presentation Scaphocephaly Using a Modified Melbourne Technique.

    Science.gov (United States)

    Macmillan, Alexandra; Lopez, Joseph; Mundinger, Gerhard S; Major, Melanie; Medina, Miguel A; Dorafshar, Amir H

    2018-02-23

    Late treatment of scaphocephaly presents challenges including need for more complex surgery to achieve desired head shape. Virtual surgical planning for total vault reconstruction may mitigate some of these challenges, but has not been studied in this unique and complex clinical setting. A retrospective chart review was conducted for patients with scaphocephaly who presented to our institution between 2000 and 2014. Patients presenting aged 12 months or older who underwent virtual surgical planning-assisted cranial vault reconstruction were included. Patient demographic, intraoperative data, and postoperative outcomes were recorded. Pre- and postoperative anthropometric measurements were obtained to document the fronto-occipital (FO) and biparietal (BP) distance and calculate cephalic index (CI). Virtual surgical planning predicted, and actual postoperative anthropometric measurements were compared. Five patients were identified who fulfilled inclusion criteria. The mean age was 50.6 months. One patient demonstrated signs of elevated intracranial pressure preoperatively. Postoperatively, all but one needed no revisional surgery (Whitaker score of 1). No patient demonstrated postoperative evidence of bony defects, bossing, or suture restenosis. The mean preoperative, simulated, and actual postoperative FO length was 190.3, 182, and 184.3 mm, respectively. The mean preoperative, simulated, and actual postoperative BP length was 129, 130.7, and 131 mm, respectively. The mean preoperative, simulated, and actual postoperative CI was 66, 72, and 71.3, respectively. Based on our early experience, virtual surgical planning using a modified Melbourne technique for total vault remodeling achieves good results in the management of late presenting scaphocephaly.

  10. Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

    Directory of Open Access Journals (Sweden)

    Christina A.W. Macano

    2017-11-01

    Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

  11. Adaptative Techniques to Reduce Power in Digital Circuits

    Directory of Open Access Journals (Sweden)

    Bharadwaj Amrutur

    2011-07-01

    Full Text Available CMOS chips are engineered with sufficient performance margins to ensure that they meet the target performance under worst case operating conditions. Consequently, excess power is consumed for most cases when the operating conditions are more benign. This article will review a suite of dynamic power minimization techniques, which have been recently developed to reduce power consumption based on actual operating conditions. We will discuss commonly used techniques like Dynamic Power Switching (DPS, Dynamic Voltage and Frequency Scaling (DVS and DVFS and Adaptive Voltage Scaling (AVS. Recent efforts to extend these to cover threshold voltage adaptation via Dynamic Voltage and Threshold Scaling (DVTS will also be presented. Computation rate is also adapted to actual work load requirements via dynamically changing the hardware parallelism or by controlling the number of operations performed. These will be explained with some examples from the application domains of media and wireless signal processing.

  12. Satisfactory patient-based outcomes after surgical treatment for idiopathic clubfoot: includes surgeon's individualized technique.

    Science.gov (United States)

    Mahan, Susan T; Spencer, Samantha A; Kasser, James R

    2014-09-01

    Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon's series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up. A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon's operative technique. In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean = 95.2; SD = 7.427) and normal controls (mean = 86.3; SD = 12.5) in Happiness Scale (P = 0.0031). In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results. Level III.

  13. Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results

    Directory of Open Access Journals (Sweden)

    Tova Lifshitz

    2012-01-01

    Full Text Available We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

  14. [Endonasal versus trans-canalicular endoscopic dacriocystorhinostomy using diode laser. Surgical techniques and outcomes].

    Science.gov (United States)

    Piédrola Maroto, David; Franco Sánchez, Javier; Reyes Eldblom, Robin; Monje Vega, Elena; Conde Jiménez, Manuel; Ortiz Rueda, Manuel

    2008-01-01

    To evaluate the benefits and disadvantages of the endoscopic endonasal versus transcanalicular approaches using diode laser, and to compare their clinical outcomes. A total of 127 patients were operated on, 80 of them with the endonasal approach (Group I) and 47 with the transcanalicular technique (Group II). Epiphora improved completely in 67 patients in Group I (83.7 %) while the other 13 (16.2 %) continued to present the same symptoms. In Group II, a successful result was achieved in 39 patients (82.9 %) and 8 (17 %) of them had to be re-operated because of the persistence of epiphora. The surgical outcomes are similar with both laser techniques. The main advantages of using diode laser are that it does not require general anaesthesia, the lower intra- and peri-operative morbidity, the lack of nasal packing and the greater ease of performing additional interventions if it fails. The only real disadvantage of laser procedures is the high cost.

  15. Utilization of two different surgical techniques in gingival recession treatment: A comparative study

    Directory of Open Access Journals (Sweden)

    Bajić Miljan

    2014-01-01

    Full Text Available Introduction. Gingival recession is a displacement of gingival margin apically to cementenamel junction. Objective. The aim of this study was to compare the results achieved with two different surgical procedures used in gingival recession treatment. Methods. Ten patients with bilateral buccal recession on maxillary canines or premolars were included in the study. Professional teeth cleaning was performed before surgery. Recession on the experimental side was treated with connective tissue graft in combination with coronally advanced, split thickness flap (tunnel technique. Control side recession was treated with connective tissue graft in combination with trapezoidal coronally advanced, full thickness flap. Coin toss was used for side decision. The following parameters were evaluated before surgery and 6 months post-op: Vertical Recession Dimension, Clinical Attachment Level, Apico-coronal width of the keratinized tissue, Healing index (Laundry, RES index, and Patient evaluation of esthetic results. Student’s t-test was used for statistical analysis. Results. Six months after surgery, mean root coverage was 91.5±14.1% and 90.1±14.6% on the experimental and on the control side, respectively. RES index, Healing index (Laundry and Patient Subjective evaluation of esthetic results showed significantly better results (p≤0.05. Conclusion. Both surgical procedures produce highly successful clinical results based on evaluated parameters, but this tunnel technique provides significantly better esthetic results. [Projekat Ministarstva nauke Republike Srbije, br. III 41008: Interakcija etiopatogenetskih mehanizama parodontopatije i periimplantitisa sa sistemskim bolestima današnjice

  16. Do Targeted Hiring Subsidies and Profiling Techniques Reduce Unemployment?

    DEFF Research Database (Denmark)

    Jahn, Elke; Wagner, Thomas

    2008-01-01

    To reduce equilibrium unemployment targeted hiring subsidies and profiling techniques for long-term unemployed are often recommended. To analyze the effects of these two instruments, our model combines two search methods: the public employment service and random search, jobseekers choose between...... an active and a passive search strategy, while labour market policy has two options available. First, only the long-term unemployed placed by the public employment service are subsidized. Second, the subsidy is paid for each match with a long-term unemployed irrespective of the search method used. We show...

  17. Do Targeted Hiring Subsidies and Profiling Techniques Reduce Unemployment?

    DEFF Research Database (Denmark)

    Jahn, Elke; Wagner, Thomas

    To reduce equilibrium unemployment targeted hiring subsidies and profilin techniques for long-term unemployed are often recommended. To analyze the effects of these two instruments, our model combines two search methods: the public employment serviceand random search, jobseekers choose between...... an active and a passive search strategy, while labour market policy has two options available. First, only the long-term unemployed placed by the public employment service are subsidized. Second, the subsidy is paid for each match with a long-term unemployed irrespective of the search method used. We show...

  18. Simple smoothing technique to reduce data scattering in physics experiments

    International Nuclear Information System (INIS)

    Levesque, L

    2008-01-01

    This paper describes an experiment involving motorized motion and a method to reduce data scattering from data acquisition. Jitter or minute instrumental vibrations add noise to a detected signal, which often renders small modulations of a graph very difficult to interpret. Here we describe a method to reduce scattering amongst data points from the signal measured by a photodetector that is motorized and scanned in a direction parallel to the plane of a rectangular slit during a computer-controlled diffraction experiment. The smoothing technique is investigated using subsets of many data points from the data acquisition. A limit for the number of data points in a subset is determined from the results based on the trend of the small measured signal to avoid severe changes in the shape of the signal from the averaging procedure. This simple smoothing method can be achieved using any type of spreadsheet software

  19. A technique to reduce plasma armature formation voltage

    International Nuclear Information System (INIS)

    Jamison, K.A.; Littrell, D.M.

    1991-01-01

    The initiation of a plasma armature by foil vaporization in a railgun is often accompanied by a large, fast, voltage transient appearing on both the breech and muzzle of the gun. For a railgun driven by an inductor/opening switch power supply, this voltage transient becomes a concern during current commutation from the switch to the railgun. To lessen the requirements on the opening switch, techniques must be found to reduce the armature formation voltage. This paper presents the experimental results from railgun firings at AFATL's Electromagnetic Launcher Basic Research Facility (Site A-15, Eglin Air Force Base, Florida) using different shapes of initiation foils. These foils have been designed to vaporize into a plasma armature with reduced transient voltages. A design criteria was developed to ensure that all portions of the foil vaporize at slightly different times

  20. Instrument-mounted displays for reducing cognitive load during surgical navigation.

    Science.gov (United States)

    Herrlich, Marc; Tavakol, Parnian; Black, David; Wenig, Dirk; Rieder, Christian; Malaka, Rainer; Kikinis, Ron

    2017-09-01

    Surgical navigation systems rely on a monitor placed in the operating room to relay information. Optimal monitor placement can be challenging in crowded rooms, and it is often not possible to place the monitor directly beside the situs. The operator must split attention between the navigation system and the situs. We present an approach for needle-based interventions to provide navigational feedback directly on the instrument and close to the situs by mounting a small display onto the needle. By mounting a small and lightweight smartwatch display directly onto the instrument, we are able to provide navigational guidance close to the situs and directly in the operator's field of view, thereby reducing the need to switch the focus of view between the situs and the navigation system. We devise a specific variant of the established crosshair metaphor suitable for the very limited screen space. We conduct an empirical user study comparing our approach to using a monitor and a combination of both. Results from the empirical user study show significant benefits for cognitive load, user preference, and general usability for the instrument-mounted display, while achieving the same level of performance in terms of time and accuracy compared to using a monitor. We successfully demonstrate the feasibility of our approach and potential benefits. With ongoing technological advancements, instrument-mounted displays might complement standard monitor setups for surgical navigation in order to lower cognitive demands and for improved usability of such systems.

  1. Towards reducing thrombogenicity of LVAD therapy: optimizing surgical and patient management strategies

    Science.gov (United States)

    Chivukula, Venkat Keshav; Lafzi, Ali; Mokadam, Nahush; Beckman, Jennifer; Mahr, Claudius; Aliseda, Alberto

    2017-11-01

    Unfavourable hemodynamics in heart failure patients implanted with left ventricular assist devices (LVAD), due to non-optimal surgical configurations and patient management, strongly influence thrombogenicity. This is consistent with the increase in devastating thromboembolic complications (specifically thrombosis and stroke) in patients, even as the risk of thrombosis inside the device decreases with modern designs. Inflow cannula and outflow graft surgical configurations have been optimized via patient-specific modeling that computes the thrombogenic potential with a combination of Eulerian (endothelial) wall shear stress and Lagrangian (platelet shear history) tracking. Using this view of hemodynamics, the benefits of intermittent aortic valve opening (promoting washout and reducing stagnant flow in the aortic valve region) have been assessed in managing the patient's residual native cardiac output. The use of this methodology to understand the contribution of the hemodynamics in the flow surrounding the LVAD itself to thrombogenesis show promise in developing holistic patient-specific management strategies to minimize stroke risk and enhance efficacy of LVAD therapy. Funded in part by an AHA postdoctoral fellowship 16POST30520004.

  2. Achieving a predictable 24-hour return to normal activities after breast augmentation: part II. Patient preparation, refined surgical techniques, and instrumentation.

    Science.gov (United States)

    Tebbetts, John B

    2006-12-01

    The goal of this study was to develop practices that would allow patients undergoing subpectoral augmentation to predictably return to full normal activities within 24 hours after the operation, free of postoperative adjuncts. Part I of this study used motion and time study principles to reduce operative times, medication dosages, perioperative morbidity, and recovery times in augmentation mammaplasty. Part II of the study focuses on details of patient education, preoperative planning, instrumentation, and surgical technique modifications that were identified, modified, and implemented to achieve the results reported in part I. Two groups of 16 patients each (groups 1 and 2) were studied retrospectively for comparison to a third group of 627 patients (group 3) studied prospectively. Patients in group 1 had axillary partial retropectoral breast augmentations in 1982-1983, using dissociative anesthesia, blunt instrument implant pocket dissection, and Dow Corning, double-lumen implants containing 20 mg of methylprednisolone and 20 cc of saline in the outer lumen of the implants. Patients in group 2 (1990) had inframammary, retromammary augmentations by using a combination of blunt and electrocautery dissection, Surgitek Replicon polyurethane-covered, silicone gel-filled implants, and general endotracheal anesthesia. Patients in group 3 (1998 to 2001, n = 627) had inframammary partial retropectoral, inframammary retromammary, and axillary partial retropectoral augmentations under general endotracheal anesthesia. Refined practices and surgical techniques from studies of groups 1 and 2 were applied in group 3. Videotapes from operative procedures of groups 1 and 2 were analyzed with macromotion and micromotion study principles, and tables of events were formulated for each move during the operation for all personnel in the operating room. Extensive details of surgical technique were examined and reexamined in 13 different stages by using principles of motion and time

  3. Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes.

    Science.gov (United States)

    Drazin, Doniel; Shirzadi, Ali; Jeswani, Sunil; Ching, Harry; Rosner, Jack; Rasouli, Alexandre; Kim, Terrence; Pashman, Robert; Johnson, J Patrick

    2011-11-01

    Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes. A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: "spondylolysis," "pars fracture," "repair," "athlete," and/or "sport." Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up. Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months. For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and

  4. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes.

    Science.gov (United States)

    Boodhwani, Munir; de Kerchove, Laurent; Glineur, David; Poncelet, Alain; Rubay, Jean; Astarci, Parla; Verhelst, Robert; Noirhomme, Philippe; El Khoury, Gébrine

    2009-02-01

    Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair. From 1996 to 2007, 264 patients underwent elective aortic valve repair for aortic insufficiency (mean age - 54 +/- 16 years; 79% male). AV was tricuspid in 171 patients bicuspid in 90 and quadricuspid in 3. One hundred fifty three patients had type I dysfunction (aortic dilatation), 134 had type II (cusp prolapse), and 40 had type III (restrictive). Thirty six percent (96/264) of the patients had more than one identified mechanism. In-hospital mortality was 1.1% (3/264). Six patients experienced early repair failure; 3 underwent re-repair. Functional classification predicted the necessary repair techniques in 82-100% of patients, with adjunctive techniques being employed in up to 35% of patients. Mid-term follow up (median [interquartile range]: 47 [29-73] months) revealed a late mortality rate of 4.2% (11/261, 10 cardiac). Five year overall survival was 95 +/- 3%. Ten patients underwent aortic valve reoperation (1 re-repair). Freedoms from recurrent Al (>2+) and from AV reoperation at 5 years was 88 +/- 3% and 92 +/- 4% respectively and patients with type I (82 +/- 9%; 93 +/- 5%) or II (95 +/- 5%; 94 +/- 6%) had better outcomes compared to type III (76 +/- 17%; 84 +/- 13%). Aortic valve repair is an acceptable therapeutic option for patients with aortic insufficiency. This functional classification allows a systematic approach to the repair of Al and can help to predict the surgical techniques required as well as the durability of repair. Restrictive cusp motion (type III), due to fibrosis or calcification, is an important predictor for recurrent Al following AV repair.

  5. A Unique Surgical Technique for Tracheostomy in Heterotopic Ossification: A Case Report.

    Science.gov (United States)

    Cheng, Esther; Thorpe, Eric

    2016-11-01

    To describe a technique for tracheostomy in heterotopic ossification that has not yet been described in the literature. We report a case of difficult tracheostomy while using conventional techniques in a 68-year-old patient who underwent mitral valve replacement requiring warfarin therapy three months prior. Imaging revealed heterotopic ossification overlying the trachea. A literature review was performed to identify similar cases or techniques. Extensive surgical planning was pursued after the initial attempted tracheostomy failed, and the airway was eventually accessed using a lighted intubation stylet for guidance and a drill. Heterotopic ossification has been described after orthopedic and abdominal surgeries. We identified one case report in the literature of tracheostomy performed in the setting of heterotopic ossification by an unspecified mechanism. There are few reported cases of tracheobronchial calcification in cardiac patients receiving warfarin therapy; however, these patients had characteristic imaging findings that were not consistent with those of our patient. We illustrate a safe and effective technique for tracheostomy in heterotopic ossification that has not been reported. Coordination with the anesthesia service was paramount for a successful operation. © The Author(s) 2016.

  6. Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review.

    Science.gov (United States)

    Kaijser, Mirjam; van Ramshorst, Gabrielle; van Wagensveld, Bart; Pierie, Jean-Pierre

    The gastric sleeve resection and gastric bypass are the 2 most commonly performed bariatric procedures. This article provides an overview of current teaching and learning methods of those techniques in resident and fellow training. A database search was performed on Pubmed, Embase, and the Education Resources Information Center (ERIC) to identify the methods used to provide training in bariatric surgery worldwide. After exclusion based on titles and abstracts, full texts of the selected articles were assessed. Included articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. In total, 2442 titles were identified and 14 full text articles met inclusion criteria. Four publications described an ex vivo training course, and 6 focused on at least 1 step of the gastric bypass procedure. Two randomized controlled trials (RCT) provided high-quality evidence on training aspects. Surgical coaching caused significant improvement of Bariatric Objective Structured Assessment of Technical Skills (BOSATS) scores (3.60 vs. 3.90, p = 0.017) and reduction of technical errors (18 vs. 10, p = 0.003). A preoperative warm-up increased global rating scales (GRS) scores on depth perception (p = 0.02), bimanual dexterity (p = 0.01), and efficiency of movements (p = 0.03). Stepwise education, surgical coaching, warming up, Internet-based knowledge modules, and ex vivo training courses are effective in relation to bariatric surgical training of residents and fellows, possibly shortening their learning curves. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  7. Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

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    Shou-sen WANG

    2012-05-01

    Full Text Available Objective  To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods  A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results  VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions  The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.

  8. Esophagogastric pathology in morbid obese patient: preoperative diagnosis and influence in the selection of surgical technique

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    Sergio Estévez-Fernández

    2015-07-01

    Full Text Available Introduction: Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy. The influence of the fibrogastroscopy (FGS findings in the therapeutic approach is analyzed. Patients and methods: A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy. Results: Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky's ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients. The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases. The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87 and the body mass index > 50 kg/m² (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4. Conclusions: The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery.

  9. The Comparison Between the Complications after Two Surgical Techniques of Esophageal Cancer

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    Mohamad Taghi Rajabi Mashhadi

    2014-08-01

    Full Text Available Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it. Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. Results: In a retrospective cohort study 100 patients entered the study with 59 male & 41 female and with a mean age 54.6±6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique (P=0.182 so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique (P=0.03 so there was a significant difference between the two groups. Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis.

  10. Surgical technique for ambulatory management of airsacculitis in a chimpanzee (Pan troglodytes).

    Science.gov (United States)

    Hill, L R; Lee, D R; Keeling, M E

    2001-02-01

    Bacterial infections of the air sac have been reported in many nonhuman primates. Approaches to the management of airsacculitis have included combinations of medical and surgical therapies. These strategies have often required repeated attempts to drain exudate from the affected air sac, as well as necessitating that the animal endure isolation or undergo intensive postoperative care before returning to its social group. A stoma was created via deliberate apposition of the air sac lining and skin to allow continuous drainage. Antibiotic therapy based on culture and antimicrobial susceptibility of the air sac contents was administered while the chimpanzee remained in its social group. We were able to attain complete resolution of the infection after a course of oral antibiotic therapy. The stoma closed gradually over a three-week period, and the chimpanzee has remained free of infection since that time. Despite the severity of the air sac infection in this chimpanzee, we were able to resolve the infection easily, using a simple surgical technique. This method allowed treatment without interfering with social standing or subjection to repeated anesthetic and treatment episodes. This method could be a simple, useful alternative for managing airsacculitis in nonhuman primates.

  11. Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia.

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    Thiénot, Sophie; Bertheuil, Nicolas; Carloni, Raphaël; Méal, Cécile; Aillet, Sylvie; Herlin, Christian; Watier, Eric

    2017-06-01

    Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple-areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle. All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed. Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m 2 . In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found. We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because

  12. Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia.

    Science.gov (United States)

    S S, Shirol

    2016-12-01

    Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results. A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique. The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%. The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.

  13. [Cardiac myxoma -- the influence of preoperative clinical presentation and surgical technique on late outcome].

    Science.gov (United States)

    Mikić, Aleksandar; Obrenović-Krcanski, Bilijana; Kocica, Mladen; Vranes, Mile; Lacković, Vesna; Velinović, Milos; Miarković, Miroslav; Kovacević, Natasa; Djukić, Petar

    2007-01-01

    Cardiac myxomas are the most frequent primary tumours of the heart in adults, and they can be found in each of four cardiac chambers. Although biologically benign, due to their unfavourable localization, myxomas are considered "functionally malignant" tumours. Diagnosis of cardiac myxoma necessitates surgical treatment. To analyse: 1) the influence of localization, size and consistency of cardiac myxomas on preoperative symptomatology; 2) the influence of different surgical techniques (left, right, biatrial approach, tumour basis solving) on early, and late outcomes. From 1982 to 2000, at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, there were 46 patients with cardiac myxomas operated on, 67.4% of them women, mean age 47.1 +/- 16.3 years. The diagnosis was made according to clinical presentation, electrocardiographic and echocardiographic examinations and cardiac catheterization. Follow-up period was 4-18 (mean 7.8) years. In 41 (89.1%) patients, myxoma was localized in the left, while in 5 (10.9%), it was found in the right atrium. Average size was 5.8 x 3.8 cm (range: 1 x l cm to 9 x 8 cm) and 6 x 4 cm (range: 3 x 2 cm to 9 x 5 cm) for the left and right atrial myxomas, respectively. A racemous form predominated in the left (82.6%) and globous in the right (80%) atrium. Fatigue was the most common general (84.8%) and dyspnoea the most common cardiologic symptom (73.9%). Preoperative embolic events were present in 8 patients (4 pulmonary, 4 systemic). In our series: 1) different localization, size and consistency had no influence on the preoperative symptomatology; 2) surgical treatment applied, regardless of different approaches and basis solving, resulted in excellent functional improvements (63.1% patients in NYHA III and IV class preoperatively vs. 6.7% patients postoperatively) and had no influence on new postoperative rhythm disturbances (8.7% patients preoperatively vs. 24.4% patients postoperatively); 3) early (97.8%), and late

  14. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    Science.gov (United States)

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  15. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

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    Miettinen Simo

    2012-09-01

    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  16. Ex-vivo partial nephrectomy after living donor nephrectomy: Surgical technique for expanding kidney donor pool

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    Yaw A Nyame

    2017-01-01

    Full Text Available Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature.

  17. Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

    Science.gov (United States)

    Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

    2016-01-01

    Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

  18. Robotic transverse colectomy for mid-transverse colon cancer: surgical techniques and oncologic outcomes.

    Science.gov (United States)

    Jung, Kyung Uk; Park, Yoonah; Lee, Kang Young; Sohn, Seung-Kook

    2015-06-01

    Robot-assisted surgery for colon cancer has been reported in many studies, most of which worked on right and/or sigmoid colectomy. The aim of this study was to report our experience of robotic transverse colectomy with an intracorporeal anastomosis, provide details of the surgical technique, and present the theoretical benefits of the procedure. This is a retrospective review of prospectively collected data of robotic surgery for colorectal cancer performed by a single surgeon between May 2007 and February 2011. Out of 162 consecutive cases, we identified three robotic transverse colectomies, using a hand-sewn intracorporeal anastomosis. Two males and one female underwent transverse colectomies for malignant or premalignant disease. The mean docking time, time spent using the robot, and total operative time were 5, 268, and 307 min, respectively. There were no conversions to open or conventional laparoscopic technique. The mean length of specimen and number of lymph nodes retrieved were 14.1 cm and 6.7, respectively. One patient suffered from a wound seroma and recovered with conservative management. The mean hospital stay was 8.7 days. After a median follow-up of 72 months, there were no local or systemic recurrences. Robotic transverse colectomy seems to be a safe and feasible technique. It may minimize the necessity of mobilizing both colonic flexures, with facilitated intracorporeal hand-sewn anastomosis. However, further prospective studies with a larger number of patients are required to draw firm conclusions.

  19. Surgical treatment of an acquired posterior urethral diverticulum with cystoscopy assisted robotic technique.

    Science.gov (United States)

    Guneri, Cagri; Kirac, Mustafa; Biri, Hasan

    2017-03-01

    A 42-year-old man with a history of recurrent urethral stenosis, recurrent urinary tract infection and macroscopic hematuria has referred to our clinic. He underwent several internal urethrotomies and currently using clean intermittent self-catheterization. During the internal urethrotomy, we noted a large posterior urethral diverticulum (UD) between verumontanum and bladder neck. His obstructive symptoms were resolved after the catheter removal. But perineal discomfort, urgency and dysuria were prolonged about 3-4 weeks. Urinalysis and urine culture confirmed recurrent urinary tract infections. Due to this conditions and symptoms, we planned a surgical approach which was planned as transperitoneal robotic-assisted laparoscopic approach. This technique is still applied for the diverticulectomy of the bladder. In addition to this we utilized the cystoscopy equipments for assistance. During this process, cystoscope was placed in the UD to help the identification of UD from adjacent tissues like seminal vesicles by its movement and translumination. Operating time was 185 min. On the post-operative third day he was discharged. Foley catheter was removed after 2 weeks. Urination was quite satisfactory. His perineal discomfort was resolved. The pathology report confirmed epidermoid (tailgut) cyst of the prostate. Urethrogram showed no radiologic signs of UD after 4 weeks. Irritative and obstructive symptoms were completely resolved after 3 months. No urinary incontinence, erectile dysfunction or retrograde ejaculation was noted. While posterior UD is an extremely rare situation, surgical treatment of posterior UD remains uncertain. To our knowledge, no above-mentioned cystoscopy assisted robotic technique for the treatment was described in the literature.

  20. Surgical technique for en bloc transurethral resection of bladder tumour with a Hybrid Knife(®).

    Science.gov (United States)

    Islas-García, J J O; Campos-Salcedo, J G; López-Benjume, B I; Torres-Gómez, J J; Aguilar-Colmenero, J; Martínez-Alonso, I A; Gil-Villa, S A

    2016-05-01

    Bladder cancer is the second most common malignancy of the urinary tract and the 9th worldwide. Latin American has an incidence of 5.6 per 100,000 inhabitants per year. Seventy-five percent of newly diagnosed cases are nonmuscle invasive bladder cancer, and 25% of cases present as muscle invasive. The mainstay of treatment for nonmuscle invasive bladder cancer is loop transurethral resection. In 2013, the group led by Dr Mundhenk of the University Hospital of Tübingen, Germany, was the first to describe the Hybrid Knife(®) equipment for performing en bloc bladder tumour resection, with favourable functional and oncological results. To describe the surgical technique of en bloc bladder tumour resection with a Hybrid Knife(®) as an alternative treatment for nonmuscle invasive bladder tumours. A male patient was diagnosed by urotomography and urethrocystoscopy with a bladder tumour measuring 2×1cm on the floor. En bloc transurethral resection of the bladder tumour was performed with a Hybrid Knife(®). Surgery was performed for 35min, with 70 watts for cutting and 50 watts for coagulation, resecting and evacuating en bloc the bladder tumour, which macroscopically included the muscle layer of the bladder. There were no complications. The technique of en bloc bladder tumour resection with Hybrid Knife(®) is an effective alternative to bipolar loop transurethral resection. Resection with a Hybrid Knife(®) is a procedure with little bleeding and good surgical vision and minimises the risk of bladder perforation and tumour implants. The procedure facilitates determining the positivity of the neoplastic process, vascular infiltration and bladder muscle invasion in the histopathology study. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

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    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  2. Comparative evaluation of diode laser ablation and surgical stripping technique for gingival depigmentation: A clinical and immunohistochemical study.

    Science.gov (United States)

    Bakutra, Gaurav; Shankarapillai, Rajesh; Mathur, Lalit; Manohar, Balaji

    2017-01-01

    There are various treatment modalities to remove the black patches of melanin pigmentation. The aim of the study is to clinically compare the diode laser ablation and surgical stripping technique for gingival depigmentation and to evaluate their effect on the histological changes in melanocyte activity. A total of 40 sites of 20 patients with bilateral melanin hyperpigmentation were treated with the surgical stripping and diode laser ablation technique. Change in Hedin index score, change in area of pigmentation using image analyzing software, pain perception, patient preference of treatment were recorded. All 40 sites were selected for immunohistochemical analysis using HMB-45 immunohistochemical marker. At 12 months post-operative visit, in all sites, repigmentation was observed with different grades of Hedin index. Paired t -test, analysis of variance, and Chi-square tests were used for statistical analysis. Repigmentation in surgical stripping is significantly lesser compared to laser ablation. Lesser numbers of melanocytes were found on immunohistological examination at 12 months postoperatively. Comparison for patient preference and pain indices give statistically significant values for diode laser techniques. Gingival hyperpigmentation is effectively managed by diode laser ablation technique and surgical stripping method. In this study, surgical stripping technique found to be better compared to diode laser ablation.

  3. Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

    Science.gov (United States)

    Shadid, Rola Muhammed; Sadaqah, Nasrin Rushdi; Othman, Sahar Abdo

    2014-01-01

    Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability. PMID:25126094

  4. Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rola Muhammed Shadid

    2014-01-01

    Full Text Available Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability.

  5. Surgical management of peptic ulcer disease today--indication, technique and outcome.

    Science.gov (United States)

    Zittel, T T; Jehle, E C; Becker, H D

    2000-03-01

    The current surgical management of peptic ulcer disease and its outcome have been reviewed. Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1-2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery.

  6. Reducing post-surgical adhesions utilizing a drug-enhanced device: sodium carboxymethylcellulose aqueous gel/poly(p-dioxanone) and Tranilast

    International Nuclear Information System (INIS)

    Cui, Helen; Gensini, Michel; Kataria, Ram; Twaddle, Tricia; Zhang, John; Wadsworth, Scott; Cooper, Kevin; Petrilli, Janel; Rodgers, Kathleen; DiZerega, Gere

    2009-01-01

    Post-surgical adhesion formation has numerous deleterious side effects in a wide variety of surgical settings. Physical barriers used together with laparoscopy were developed to reduce tissue trauma seen with open procedures. However, despite surgeons' meticulous techniques and the use of such barriers, adhesion formation remains a serious clinical problem, creating complications that cost the health care system over $1 billion annually. Our laboratories have combined a previously marketed drug, Tranilast, with a sodium carboxymethylcellulose (NaCMC) gel in a sustained release formulation using poly(p-dioxanone) (PDO) to provide a locally delivered medicated device that significantly reduces adhesions. This paper describes the preparation of the gel and the sustained release formulation, its key physical properties, and its sustained release kinetics. Pre-clinical data on inhibition of adhesion formation by the sustained release poly(p-dioxanone)/sodium carboxymethylcellulose/Tranilast drug enhanced device are also presented.

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

    African Journals Online (AJOL)

    cannot be protruded beyond lower incisor teeth because of a short lingual ... suggests that surgical interventions are absolutely safe at any age including ... Surgical procedures indicated for ankyloglossia are highly predictable but shows poor ...

  8. A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series.

    Science.gov (United States)

    Landi, Luca; Manicone, Paolo Francesco; Piccinelli, Stefano; Raia, Alessandro; Raia, Roberto

    2010-05-01

    Extraction of impacted mandibular third molars (M3s) may cause temporary or permanent neurosensorial disturbances of the inferior alveolar nerve (IAN). Although the incidence of this complication is low, a great range of variability has been reported in the literature. Several methods to reduce or eliminate this complication have been proposed, such as orthodontic-assisted extraction, extraction of the second molar, or intentional odontoectomy. The purpose of this series of cases is to present a novel approach for a riskless extraction of impacted mandibular M3s in contact with the IAN. Nine consecutive patients (4 male and 5 female; mean age 24.9 years, range 18-43 years) required the extraction of 10 horizontally or mesioangular impacted mandibular M3s. In all cases the M3 was in contact with the IAN with a high risk of nerve injury. A staged approached was proposed and accepted by the patients. This approach consisted in the surgical removal of the mesial portion of the anatomic crown to create adequate space for mesial M3 migration. After the migration of the M3 had taken place, the extraction could then be accomplished in a second surgical session minimizing neurological risks. All M3s moved mesially within 6 months (mean 174.1 days, range 92-354 days) and could be successfully removed without any neurological consequences. This technique may be considered as an alternative approach to the extraction of horizontally or mesioangular impacted M3s in proximity to the IAN. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  9. A Randomized Controlled Trial of Video Education versus Skill Demonstration: Which Is More Effective in Teaching Sterile Surgical Technique?

    Science.gov (United States)

    Pilieci, Stephanie N; Salim, Saad Y; Heffernan, Daithi S; Itani, Kamal M F; Khadaroo, Rachel G

    2018-04-01

    Video education has many advantages over traditional education including efficiency, convenience, and individualized learning. Learning sterile surgical technique (SST) is imperative for medical students, because proper technique helps prevent surgical site infections (SSIs). We hypothesize that video education is at least as effective as traditional skill demonstration in teaching first-year medical students SST. A video series was created to demonstrate SST ( https://www.youtube.com/playlist?list=PLcRU-gvOmxE2mwMWkowouBkxGXkLZ8Uis ). A randomized controlled trial was designed to assess which education method best teaches SST: video education or skill demonstration. First-year medical students (n = 129) were consented and randomly assigned into two groups: those who attended a skill demonstration (control group; n = 70) and those who watched the video series (experimental group; n = 59). The control group attended a pre-existing 90-minute nurse educator-led skill demonstration. Participants then completed a 30-item multiple choice quiz to test their knowledge. Each group then received the alternate education method and completed a 23-item follow-up survey to determine their preferred method. Seven 2- to 6-minute videos (30 minutes total) were created on surgical attire, scrubbing, gowning and gloving, and maintaining sterility. The experimental group (n = 51) scored higher on the quiz compared with the control group (n = 63) (88% ± 1% versus 72% ± 1%; p < 0.0001). Students preferred the videos when it came to convenience, accessibility, efficiency, and review, and preferred the skill demonstration when it came to knowledge retention, preparedness, and ease of completion. Video education is superior to traditional skill demonstration in providing medical students with knowledge of SST. Students identified strengths to each method of teaching. Video education can augment medical students' knowledge prior to their operating room

  10. Real-time surgical simulation for deformable soft-tissue objects with a tumour using Boundary Element techniques

    Science.gov (United States)

    Wang, P.; Becker, A. A.; Jones, I. A.; Glover, A. T.; Benford, S. D.; Vloeberghs, M.

    2009-08-01

    A virtual-reality real-time simulation of surgical operations that incorporates the inclusion of a hard tumour is presented. The software is based on Boundary Element (BE) technique. A review of the BE formulation for real-time analysis of two-domain deformable objects, using the pre-solution technique, is presented. The two-domain BE software is incorporated into a surgical simulation system called VIRS to simulate the initiation of a cut on the surface of the soft tissue and extending the cut deeper until the tumour is reached.

  11. Real-time surgical simulation for deformable soft-tissue objects with a tumour using Boundary Element techniques

    International Nuclear Information System (INIS)

    Wang, P; Becker, A A; Jones, I A; Glover, A T; Benford, S D; Vloeberghs, M

    2009-01-01

    A virtual-reality real-time simulation of surgical operations that incorporates the inclusion of a hard tumour is presented. The software is based on Boundary Element (BE) technique. A review of the BE formulation for real-time analysis of two-domain deformable objects, using the pre-solution technique, is presented. The two-domain BE software is incorporated into a surgical simulation system called VIRS to simulate the initiation of a cut on the surface of the soft tissue and extending the cut deeper until the tumour is reached.

  12. Novel technique of reducing radon levels in living premises

    International Nuclear Information System (INIS)

    Khaydarov, R.A.; Gapurova, O.U.; Khaydarov, R.R.

    2006-01-01

    Full text: Radon is a naturally occurring gas seeping into homes and underground structures (buildings, tunnels, hangars, garages, etc.) from the surrounding soil through walls, floor, etc. and emanating from construction materials such as concrete, granite, etc. The level of radon is especially great in regions with the higher content of uranium in soil and water and with geological breaks of the Earth's crust. Concentrations of uranium higher than 10 g per ton of soil have been found in 14% of territory of Uzbekistan. As a result, for instance, concentration of radon 10-100 times exceeds the regulation level in 14% of premises in Tashkent, 41% of premises in Almalik town and 44% in Yangiabad town. The purpose of this work was creating a method to reduce concentration of radon gas in buildings and underground structures. We suppose that the most effective technique is a treatment of walls, floors, etc. of basement and underground structures by special chemicals which seal micropores inside the construction materials. Sealing the pores stops radon diffusion and, in addition, it blocks another radon pathway - water migration and emanation from concrete, gypsum or other construction materials. In the paper polymeric silicoorganic compounds are investigated and selected as the chemicals to prevent radon seeping indoors. Gas (air, Ar, Rn-222, H 2 O) permeability of concrete and gypsum after treatment by chemicals has been examined. Influence of types of cement and sand, preliminary treatment by different chemicals, different types of polymeric silicoorganic compounds, time between treatments, moisture of concrete, time between preparation of chemicals and treatment of concrete (ageing of chemicals), time between treatment of concrete and testing (ageing of treated concrete) have been examined. Surfaces of the samples were treated by spray. Experiments have shown that chosen method of treatment of the construction materials allows reducing the coefficient of gas

  13. Training situational awareness to reduce surgical errors in the operating room

    NARCIS (Netherlands)

    Graafland, M.; Schraagen, J.M.C.; Boermeester, M.A.; Bemelman, W.A.; Schijven, M.P.

    2015-01-01

    Background: Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim

  14. International consensus statement on surgical education and training in an era of reduced working hours.

    Science.gov (United States)

    Collins, John P

    2011-01-01

    An international consensus statement has been developed as a reference on the key principles to be considered during discussions on surgical education and training and the delivery of surgical care in an era of restricted hours. Copyright © 2011. Published by Elsevier Ltd.

  15. Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

    Science.gov (United States)

    Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

    2009-09-01

    The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

  16. Biodegradable Magnesium Stent Treatment of Saccular Aneurysms in a Rat Model - Introduction of the Surgical Technique.

    Science.gov (United States)

    Nevzati, Edin; Rey, Jeannine; Coluccia, Daniel; D'Alonzo, Donato; Grüter, Basil; Remonda, Luca; Fandino, Javier; Marbacher, Serge

    2017-10-01

    The steady progess in the armamentarium of techniques available for endovascular treatment of intracranial aneurysms requires affordable and reproducable experimental animal models to test novel embolization materials such as stents and flow diverters. The aim of the present project was to design a safe, fast, and standardized surgical technique for stent assisted embolization of saccular aneurysms in a rat animal model. Saccular aneurysms were created from an arterial graft from the descending aorta.The aneurysms were microsurgically transplanted through end-to-side anastomosis to the infrarenal abdominal aorta of a syngenic male Wistar rat weighing >500 g. Following aneurysm anastomosis, aneurysm embolization was performed using balloon expandable magnesium stents (2.5 mm x 6 mm). The stent system was retrograde introduced from the lower abdominal aorta using a modified Seldinger technique. Following a pilot series of 6 animals, a total of 67 rats were operated according to established standard operating procedures. Mean surgery time, mean anastomosis time, and mean suturing time of the artery puncture site were 167 ± 22 min, 26 ± 6 min and 11 ± 5 min, respectively. The mortality rate was 6% (n=4). The morbidity rate was 7.5% (n=5), and in-stent thrombosis was found in 4 cases (n=2 early, n=2 late in stent thrombosis). The results demonstrate the feasibility of standardized stent occlusion of saccular sidewall aneurysms in rats - with low rates of morbidity and mortality. This stent embolization procedure combines the opportunity to study novel concepts of stent or flow diverter based devices as well as the molecular aspects of healing.

  17. Short-term surgical outcomes of reduced port surgery for esophageal achalasia.

    Science.gov (United States)

    Omura, Nobuo; Yano, Fumiaki; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Se Ryung; Akimoto, Shunsuke; Ishibashi, Yoshio; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2015-09-01

    To clarify the feasibility and utility of reduced port surgery (RPS) for achalasia. Between September 2005 and June 2013, 359 patients with esophageal achalasia, excluding cases of reoperation, underwent laparoscopic Heller myotomy and Dor fundoplication (LHD) according to our clinical pathway. Three-hundred and twenty-seven patients underwent LHD with five incisions (conventional approach), while the other 32 patients underwent RPS, including eight via SILS. The clinical data were collected in a prospective fashion and retrospectively reviewed. We selected 24 patients matched for gender, age and morphologic type with patients in the RPS group from among the 327 patients (C group). The surgical outcomes were compared between the C and RPS groups. There were no significant differences between the two groups in the duration of symptoms, dysphagia score, chest pain score, shape of the distal esophagus and esophageal clearance. The operative time was significantly longer in the RPS group than in the C group (p achalasia are comparable to those obtained with the conventional method.

  18. Clinical and Surgical Strategies for Avoiding or Reducing Allogeneic Blood Transfusions.

    Science.gov (United States)

    Dos Santos, Antonio Alceu; Baumgratz, Jose Francisco; Vila, Jose Henrique Andrade; Castro, Rodrigo Moreira; Bezerra, Rodrigo Freire

    2016-04-01

    Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was successfully handled without using the standard therapy to treat anemia with hemotransfusions. Such a case of severe anemia condition resulted after the patient was submitted to ascending aortic aneurism repair, valvar aortic replacement, reimplantation of right coronary ostium, followed by a coronary artery bypass grafting and several postoperative complications. The main clinical and surgical strategies used in this case to avoid blood transfusions were acute normovolemic hemodilution, intraoperative blood cell salvage, and meticulous hemostasis, beyond epsilon-aminocaproic acid, desmopressin, prothrombin complex concentrate, human fibrinogen concentrate, factor VIIa recombinant, erythropoietin and hyperoxic ventilation.

  19. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

    Directory of Open Access Journals (Sweden)

    Ana K. Islam

    2016-01-01

    Full Text Available Background. Acceptance of dual kidney transplantation (DKT has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001. For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2% and acute rejection (20.7 versus 22.4% were equivalent (p = ns. A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p<0.01 was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns. Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  20. Use of the Toric Surgical Marker to Aid in Intraoperative Plaque Placement for the USC Eye Physics Plaques to Treat Uveal Melanoma: A New Surgical Technique.

    Science.gov (United States)

    Berry, Jesse L; Kim, Jonathan W; Jennelle, Richard; Astrahan, Melvin

    2015-09-01

    To describe a new surgical technique for intraoperative placement of Eye Physics (EP) plaques for uveal melanoma using a toric marker. A toric marker is designed for cataract surgery to align the axis of astigmatism; its use was modified in this protocol to mark the axis of suture coordinates as calculated by Plaque Simulator (PS) software. The toric marker can be used to localize suture coordinates, in degrees, during intraoperative plaque placement. Linear marking using the toric marker decreases potential inaccuracies associated with the surgeon estimating 'clock-hours' by dot placement. Use of the toric marker aided surgical placement of EP plaques. The EP planning protocol is now designed to display the suture coordinates either by clock-hours or degrees, per surgeon preference. Future research is necessary to determine whether routine use of the toric marker improves operative efficiency. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:866-870.]. Copyright 2015, SLACK Incorporated.

  1. Localization techniques for guided surgical excision of non-palpable breast lesions.

    Science.gov (United States)

    Chan, Benjamin K Y; Wiseberg-Firtell, Jill A; Jois, Ramesh H S; Jensen, Katrin; Audisio, Riccardo A

    2015-12-31

    contrast, WGL had fewer postoperative complications to both ROLL (RR 1.18, 95% CI 0.71 to 1.98; 642 participants; four trials) and RSL (RR 1.51, 95% CI 0.75 to 3.03; 305 participants; one trial), although this was also not statistically significant.The overall quality of evidence was good. The main risk of bias amongst included studies consisted of incomplete data sets, selective reporting, and allocation concealment. Interpretation and applicability of this meta-analysis was hindered by the mixed indication of diagnostic versus therapeutic purposes when undertaking WGL, ROLL, or RSL, leading to a high level of mixed pathology in numerous trials. Other limitations include underpowered studies, lack of data in standardized format for meta-analysis, lack of complete data amongst the trials, and absence of long-term data. Owing to a lack of trials in certain localization techniques, we could only draw conclusions about ROLL and RSL versus WGL. There is no clear evidence to support one guided technique for surgically excising a non-palpable breast lesion over another. Results from this Cochrane review support the continued use of WGL as a safe and tested technique that allows for flexibility in selected cases when faced with extensive microcalcification. ROLL and RSL could be offered to patients as a comparable replacement for WGL as they are equally reliable. Other techniques such as IOUS, RCML, and CAL are of academic interest, but recommendation for routine use in the clinical environment and oncological outcomes require further validation. The results of this Cochrane review also stress the need for more fully powered RCTs to evaluate the best technique according to the comprehensive criteria described, with a more consistent and standardized approach in outcome reporting.

  2. Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

    Science.gov (United States)

    Hut, Adnan; Tatar, Cihad; Yıldırım, Doğan; Dönmez, Turgut; Ünal, Akın; Kocakuşak, Ahmet; Akıncı, Muzaffer

    2017-01-01

    Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Data from 112 patients presenting at our Training and Research Hospital Emergency Surgery Department between January 2010 and December 2015 who were diagnosed with PUP through physical examination and laboratory and radiological tests and operated at the hospital have been retrospectively analyzed. Patients were divided into three groups based on morbidity (Group 1), mortality (Group 2), and no complication (Group 3). Of the 112 patients included in the study, morbidity was observed in 21 (18.8%), mortality in 11 (9.8%), and no complication was observed in 80 (71.4%), who were discharged with cure. The differences between group for the average values of the perforation diameter and American Society of Anesthesiologists, Acute Physiology and Chronic Health Evaluation II, and Mannheim Peritonitis Index scores were statistically significant (p<0.001 for each). The average values for the group with mortality were significantly higher than those of the other groups. In this study where we investigated risk factors for increased morbidity and mortality in PUPs, there was statistically significant difference between the average values for age, body mass index, perforation diameter, and Acute Physiology and Chronic Health Evaluation II and Mannheim Peritonitis Index scores among the three groups, whereas the amount of subdiaphragmatic free air did not differ.

  3. Recurrent tricuspid insufficiency: is the surgical repair technique a risk factor?

    Science.gov (United States)

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available.

  4. Bilateral posterior tarsal tunnel syndrome caused by accessory flexor digitorum longus; case report and surgical technique.

    Science.gov (United States)

    Schmidt-Hebbel, A; Elgueta, J; Villa, A; Mery, P; Filippi, J

    To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused by an accessory flexor digitorum longus (AFDL), including the surgical technique and a review of the literature. Twenty-nine year old male diagnosed with bilateral PTTS, refractory to conservative management, with 53 points on the preoperative AOFAS score. MR of both ankles showed an AFDL within the tarsal tunnel, in close relationship to the posterior tibial nerve. Bilateral tarsal tunnel decompression and AFDL resection was performed. There were no post-operative complications. At 6 months after surgery, the patient had no pain and had 87 points on the AOFAS score. The PTTS is an entrapment neuropathy of the posterior tibial nerve or one of its terminal branches. A rare cause is the presence of an AFDL, and its resection is associated with good clinical results. Careful scar tissue resection and neurolysis is recommended. Knowing the normal pathway and anatomical variability of the posterior tibial nerve and its branches is essential to avoid iatrogenic injury. In our case report, MR and intraoperative findings identified a bilateral FDLA in close relationship to the common flexor digitorum, an unusual finding, with few reports in current literature. Careful tarsal tunnel decompression and AFDL resection in our patient with bilateral symptomatic PTTS has good clinical results and no complications, particularly when diagnosed and treated early. Copyright © 2015 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique

    Directory of Open Access Journals (Sweden)

    Elisa Bellini

    2017-01-01

    Full Text Available Objective. Breast cancer, the most common malignancy in women, comprises 18% of all female cancers. Mastectomy is an essential intervention to save lives, but it can destroy one’s body image, causing both physical and psychological trauma. Reconstruction is an important step in restoring patient quality of life after the mutilating treatment. Material and Methods. Tissue expanders and implants are now commonly used in breast reconstruction. Autologous reconstruction allows a better aesthetic result; however, many patients prefer implant reconstruction due to the shorter operation time and lack of donor site morbidity. Moreover, this reconstruction strategy is safe and can be performed in patients with multiple health problems. Tissue-expander reconstruction is conventionally performed as a two-stage procedure starting immediately after mammary gland removal. Results. Mastectomy is a destructive but essential intervention for women with breast cancer. Tissue expansion breast reconstruction is a safe, reliable, and efficacious procedure with considerable psychological benefits since it provides a healthy body image. Conclusion. This article focuses on this surgical technique and how to achieve the best reconstruction possible.

  6. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis

    Science.gov (United States)

    Ortega, Javier; García-Rayo, Ramón; Resines, Carlos

    2009-01-01

    This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15–84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48–77) to 91 (range 76–95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60–99) to 13 (range 0–70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal “Z” lengthening of the fascia lata appears to be a good alternative for treatment of this condition. PMID:19214507

  7. Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim.

    Science.gov (United States)

    Kold, Søren; Bechtold, Joan E; Mouzin, Olivier; Elmengaard, Brian; Chen, Xinqian; Søballe, Kjeld

    2005-03-01

    Revision joint replacement has poorer outcomes compared with primary joint replacement, and these poor outcomes have been associated with poorer fixation. We investigated a surgical technique done during the revision operation to improve access from the marrow space to the implant interface by locally cracking the sclerotic bone rim that forms during aseptic loosening. Sixteen implants were inserted bilaterally by distal femur articulation of the knee joint of eight dogs, using our controlled experimental model that replicates the revision setting (sclerotic bone rim, dense fibrous tissue, macrophages, elevated cytokines) by pistoning a loaded 6.0-mm implant 500 microm into the distal femur with particulate PE. At 8 weeks, one of two revision procedures was done. Both revision procedures included complete removal of the membrane, scraping, lavaging, and inserting a revision plasma-spray Ti implant. The crack revision procedure also used a splined tool to circumferentially locally perforate the sclerotic bone rim before insertion of an identical revision implant. Superior fixation was achieved with the cracking procedure in this experimental model. Revision implants inserted with the rim cracking procedure had a significantly higher pushout strength (fivefold median increase) and energy to failure (sixfold median increase), compared with the control revision procedure. Additional evaluation is needed of local perforation of sclerotic bone rim as a simple bone-sparing means to improve revision implant fixation and thereby increase revision implant longevity.

  8. Arthroscopic Surgical Technique for an Acute Talar Dome Osteochondral Lesion in a Professional Rugby League Player.

    Science.gov (United States)

    Sullivan, Martin; Fraser, Ethan J; Linklater, James; Harris, Craig; Morgan, Kieran

    2017-06-01

    Talar osteochondral lesions represent challenging clinical entities, particularly in high-demand athletes. Surgical treatment of large lesions often requires a 2-step procedure, or the use of osteotomy in the case of autologous osteochondral transfer, which can delay return to sport. A professional rugby league player underwent surgery for a complex injury to the ankle. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Autologous cartilage was then reimplanted arthroscopically. The patient was allowed full ankle motion from 2 weeks postoperatively, and weightbearing was commenced at 6 weeks. Follow-up imaging and functional outcomes, including return to sport, were assessed at regular intervals. The patient was able to return to professional rugby league by 23 weeks postoperatively. Magnetic resonance imaging at 16 months postoperatively showed restoration of the subchondral plate and osseous infill. At final follow-up, the patient remained pain free and was playing at preinjury level. This report describes good outcomes using a novel, 1-step cartilage repair technique to treat a large talar osteochondral lesion in a professional athlete. Level V: Expert opinion.

  9. Laparoscopic cystostomy in pigs: Technique and comparison with traditional open cystostomy for surgical stress

    Directory of Open Access Journals (Sweden)

    Hua Zhang

    2014-01-01

    Full Text Available Cystostomy is a common procedure in veterinary surgery. We describe a technique for laparoscopic cystostomy (LC group; n = 7 in Bama miniature pigs and compare the surgical stress induced by this procedure to open cystostomy (OC group; n = 7. A three-portal approach was used for laparoscopic cystostomy. First, we placed 2 simple interrupted sutures between the ventral body wall and urinary bladder. Then, a purse-string suture was placed in the urinary bladder wall, approximately 1 cm cranially to the two sutures. A stab incision was made at the center of the purse-string suture and a 12-F Foley catheter advanced into the urinary bladder; the suture was then pulled tightly and tied. Again, two interrupted sutures were placed 1 cm cranially to the catheter, between the ventral body wall and the bladder, to establish cystopexy. The extracorporeal portion of the catheter was fixed to the skin by a finger-trap suture. Blood samples were collected to measure the white blood cell count and serum concentrations of cortisol, interleukin-6, and C-reactive protein; follow-up laparoscopy was performed 1 month after the surgery. Laparoscopic cystotomy was successfully performed in all the pigs; the mean operating time was 43 ± 5 min. The levels of the stress markers reflected a lower stress response for LC than OC. Thus, LC appears to be better than OC both in terms of technique and physiological responses elicited, and may be more suitable than OC in the creation of experimental animal models for investigations on urinary diseases and those requiring diversion of urine flow.

  10. Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.

    Science.gov (United States)

    Tanner, J; Khan, D; Walsh, S; Chernova, J; Lamont, S; Laurent, T

    2009-03-01

    Though brushes are no longer used on the hands and forearms during the surgical scrub, they are still widely used on the nails. The aim of this study was to determine whether nail picks and nail brushes are effective in providing additional decontamination during a surgical hand scrub. A total of 164 operating department staff were randomised to undertake one of the following three surgical hand-scrub protocols: chlorhexidine only; chlorhexidine and a nail pick; or chlorhexidine and a nail brush. Bacterial hand sampling was conducted before and 1h after scrubbing using a modified version of the glove juice method. No statistically significant differences in bacterial numbers were found between any two of the three intervention groups. Nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers and are unnecessary.

  11. Pilot study: evaluation of the use of the convergent interview technique in understanding the perception of surgical design and simulation.

    Science.gov (United States)

    Logan, Heather; Wolfaardt, Johan; Boulanger, Pierre; Hodgetts, Bill; Seikaly, Hadi

    2013-06-19

    It is important to understand the perceived value of surgical design and simulation (SDS) amongst surgeons, as this will influence its implementation in clinical settings. The purpose of the present study was to examine the application of the convergent interview technique in the field of surgical design and simulation and evaluate whether the technique would uncover new perceptions of virtual surgical planning (VSP) and medical models not discovered by other qualitative case-based techniques. Five surgeons were asked to participate in the study. Each participant was interviewed following the convergent interview technique. After each interview, the interviewer interpreted the information by seeking agreements and disagreements among the interviewees in order to understand the key concepts in the field of SDS. Fifteen important issues were extracted from the convergent interviews. In general, the convergent interview was an effective technique in collecting information about the perception of clinicians. The study identified three areas where the technique could be improved upon for future studies in the SDS field.

  12. An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap technique

    Directory of Open Access Journals (Sweden)

    W L Adeyemo

    2013-01-01

    Full Text Available Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390 of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision surgery. The most common surgical technique employed was modified Fork flap (Millard technique, which was employed in 37 (95% cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

  13. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    Science.gov (United States)

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

  14. WE-G-204-08: Optimized Digital Radiographic Technique for Lost Surgical Devices/Needle Identification

    International Nuclear Information System (INIS)

    Gorman, A; Seabrook, G; Brakken, A; Dubois, M; Marn, C; Wilson, C; Jacobson, D; Liu, Y

    2015-01-01

    Purpose: Small surgical devices and needles are used in many surgical procedures. Conventionally, an x-ray film is taken to identify missing devices/needles if post procedure count is incorrect. There is no data to indicate smallest surgical devices/needles that can be identified with digital radiography (DR), and its optimized acquisition technique. Methods: In this study, the DR equipment used is a Canon RadPro mobile with CXDI-70c wireless DR plate, and the same DR plate on a fixed Siemens Multix unit. Small surgical devices and needles tested include Rubber Shod, Bulldog, Fogarty Hydrogrip, and needles with sizes 3-0 C-T1 through 8-0 BV175-6. They are imaged with PMMA block phantoms with thickness of 2–8 inch, and an abdomen phantom. Various DR techniques are used. Images are reviewed on the portable x-ray acquisition display, a clinical workstation, and a diagnostic workstation. Results: all small surgical devices and needles are visible in portable DR images with 2–8 inch of PMMA. However, when they are imaged with the abdomen phantom plus 2 inch of PMMA, needles smaller than 9.3 mm length can not be visualized at the optimized technique of 81 kV and 16 mAs. There is no significant difference in visualization with various techniques, or between mobile and fixed radiography unit. However, there is noticeable difference in visualizing the smallest needle on a diagnostic reading workstation compared to the acquisition display on a portable x-ray unit. Conclusion: DR images should be reviewed on a diagnostic reading workstation. Using optimized DR techniques, the smallest needle that can be identified on all phantom studies is 9.3 mm. Sample DR images of various small surgical devices/needles available on diagnostic workstation for comparison may improve their identification. Further in vivo study is needed to confirm the optimized digital radiography technique for identification of lost small surgical devices and needles

  15. One-Step Cartilage Repair Technique as a Next Generation of Cell Therapy for Cartilage Defects: Biological Characteristics, Preclinical Application, Surgical Techniques, and Clinical Developments.

    Science.gov (United States)

    Zhang, Chi; Cai, You-Zhi; Lin, Xiang-Jin

    2016-07-01

    To provide a comprehensive overview of the basic science rationale, surgical technique, and clinical outcomes of 1-step cartilage repair technique used as a treatment strategy for cartilage defects. A systematic review was performed in the main medical databases to evaluate the several studies concerning 1-step procedures for cartilage repair. The characteristics of cell-seed scaffolds, behavior of cells seeded into scaffolds, and surgical techniques were also discussed. Clinical outcomes and quality of repaired tissue were assessed using several standardized outcome assessment tools, magnetic resonance imaging scans, and biopsy histology. One-step cartilage repair could be divided into 2 types: chondrocyte-matrix complex (CMC) and autologous matrix-induced chondrogenesis (AMIC), both of which allow a simplified surgical approach. Studies with Level IV evidence have shown that 1-step cartilage repair techniques could significantly relieve symptoms and improve functional assessment (P studies clearly showed hyaline-like cartilage tissue in biopsy tissues by second-look arthroscopy. The 1-step cartilage repair technique, with its potential for effective, homogeneous distribution of chondrocytes and multipotent stem cells on the surface of the cartilage defect, is able to regenerate hyaline-like cartilage tissue, and it could be applied to cartilage repair by arthroscopy. Level IV, systematic review of Level II and IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Different techniques for reducing alcohol levels in wine: A review⋆

    Directory of Open Access Journals (Sweden)

    Ozturk Burcu

    2014-01-01

    The aim of this review is to provide technical and practical information covering the outstanding techniques that may be used to adjust elevated alcohol concentration in wine and their effects on wine from the point of organoleptic characteristics view.

  17. Surgical treatment reduces blood pressure in children with unilateral congenital hydronephrosis.

    Science.gov (United States)

    Al-Mashhadi, Ammar; Nevéus, Tryggve; Stenberg, Arne; Karanikas, Birgitta; Persson, A Erik G; Carlström, Mattias; Wåhlin, Nils

    2015-04-01

    Renal disorders can cause hypertension, but less is known about the influence of hydronephrosis on blood pressure. Hydronephrosis due to pelvo-ureteric junction obstruction (PUJO) is a fairly common condition (incidence in newborns of 0.5-1%). Although hypertensive effects of hydronephrosis have been suggested, this has not been substantiated by prospective studies in humans [1-3]. Experimental studies with PUJO have shown that animals with induced hydronephrosis develop salt-sensitive hypertension, which strongly correlate to the degree of obstruction [4-7]. Moreover, relief of the obstruction normalized blood pressure [8]. In this first prospective study our aim was to study the blood pressure pattern in pediatric patients with hydronephrosis before and after surgical correction of the ureteral obstruction. Specifically, we investigated if preoperative blood pressure is reduced after surgery and if split renal function and renographic excretion curves provide any prognostic information. Twelve patients with unilateral congenital hydronephrosis were included in this prospective study. Ambulatory blood pressure (24 h) was measured preoperatively and six months after surgery. Preoperative evaluations of bilateral renal function by Tc99m-MAG3 scintigraphy, and renography curves, classified according to O'Reilly, were also performed. As shown in the summary figure, postoperative systolic (103 ± 2 mmHg) and diastolic (62 ± 2 mmHg) blood pressure were significantly lower than those obtained preoperatively (110 ± 4 and 69 ± 2 mmHg, respectively), whereas no changes in circadian variation or pulse pressure were observed. Renal functional share of the hydronephrotic kidney ranged from 11 to 55%. There was no correlation between the degree of renal function impairment and the preoperative excretory pattern, or between the preoperative excretory pattern and the blood pressure reduction postoperatively. However, preoperative MAG3 function of the affected kidney correlated

  18. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique.

    Science.gov (United States)

    Islam, Ana K; Knight, Richard J; Mayer, Wesley A; Hollander, Adam B; Patel, Samir; Teeter, Larry D; Graviss, Edward A; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H; Gaber, A Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.

  19. [Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases].

    Science.gov (United States)

    Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A

    2010-01-01

    Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

  20. Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique.

    Science.gov (United States)

    Sharma, Namrata; Urkude, Jayanand; Chaniyara, Manthan; Titiyal, Jeewan S

    2017-10-01

    We describe the surgical technique of microscope-integrated intraoperative optical coherence tomography (OCT)-guided small-incision lenticule extraction. The technique enables manual tracking of surgical instruments and identification of the desired dissection plane. It also helps discern the relation between the dissector and the intrastromal lenticule. The dissection plane becomes hyperreflective on dissection, ensuring complete separation of the intrastromal lenticule from the overlying and underlying stroma. Inadvertent posterior plane entry, cap-lenticule adhesion, incomplete separation of the lenticule, creation of a false plane, and lenticule remnants may be recognized intraoperatively so corrective steps can be taken immediately. In cases with a hazy overlying cap, microscope-integrated intraoperative OCT enables localization and extraction of the lenticule. The technique is helpful for inexperienced surgeons, especially in cases with low amplitudes of refractive errors, ie, thin lenticules. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  1. A novel technique to reduce staff exposure when preparing radiopharmaceuticals

    International Nuclear Information System (INIS)

    Collins, P.J.; Tsopelas, C.; Blefari, C.

    2003-01-01

    Full text: Staff receive considerable radiation exposure to the hands when withdrawing activity from the milking vial for reconstitution of radiopharmaceuticals. This exposure is due not only to the syringe activity, but also to the remaining, higher activity in the vial contained in the lead pot. A new technique has been developed, which involves withdrawing activity through a small hole (2.5 mm diameter) in the lid of the lead pot, with the use of a syringe bearing a long needle (0.8 x 38 mm), and a sterile blunt plastic cannula (Becton Dickinson and Co.) as the needle guide. We have investigated the effect of using this modified lid on radiation exposure at the hand position. A scintillation camera (General Electric Millenium MPR) was used to obtain count (an approximation for radiation dose) profiles using 99mTc sources. The profiles showed counts as a function of distance perpendicular to the axis of the vial and syringe. The simplest orientation was used in the initial experiments, with the syringe needle passing through the lid hole into the vial in the lead pot, which was facing upwards and resting on a flat surface. This is the usual orientation when redispensing activity back into a vial. The camera, without the collimator, was positioned 2 mm above the syringe plunger to acquire the images. The distance for the mid-point of the syringe and vial activities to the camera face was 9.3 and 21.1 cm respectively. To simulate common working levels, the ratio of activity in the vial to activity in the syringe was 20:1, and low activities (< 1 MBq) were used to avoid dead-time errors. A15 minute images was acquired, with and without the modified lid. In another experiment non-radioactive saline solution was used in the syringe to determine the contribution to radiation exposure from the milking vial in the pot, both with and without the modified lid. The modified lid is highly effective in reducing exposure from the milking vial, with a count reduction of more

  2. Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients.

    Science.gov (United States)

    Alfotih, Gobran Taha Ahmed; Zheng, Mei Guang; Cai, Wang Qing; Xu, Xin Ke; Hu, Zhen; Li, Fang Cheng

    2016-01-01

    Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death. We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes. This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side. No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients. Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  3. Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

    Science.gov (United States)

    Uysal, Ismail Onder; Ozçimen, Muammer; Yener, Halil Ibrahim; Kal, Ali

    2011-09-01

    The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.

  4. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  5. Para-axillary subcutaneous endoscopic approach in torticollis: tips and tricks in the surgical technique.

    Science.gov (United States)

    Tokar, Baran; Karacay, Safak; Arda, Surhan; Alici, Umut

    2015-04-01

    An obvious scar on the neck may appear following the open surgery for congenital muscular torticollis (CMT). The cosmetic result may displease the patient and the family. In this study, we describe a minimally invasive technique, para-axillary subcutaneous endoscopic approach (PASEA) in CMT. A total of 11 children (seven girls and four boys with the age range between 1 and 15 years) were operated for torticollis by PASEA. All patients had facial asymmetry and head and neck postural abnormality. Following an incision at the ipsilateral para-axillary region, a subcutaneous cavernous working space is formed toward sternocleidomastoid (SCM) muscle. The muscle and fascia are cut by cautery under endoscopic vision. The patients had postoperative 2nd-week and 3rd-month visits. The incision scar, inspection, and palpation findings of the region, head posture, and shoulder position of the affected side were considered in evaluation of the cosmetic outcome. Preoperative and postoperative range of motion of the head and neck were compared for functional outcome. We preferred single incision surgery in our last two patients; the rest had double para-axillary incision for port insertion. Incomplete transection of the muscle was not observed. There was no serious complication. Postoperatively, head posture and shoulder elevation were corrected significantly. Range of motion of the head was improved. Postoperatively, all the patients had rotation capacity with more than 30 degrees. The range of postoperative flexion and extension movements was between 45 and 60 degrees. The open surgery techniques of CMT causes visible lifelong incision scar on the neck. PASEA leaves a cosmetically hidden scar in the axillary region. A single incision surgery is also possible. A well-formed cavernous working space is needed. External manual palpation, delicate dissection, and cutting of SCM muscle with cautery are the important components of the procedure. Surgeons having experience in pediatric

  6. Reduced risk of surgical site infections through surveillance in a network

    NARCIS (Netherlands)

    Geubbels, Eveline L. P. E.; Nagelkerke, Nico J. D.; Mintjes-de Groot, A. Joke; Vandenbroucke-Grauls, Christina M. J. E.; Grobbee, Diederick E.; de Boer, Annette S.

    2006-01-01

    OBJECTIVE: To estimate the effect of multicentre surveillance for nosocomial infections on patients' risk of surgical site infection (SSI). DESIGN: Prospective multi-centre cohort study, from January 1996 to December 2000. SETTING: Acute care hospitals in The Netherlands. STUDY PARTICIPANTS: All 50

  7. Surgical extrusion: A reliable technique for saving compromised teeth. A 5-years follow-up case report

    Directory of Open Access Journals (Sweden)

    Jenner Argueta

    2018-06-01

    Full Text Available Aim: To present a long term follow up clinical case in which a compromised anterior tooth was saved by a surgical extrusion procedure. Summary: Although different techniques have been suggested for clinical crown lengthening in the anterior zone, some of them have limitations in terms of aesthetics and procedural requirements. The current case report demonstrates how a simplified surgical extrusion procedure was successfully performed for saving a severely damaged anterior tooth; furthermore, it is possible to apply the technique described in this case using minimum and simple armamentarium like a scalpel, elevators, forceps and splinting flexible cord. Key-learning points: Saving severely compromised anterior teeth is possible by applying surgical extrusion techniques when crown-root ratio allows it. Risk of root resorption or ankylosis is minimum. Riassunto: Obiettivo: Presentare un caso clinico con controllo a 5 anni in cui un dente anteriore compromesso è stato recuperato con una procedura di estrusione chirurgica. Riassunto: Sebbene siano state suggerite diverse tecniche per l’allungamento della corona clinica nella zona anteriore, alcune di esse presentano limitazioni in termini di estetica e competenza nelle procedure. Il presente case report dimostra come una procedura di estrusione chirurgica semplificata sia stata eseguita con successo per salvare un dente anteriore gravemente danneggiato. Va sottolineato che la tecnica descritta in questo caso può essere portata a termine utilizzando un armamentario minimo e molto semplice come un bisturi, leve, pinze e uno splintaggio flessibile. Key learning points: E’ possibile salvare elementi dentari gravemente compromessi applicando tecniche di estrusione chirurgica quando il rapporto corona-radice lo consente. Il rischio di riassorbimento della radice o anchilosi è minimo. Keywords: Crown fracture, Crown lengthening, Surgical extrusion, Surgical repositioning, Biologic width, Parole

  8. Do Targeted Hiring Subsidies and Profiling Techniques Reduce Unemployment?

    DEFF Research Database (Denmark)

    Jahn, Elke; Wagner, Thomas

    To reduce unemployment targeted hiring subsidies for long-term unemployed are often recommended. To explore their effect on employment and wages, we devise a model with two types of unemployed and two methods of search, a public employment service (PES) and random search. The eligibility of a new......, which ad­vance the search effectiveness of the PES, crowd out the active jobseekers and reduce overall employment as well as social welfare. Nevertheless, reforms are a visible success for the PES and its target group, as they significantly increase the service's placement rate and lower the duration...

  9. Do Targeted Hiring Subsidies and Profiling Techniques Reduce Unemployment?

    DEFF Research Database (Denmark)

    Jahn, Elke; Wagner, Thomas

    , which advance the search effectiveness of the PES, crowd out the active jobseekers and reduce overall employment as well as social welfare. Nevertheless, reforms are a visible success for the PES and its target group, as they significantly increase the service's placement rate and lower the duration...

  10. Applying industrial process improvement techniques to increase efficiency in a surgical practice.

    Science.gov (United States)

    Reznick, David; Niazov, Lora; Holizna, Eric; Siperstein, Allan

    2014-10-01

    The goal of this study was to examine how industrial process improvement techniques could help streamline the preoperative workup. Lean process improvement was used to streamline patient workup at an endocrine surgery service at a tertiary medical center utilizing multidisciplinary collaboration. The program consisted of several major changes in how patients are processed in the department. The goal was to shorten the wait time between initial call and consult visit and between consult and surgery. We enrolled 1,438 patients enrolled in the program. The wait time from the initial call until consult was reduced from 18.3 ± 0.7 to 15.4 ± 0.9 days. Wait time from consult until operation was reduced from 39.9 ± 1.5 to 33.9 ± 1.3 days for the overall practice and to 15.0 ± 4.8 days for low-risk patients. Patient cancellations were reduced from 27.9 ± 2.4% to 17.3 ± 2.5%. Overall patient flow increased from 30.9 ± 5.1 to 52.4 ± 5.8 consults per month (all P process improvement methodology, surgery patients can benefit from an improved, streamlined process with significant reduction in wait time from call to initial consult and initial consult to surgery, with reduced cancellations. This generalized process has resulted in increased practice throughput and efficiency and is applicable to any surgery practice. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. The Cost-Effectiveness of Conventional Discectomy Compared to Other Surgical Techniques for Lumbar Disk Herniation. A Systematic Review

    DEFF Research Database (Denmark)

    Thorsen, May Tone; Ødegaard-Olsen, Øystein; Leboeuf-Yde, Charlotte

    2018-01-01

    Background: The current study reviews the literature on the cost-effectiveness of conventional diskectomy compared to other surgical techniques, by assessing studies with economical evaluation and studies using proxy measures of cost-effectiveness. Methods: In April 2016, a comprehensive search w...... studies. The available evidence, however, suggests that any cost-effectiveness difference between conventional diskectomy and the alternatives is unlikely to be great.......Background: The current study reviews the literature on the cost-effectiveness of conventional diskectomy compared to other surgical techniques, by assessing studies with economical evaluation and studies using proxy measures of cost-effectiveness. Methods: In April 2016, a comprehensive search......-four articles were included in the review, 9 retrieved from the original search, and an additional 15 from reference lists. Four studies included an economical evaluation and 20 reported proxy measures of cost-effectiveness. The quality of studies varied considerably and results were ambiguous; the four...

  12. "Two-step" technique with OsiriXTM to evaluate feasibility of C2 pedicle for surgical fixation

    Directory of Open Access Journals (Sweden)

    Luis Miguel Sousa Marques

    2016-01-01

    Full Text Available Background: Surgical treatment of craniovertebral junction pathology has evolved considerably in recent decades with the implementation of short atlanto-axial fixation techniques, notwhithstanding increasing neurovascular risks. Also, there is strong evidence that fixation of C2 anatomical pedicle has the best biomechanical profile of the entire cervical spine. However, it is often difficult and misleading, to evaluate anatomical bony and vascular anomalies using the three orthogonal planes (axial, coronal, and sagittal of CT. Objectives: The authors describe an innovative and simple technique to evaluate the feasibility of C2 pedicle for surgical screw fixation using preoperative planning with the free DICOM (Digital Imaging and Communications in Medicine software OsiriX TM . Materials and Methods: The authors report the applicatin of this novel technique in 5 cases (3 traumatic, 1 Os Odontoideum, and 1 complex congenital malformation collected from our general case series of the Department in the last 5 years. Results: In this "proof of concept" study, the pre-operative analysis with the "two-step" tecnique was detrimental for choosing the surgical tecnique. Detailed post-operative analysis confirmed correct position of C2 screws without cortical breach. There were no complications or mortality reported. Conclusion: This "two-step" technique is an easy and reliable way to determine the feasibility of C2 pedicle for surgical fixation. The detailed tridimensional radiological preoperative evaluation of craniovertebral junction anatomy is critical to the sucess and safety of this surgeries, and can avoid, to certain degree, expensive intra-operative tridimensional imaging facilities.

  13. Opportunities to reduce risk associated with nuclear logging techniques

    International Nuclear Information System (INIS)

    Wraight, P.D.; Robinson, E.; de Fleurieu, R.

    1991-01-01

    Nuclear logging provides petroleum exploration and production companies with data that are critical to their decisions and operations. Because this type data is so important, environmentally conscious well-logging and service companies are constantly reviewing the risks to people and environment associated with nuclear sources with the ALARA (as low as reasonably achievable) principle in mind. Opportunities to additionally reduce risks, which can be accomplished only with the active involvement of oil companies, are proposed in this paper

  14. Surgical Management of Hemorrhoids

    Science.gov (United States)

    Agbo, S. P.

    2011-01-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

  15. Reducing the risk of surgical site infection: a case controlled study of contamination of theatre clothing.

    Science.gov (United States)

    Sivanandan, Indu; Bowker, Karen E; Bannister, Gordon C; Soar, Jasmeet

    2011-02-01

    Surgical site infections are one of the most important causes of healthcare associated infections (HCAI), accounting for 20% of all HCAIs. Surgical site infections affect 1% of joint replacement operations. This study was designed to assess whether theatre clothing is contaminated more inside or outside the theatre suite. Petri dishes filled with horse blood agar were pressed on theatre clothes at 0, 2, 4, 6 and 8 hours to sample bacterial contamination in 20 doctors whilst working in and outside the theatre suite. The results showed that there was greater bacterial contamination when outside the theatre suite at 2 hours. There were no differences in the amount of contamination at 4, 6 and 8 hours. This study suggests that the level of contamination of theatre clothes is similar both inside and outside the theatre setting.

  16. Do Prolonged Prophylactic Antibiotics Reduce the Incidence of Surgical-Site Infections in Immediate Prosthetic Breast Reconstruction?

    Science.gov (United States)

    Wang, Frederick; Chin, Robin; Piper, Merisa; Esserman, Laura; Sbitany, Hani

    2016-12-01

    Approximately 50,000 women in the United States undergo mastectomy and immediate prosthetic breast reconstruction annually, and most receive postoperative prophylactic antibiotics. The effect of these antibiotics on the risk of surgical-site infections remains unclear. The authors searched the Medline, Embase, and Cochrane Library databases for studies that compared less than 24 hours and greater than 24 hours of antibiotics following immediate prosthetic breast reconstruction. Primary outcomes were surgical-site infections and implant loss. Conservative random effects models were used to obtain pooled relative risk estimates. The authors identified 927 studies, but only four cohort studies and one randomized controlled trial met their inclusion criteria. Unadjusted incidences of surgical-site infections were 14 percent with more than 24 hours of antibiotics, 19 percent with less than 24 hours of antibiotics, and 16 percent overall. Unadjusted incidences of implant loss were 8 percent with more than 24 hours of antibiotics, 10 percent with less than 24 hours of antibiotics, and 9 percent overall. The pooled relative risk of implant loss was 1.17 (95 percent CI, 0.39 to 3.6) with less than 24 hours of antibiotics, which was not statistically significant. Prolonged antibiotic use did not have a statistically significant effect on reducing surgical-site infections or implant loss. There was significant heterogeneity between studies, and prolonged antibiotics may have increased the risk of implant loss in the randomized controlled trial. Definitive evidence may only be obtained with data from more prospective randomized controlled trials.

  17. Reducing maternal mortality in conflict areas: Surgical-anesthetic experience in Boost Hospital - Afghanistan

    OpenAIRE

    Izquierdo, Gilda; Trelles, Miguel; Khan, Nasrullah

    2016-01-01

    Introduction: Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009. Method: Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012. Results: 5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = ...

  18. Development of an adhesive surgical ward round checklist: a technique to improve patient safety.

    LENUS (Irish Health Repository)

    Dhillon, P

    2012-02-01

    Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

  19. Metastases but not cardiovascular mortality reduces life expectancy following surgical resection of apparently benign pheochromocytoma.

    Science.gov (United States)

    Timmers, H J L M; Brouwers, F M; Hermus, A R M M; Sweep, F C G J; Verhofstad, A A J; Verbeek, A L M; Pacak, K; Lenders, J W M

    2008-12-01

    The treatment of choice for non-metastatic pheochromocytoma is surgical resection. Its goals are to abolish catecholamine hypersecretion, normalize blood pressure, and prevent further tumor growth or progression to metastatic disease. Data on long-term mortality and morbidity after pheochromocytoma surgery are limited. We here report a retrospective study on the long-term outcome after surgery for apparently benign pheochromocytoma at the Radboud University Nijmegen Medical Centre. Data on clinical presentation, treatment, post-surgical blood pressure and recurrence, metastasis and death were collected of 69 consecutive patients (January 1966-December 2000; follow-up: until death or January 2006). Survival was compared with survival of a matched reference population. Two patients died of surgical complications. All ten patients with metastatic disease (including three diagnosed at first surgery) died. At follow-up, 40 patients were alive and recurrence free and three patients were lost to follow up. Two patients experienced a benign recurrence. Mean+/-s.d. follow-up was 10.2+/-7.5 (median 9, range 1-38) years. Kaplan-Meier estimates for 5- and 10-year survival since surgery were 85.8% (95% CI: 77.2-94.4%) and 74.2% (95% CI: 62.0-86.4%) for patients versus 95.5 and 89.4% in the reference population (Prisk of developing metastatic disease. Only one-third becomes normotensive without antihypertensive medication. Therefore, lifelong follow-up is warranted.

  20. Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program.

    Science.gov (United States)

    Hakkarainen, Timo W; Dellinger, E Patchen; Evans, Heather L; Farjah, Farhood; Farrokhi, Ellen; Steele, Scott R; Thirlby, Richard; Flum, David R

    2014-03-01

    Surgical site infections (SSI) are an important source of morbidity and mortality. Chlorhexidine in isopropyl alcohol is effective in preventing central venous-catheter associated infections, but its effectiveness in reducing SSI in clean-contaminated procedures is uncertain. Surgical studies to date have had contradictory results. We aimed to further evaluate the relationship of commonly used antiseptic agents and SSI, and to determine if isopropyl alcohol has a unique effect. We performed a prospective cohort analysis to evaluate the relationship of commonly used skin antiseptic agents and SSI for patients undergoing mostly clean-contaminated surgery from January 2011 through June 2012. Multivariate regression modeling predicted expected rates of SSI. Risk adjusted event rates (RAERs) of SSI were compared across groups using proportionality testing. Among 7,669 patients, the rate of SSI was 4.6%. The RAERs were 0.85 (p = 0.28) for chlorhexidine (CHG), 1.10 (p = 0.06) for chlorhexidine in isopropyl alcohol (CHG+IPA), 0.98 (p = 0.96) for povidone-iodine (PVI), and 0.93 (p = 0.51) for iodine-povacrylex in isopropyl alcohol (IPC+IPA). The RAERs were 0.91 (p = 0.39) for the non-IPA group and 1.10 (p = 0.07) for the IPA group. Among elective colorectal patients, the RAERs were 0.90 (p = 0.48) for CHG, 1.04 (p = 0.67) for CHG+IPA, 1.04 (p = 0.85) for PVI, and 1.00 (p = 0.99) for IPC+IPA. For clean-contaminated surgical cases, this large-scale state cohort study did not demonstrate superiority of any commonly used skin antiseptic agent in reducing the risk of SSI, nor did it find any unique effect of isopropyl alcohol. These results do not support the use of more expensive skin preparation agents. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Fronto-orbital feminization technique. A surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio.

    Science.gov (United States)

    Villepelet, A; Jafari, A; Baujat, B

    2018-05-04

    The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique. Orbital remodeling comprises a superolateral orbital opening, a reduction of ridges and a trough at the lateral orbital rim to support the lateral canthopexy. Frontal, corrugator and procerus myectomies, plus minimal scalp excision, complete the surgery. Our technique results in significant, natural-looking feminization. No complications were observed in our series of patients. The eggshell technique is an alternative to bone flap on over-pneumatized sinus. Fronto-orbital feminization fits into a wider surgical strategy. It can be associated to rhinoplasty, genioplasty, mandibular angle remodeling, face lift and laryngoplasty. Achieving facial feminization in 2 or 3 stages improves psychological and physiological tolerance. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  2. New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma

    NARCIS (Netherlands)

    Cobben, DCP; Koopal, S; Tiebosch, ATMG; Jager, PL; Elsinga, PH; Wobbes, T; Hoekstra, HJ

    2002-01-01

    The emphasis of the research on the surgical treatment of melanoma has been on the resection margins, the role of elective lymph node dissection. in high risk patients and the value of adjuvant regional treatment with hyperthermic isolated lymph perfusion with melphalan. Parallel to this research,

  3. Journal of Surgical Technique and Case Report - Vol 2, No 1 (2010)

    African Journals Online (AJOL)

    Mayer-Rokitansky-Kuster-Hauser syndrome: Surgical management of two cases · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. L.A Mungadi, Y Ahmad, G.H Yunusa, N.P Agwu, S Ismail, 39-43. http://dx.doi.org/10.4103/2006-8808.63725 ...

  4. Flail Chest in Polytraumatized Patients: Surgical Fixation Using Stracos Reduces Ventilator Time and Hospital Stay

    Directory of Open Access Journals (Sweden)

    Christophe P. M. Jayle

    2015-01-01

    Full Text Available Objectives. Conservative management of patients with flail chest is the treatment of choice. Rib fracture repair is technically challenging; however, with the advent of specially designed molding titanium clips, surgical management has been simplified. Surgical stabilization has been used with good outcomes. We are reporting on our institutional matched-case-control study. Methods. Between April 2010 and April 2011, ten polytraumatized patients undergoing rib stabilization for flail chest were matched 1 : 1 to 10 control patients by age ±10 years, sex, neurological or vertebral trauma, abdominal injury, and arm and leg fractures. Surgery was realized in the first 48 hours. Results. There were no significant differences between groups for matched data and prognostic scores: injury severity score, revised trauma score, and trauma injury severity score. Ventilator time (142 ± 224 versus 74 ± 125 hours, P=0.026 and overall hospital stay (142 ± 224 versus 74 ± 125 hours, P=0.026 were significantly lower for the surgical group after adjustment on prognostic scores. There was a trend towards shorter ICU stay for operative patients (12.3 ± 8.5 versus 9.0 ± 4.3 days, P=0.076. Conclusions. Rib fixation with Stracos is feasible and decreases the length of ventilation and hospital stay. A multicenter randomized study is warranted so as to confirm these results and to evaluate impact on pulmonary function status, pain, and quality of life.

  5. Surgical handover in an era of reduced working hours: an audit of current practice.

    Science.gov (United States)

    Shafiq-ur-Rehman; Mehmood, Sajid; Ahmed, Jamil; Razzaq, Muhammad Haroon; Khan, Shakeeb; Perry, Eugene Phillip

    2012-06-01

    To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.

  6. Evaluation of Techniques for Reducing In-Use Automotive Fuel Consumption

    Science.gov (United States)

    1981-04-01

    This report presents an assessment of proposed techniques for reducing fuel consumption in the in-use light duty road vehicle fleet. Three general classes of techniques are treated: (1) modification of vehicles, (2) modification of traffic flow, and ...

  7. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Boris Abayev

    2015-03-01

    Full Text Available Objectives: The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN repositioning with a minimum 6 months of follow-up. Results: A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions: Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

  8. Results of a protocol of transfusion threshold and surgical technique on transfusion requirements in burn patients.

    Science.gov (United States)

    O'Mara, Michael S; Hayetian, Fernando; Slater, Harvey; Goldfarb, I William; Tolchin, Eric; Caushaj, Philip F

    2005-08-01

    Blood loss and high rates of transfusion in burn centers remains an area of ongoing concern. Blood use brings the risk of infection, adverse reaction, and immunosuppression. A protocol to reduce blood loss and blood use was implemented. Analysis included 3-year periods before and after institution of the protocol. All patients were transfused for a hemoglobin below 8.0 gm/dL. Operations per admission did not change during the two time periods (0.78 in each). Overall units transfused per operation decreased from 1.56+/-0.06 to 1.25+/-0.14 units after instituting the protocol (pburns of less than 20% surface area, declining from 386 to 46 units after protocol institution, from 0.37 to 0.04 units per admission, and from 0.79 to 0.08 units per operation in this group of smallest burns. There was no change noted in the larger burns. This study suggests that a defined protocol of hemostasis, technique, and transfusion trigger should be implemented in the process of burn excision and grafting. This will help especially those patients with the smallest burns, essentially eliminating transfusion need in that group.

  9. Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy.

    Science.gov (United States)

    Sunil, Kanoujia; Gupta, Archika; Chaubey, Digamber; Pandey, Anand; Kureel, Shiv Narain; Verma, Ajay Kumar

    2018-01-01

    To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

  10. Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    André L Mihaljevic

    Full Text Available Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%. The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%. Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55 than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92, but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23% than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46% and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%.Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to

  11. The management of thoracic inlet syndrome associated with Hurler's syndrome: a novel surgical technique.

    LENUS (Irish Health Repository)

    Ahsan, Rauf M

    2012-02-01

    A 21-year-old male developed significant swelling of his tongue after a respiratory arrest. The patient had a history of Hurler\\'s syndrome. Magnetic resonance imaging (MRI) angiogram delineated that the swelling was due to compression of his internal jugular veins at the level of the first rib, resulting in thoracic inlet obstruction. The standard surgical treatment of thoracic inlet obstruction was not suitable in this patient\\'s case due to his short thick neck and his characteristic Hurler\\'s syndrome body habitus. Therefore, a novel surgical strategy was used to decompress his head and neck vessels. The manubrium was widened using an iliac crest bone graft, stabilised using internal fixation plates and reconstructed with a pectoral muscle flap.

  12. Duodenum preserving pancreatectomy in chronic pancreatitis: Design of a randomized controlled trial comparing two surgical techniques [ISRCTN50638764

    Directory of Open Access Journals (Sweden)

    Reidel Margot A

    2006-05-01

    Full Text Available Abstract Background Chronic pancreatitis is an inflammatory disease which is characterized by an irreversible conversion of pancreatic parenchyma to fibrous tissue. Beside obstructive jaundice and pseudocyst formation, about half of the patients need surgical intervention due to untreatable chronic pain during the course of the disease. In most of the patients with chronic pancreatitis, the head of the pancreas is the trigger of the chronic inflammatory process. Therefore, resection of pancreatic head tissue must be the central part of any surgical intervention. However, it is unclear to which extent the surgical procedure must be radical in order to obtain a favourable outcome for the patients. Design A single centre randomized controlled, superiority trial to compare two techniques of duodenum preserving pancreatic head resection. Sample size: 65 patients will be included and randomized intraoperatively. Eligibility criteria: All patients with chronic pancreatitis and indication for surgical resection and signed informed consent. Cumulative primary endpoint (hierarchical model: duration of surgical procedure, quality of life after one year, duration of intensive care unit stay, duration of hospital stay. Reference treatment: Resection of the pancreatic head with dissection of the pancreas from the portal vein and transsection of the gland (Beger procedure. Intervention: Partial Resection of the pancreatic head without transsection of the organ and visualization of the portal vein (Berne procedure. Duration: September 2003-October 2007. Organisation/responsibility The trial is conducted in compliance with the protocol and in accordance with the moral, ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and the Good Clinical Practice guideline (GCP. The Center for Clinical Studies of the Department of Surgery Heidelberg is responsible for planning, conducting and final

  13. Visualization and simulation techniques for surgical simulators using actual patient's data.

    Science.gov (United States)

    Radetzky, Arne; Nürnberger, Andreas

    2002-11-01

    Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators. Copyright 2002 Elsevier Science B.V.

  14. 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

  15. Transvaginal Cystocele Repair by Purse-String Technique Reinforced with Three Simple Sutures: Surgical Technique and Results

    Directory of Open Access Journals (Sweden)

    Ho-Sook Song

    2012-09-01

    Full Text Available Purpose Different techniques for cystocele repair including the conventional anterior colporrhaphy and mesh technique are known. Our goal was to evaluate the anatomical success and safety of our method of transvaginal anterior vaginal wall repair by the purse-string technique reinforced with three simple additional sutures in the repair of cystocele over a 4-year follow-up period. Methods This was a retrospective review of 69 consecutive patients (grades 2 to 4 who underwent the above operations between 2001 and 2011, including their success rates as assessed by use of the Baden-Walker halfway classification system. Results Of the patients, 62 patients (98% were completely cured of cystocele and 1 patient showed grade 2 cystocele recurrence that required no further treatment. Two patients with grade 4 cystocele were completely cured. There was no vaginal erosion related to the cystocele repair. Conclusions Transvaginal anterior colporrhaphy by a purse-string technique reinforced with simple additive sutures appears to be a simple, safe, and easily performed approach in cystocele repair. There is no need for other material for reinforcement, even in high-grade cystocele, which is an advantage of our technique.

  16. Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.

    Science.gov (United States)

    Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando

    2016-07-01

    The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols. Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest. Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels. Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when

  17. Using a change model to reduce the risk of surgical site infection.

    Science.gov (United States)

    Burden, Mel

    2016-09-22

    A surgical site infection (SSI) surveillance module completed in 2014 highlighted that infection rates for breast surgery inpatients and readmissions at an acute trust had increased to 2.2%, from 0.5% in 2012. The national benchmark for 2014 established by Public Health England (PHE) was 1.0%. This demonstrated a greater than fourfold absolute increase in SSI for breast surgery during these periods. The infection rate could have been due to chance, but warranted investigation. The results were presented to the breast team and used to drive practice transformation through audit and observation, identifying areas of change to improve patient safety. The project used a recognised 8-step model for leading change developed by John Kotter, a professor at Harvard Business School and world-renowned change expert. The project presented opportunities to promote infection prevention while implementing care improvement strategies and behaviour change in partnership with the breast team.

  18. Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer.

    Science.gov (United States)

    Mulhern, Kayln C; Wahl, Tyler S; Goss, Lauren E; Feng, Katey; Richman, Joshua S; Morris, Melanie S; Chen, Herbert; Chu, Daniel I

    2017-10-01

    Studies suggest Asian Americans may have improved oncologic outcomes compared with other ethnicities. We hypothesized that Asian Americans with colorectal cancer would have improved surgical outcomes in mortality, postoperative complications (POCs), length of stay (LOS), and readmissions compared with other racial/ethnic groups. We queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program for patients who underwent surgery for colorectal cancer and stratified patients by race. Primary outcome was 30-d mortality with secondary outcomes including POCs, LOS, and 30-d readmission. Stepwise backward logistic regression analyses and incident rate ratio calculations were performed to identify risk factors for disparate outcomes. Of the 28,283 patients undergoing colorectal surgery for malignancy, racial/ethnic groups were divided into Caucasian American (84%), African American (12%), or Asian American (4%). On unadjusted analyses, compared with other racial/ethnic groups, Asian Americans were more likely to have normal weight, not smoke, and had lower American Society of Anesthesiologists score of 1 or 2 (P Asian Americans had the shortest LOS and the lowest rates of complications due to ileus, respiratory, and renal complications (P Asian American race was independently associated with less postoperative ileus (odds ratio 0.8, 95% confidence interval 0.66-0.98, P American and Caucasian American patients, respectively (P Asian Americans undergoing surgery for colorectal cancer have shorter LOS and fewer POCs when compared with other racial/ethnic groups without differences in 30-d mortality or readmissions. The mechanism(s) underlying these disparities will require further study, but may be a result of patient, provider, and healthcare system differences. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Assessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome

    International Nuclear Information System (INIS)

    Spencer, J.A.; Ward, J.; Guthrie, J.A.; Robinson, P.J.A.; Guillou, P.J.

    1998-01-01

    The aim of our work was to investigate the use of a dynamic contrast-enhanced MR (DCEMR) technique for staging apparently localised pancreatic cancer, and to determine the patterns of tumour and vascular enhancement with this technique. Thirty-five consecutive patients were examined. The MR findings were correlated with surgical findings in 13 patients and with clinical outcome in 22 patients. Breath-hold gradient-echo fast low angle shot (TR = 100, TE = 4, flip angle 80 ) acquisitions were obtained at 10 and 40 s (right anterior coronal oblique plane) and at 90 s (axial plane) following intravenous gadolinium. Mean contrast-to-noise ratio was higher on the first than the second acquisition (p < 0.001) and higher on the second acquisition than the third (p < 0.005). Tumour conspicuity was greatest and arterial anatomy was best demonstrated on the first acquisition and the portal venous anatomy on the second. Small tumours were isointense by the third acquisition. Maximal intensity projections were helpful. The MR findings correctly predicted the surgical findings in 11 of 13 cases (85 %) and the clinical course in the other 22 patients. The DCEMR imaging technique is valuable in the staging of patients with pancreatic cancer. Capillary and portal venous phase images are both required for complete local staging. (orig.)

  20. Bilateral sacroiliac luxation fixation using a single transiliosacral pin: surgical technique and clinical outcomes in eight cats.

    Science.gov (United States)

    Parslow, A; Simpson, D J

    2017-06-01

    A very limited safe anatomical window for transiliosacral implant placement exists in cats (sacroiliac fixation in cats using a single implant to minimise inadvertent iatrogenic damage to local structures and restore pelvic canal diameter. Eight cats underwent surgical fixation for traumatic bilateral sacroiliac luxation using a single smooth intramedullary pin. The pin spanned both ilial wings and sacrum. Implants were applied using a Universal C-guide. Pre- and postsurgery pelvic canal diameter ratios were calculated. Short-term follow-up was performed at 10 to 14 days postoperatively. Long-term follow-up was performed using the Feline Musculoskeletal Pain Index Questionnaire. Long-term radiographic assessment was available in two cases. The technique achieved safe and accurate implant position with precise sacroiliac joint reduction. Pelvic canal diameter ratios were restored to normal in all cases. Rapid return to normal hind leg function and excellent long-term clinical outcomes were achieved. This technique offers a simple, safe, repeatable and affordable technique for treating bilateral sacroiliac luxations in the cat without the aid of fluoroscopy. The procedure can be performed using surgical tools and inventory readily available in general small animal practices. © 2017 British Small Animal Veterinary Association.

  1. Transanal endoscopic microsurgery as technique surgical for the treatment of the rectal adenocarcinoma: history, evolution and current tendency

    International Nuclear Information System (INIS)

    Vega Padilla, Luis Carlos

    2013-01-01

    The modalities of local and minimally invasive treatment were described for early rectal adenocarcinomas. The most adequate diagnostic studies and interdisciplinary interactions involved were considered in the process and the therapeutic results, in comparison with the current radical treatments. The historical evolution of the different surgical techniques developed over time, and the anatomical and physiological concepts were reviewed. The epidemiological behavior of the disease was documented according to gender, age and most prevalent sites to direct the possible risk groups to suffer the disease. Risk factors that affect patients with colorectal cancer were identified and related to the environment, social habits and hereditary. The different genetic syndromes involved in colorectal cancer, its physiopathology and clinical manifestations and implications were examined with respect to colorectal cancer. Colorectal cancer was defined according to the updated classifications of the American Joint Cancer Committee, according to the depth, affectation of lymph nodes and metastasis to distant organs, in relation to its clinical stage. Current surgical techniques were named to treat early adenocarcinomas of inferior rectus. The different risk factors were analyzed to allow local resections of the early rectal tumors, from the histopalogical, radiological and clinical point of view. The traditional techniques of transanal and radical resection were compared against the transanal endoscopic microsurgery between different aspects such as technical difficulty, recurrence rate, morbidity and mortality, and economic cost [es

  2. Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones.

    Science.gov (United States)

    Aydemir, Hüseyin; Budak, Salih; Kumsar, Şükrü; Köse, Osman; Sağlam, Hasan Salih; Adsan, Öztuğ

    2014-09-01

    In this study, we aimed to evaluate, the efficacy of surgical methods and the factors affecting the residual stone rate by scrutinizing retrospectively the patients who had undergone renal stone surgery. Records of 109 cases of kidney stones who had been surgically treated between January 2010, and July 2013 were reviewed. Patients were divided into three groups in terms of surgical treatment; open stone surgery, percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS). Patients' history, physical examination, biochemical and radiological images and operative and postoperative data were recorded. The patients had undergone PNL (n=74; 67.9%), RIRS (n=22;20.2%), and open renal surgery (n=13; 11.9%). The mean and median ages of the patients were 46±9, 41 (21-75) and, 42 (23-67) years, respectively. The mean stone burden was 2.6±0.7 cm(2) in the PNL, 1.4±0.1 cm(2) in the RIRS, and 3.1±0.9 cm(2) in the open surgery groups. The mean operative times were 126±24 min in the PNL group, 72±12 min in the RIRS group and 82±22 min in the open surgery group. The duration of hospitalisation was 3.1±0.2 days, 1.2±0.3 days and 3.4±1.1 days respectively. While the RIRS group did not need blood transfusion, in the PNL group blood transfusions were given in the PNL (n=18), and open surgery (n=2) groups. Residual stones were detected in the PNL (n=22), open surgery (n=2), and RIRS (n=5) groups. PNL and RIRS have been seen as safe and effective methods in our self application too. However, it should not be forgotten that as a basical method, open surgery may be needed in cases of necessity.

  3. Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique.

    Science.gov (United States)

    Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

    2014-10-01

    Surgical approach for persistent ductus arteriosus ligation is typically a left lateral thoracotomy opening the pleural-space with left lung retraction. We describe an alternative approach, with a minimally invasive anterior parasternal incision. This is particularly adapted to preterm infants weighing less than 1.5 kg. This approach ensures a good exposure of vessels. We believe that it is safe, reliable and reproducible. The learning curve should not be an issue for surgeons used to manage low weight patients. Georg Thieme Verlag KG Stuttgart · New York.

  4. Static antibiotic spacers augmented by calcium sulphate impregnated beads in revision TKA: Surgical technique and review of literature.

    Science.gov (United States)

    Risitano, Salvatore; Sabatini, Luigi; Atzori, Francesco; Massè, Alessandro; Indelli, Pier Francesco

    2018-06-01

    Periprosthetic joint infection (PJI) is a serious complication in total knee arthroplasty (TKA) and represents one of the most common causes of revision. The challenge for surgeons treating an infected TKA is to quickly obtain an infection-free joint in order to re-implant, when possible, a new TKA. Recent literature confirms the role of local antibiotic-loaded beads as a strong bactericidal, allowing higher antibiotic elution when compared with antibiotic loaded spacers only. Unfortunately, classical Polymethylmethacrylate (PMMA) beads might allow bacteria adhesion, secondary development of antibiotic resistance and eventually surgical removal once antibiotics have eluted. This article describes a novel surgical technique using static, custom-made antibiotic loaded spacers augmented by calcium sulphate antibiotic-impregnated beads to improve the success rate of revision TKA in a setting of PJI. The use of calcium sulphate beads has several potential benefits, including a longer sustained local antibiotic release when compared with classical PMMA beads and, being resorbable, not requiring accessory surgical interventions.

  5. “A Tree Must Be Bent While It Is Young”: Teaching Urological Surgical Techniques to Schoolchildren

    Science.gov (United States)

    Buntrock, Stefan

    2012-01-01

    Background Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as “doctor games 2.0” will doubtlessly begin to incorporate virtual laparoscopic techniques. Objectives To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. Materials and Methods As part of EAU Urology Week 2010, 108 school children aged 15–19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were “video games,” “children,” and “surgical skills.” Searches were performed without restriction for a certain period of time. Results In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Conclusions Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology. PMID:23573467

  6. In-hospital fellow coverage reduces communication errors in the surgical intensive care unit.

    Science.gov (United States)

    Williams, Mallory; Alban, Rodrigo F; Hardy, James P; Oxman, David A; Garcia, Edward R; Hevelone, Nathanael; Frendl, Gyorgy; Rogers, Selwyn O

    2014-06-01

    Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events. A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods. Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (Pcommunicated 89% of events during IHFC vs 51% of events during HC (PCommunication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, Pcommunicated 66% of events (94% IHFC vs 52% HC, PCommunication errors were lower in all ICUs during IHFC (Pcommunication errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Non-Surgical Periodontal Therapy Reduces Saliva Adipokine and Matrix Metalloproteinase Levels in Periodontitis.

    Science.gov (United States)

    Özcan, Erkan; Işıl Saygun, N; Serdar, Muhittin A; Umut Bengi, V; Kantarcı, Alpdoğan

    2016-08-01

    Adipokines enhance the synthesis of proinflammatory cytokines and matrix metalloproteinases (MMPs), which play a role in extracellular matrix degeneration. The aim of this study is to determine the levels of some adipokines, proinflammatory cytokines, and MMPs in the saliva of patients with periodontitis and healthy individuals and to evaluate the changes after non-surgical periodontal therapy (NSPT). Of 32 individuals included in the study, 17 had periodontitis and 15 had healthy gingiva. Saliva samples were obtained from all individuals. In patients with periodontitis, samples were recollected 3 and 6 months after NSPT. Visfatin, chemerin, progranulin, interleukin (IL)-1β, IL-8, MMP-8, and MMP-13 levels were measured using enzyme-linked immunosorbent assay. In patients with periodontitis, all of the parameters measured in the saliva were higher than those of healthy individuals. At 3 months, visfatin, progranulin, IL-8, and MMP-8 levels were significantly decreased compared with baseline values. The levels of other biochemical parameters, chemerin and IL-1β, were significantly decreased compared with baseline values at 6 months, and the levels became similar to those in healthy individuals. In the periodontitis group, positive correlations were found among visfatin and IL-8 (r = 0.909, P periodontal tissue in periodontitis by stimulating the expression of proinflammatory cytokines and MMPs.

  8. Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review.

    Science.gov (United States)

    Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A

    2017-10-01

    The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Luis Marchi

    2012-01-01

    Full Text Available Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3% stand-alone levels experienced cage subsidence. Pain (VAS and disability (ODI improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months.

  10. Repair of Total Tractional Retinal Detachment in Norrie Disease: Report of Technique and Successful Surgical Outcome.

    Science.gov (United States)

    Todorich, Bozho; Thanos, Aristomenis; Yonekawa, Yoshihiro; Capone, Antonio

    2017-03-01

    Norrie disease is a rare, but devastating cause of pediatric retinal detachment, universally portending a poor visual prognosis. This paper describes successful surgical management of an infant with total retinal detachment associated with Norrie disease mutation. The infant was a full-term white male who presented with bilateral total funnel retinal detachments (RDs). He underwent genetic testing, which demonstrated single-point mutation 133 G>A transition in exon 2 of the NDP gene. The retinal detachment was managed with translimbal iridectomy, lensectomy, capsulectomy, and vitrectomy. Careful dissection of the retrolental membranes resulted in opening of the funnel. Single-stage surgery in this child's eye achieved re-attachment of the posterior pole with progressive reabsorption of subretinal fluid and cholesterol without the need for external drainage. Fluorescein angiography, performed at 2 months postoperatively, demonstrated perfusion of major vascular arcades, but with significant abnormalities and aneurysmal changes of higher-order vessels, suggestive of retinal and vascular dysplasia. The child has maintained brisk light perception vision. Early surgical intervention with careful dissection of tractional tissues can potentially result in good anatomic outcomes in some patients with Norrie disease-associated retinal detachment. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:260-262.]. Copyright 2017, SLACK Incorporated.

  11. A Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade.

    Science.gov (United States)

    Davo-Cabrera, Juan Maria; Lanzagorta-Aresti, Aitor; Alcocer Yuste, Pablo

    2017-10-01

    The purpose of the study is to describe a novel technique to implant Ahmed valves in patients with refractory glaucoma because of silicone oil (SO) endotamponade PATIENTS:: Three patients with glaucoma without SO removal were used as an example for this technique. Technique report. We introduce a standard technique modification for Ahmed valves in patients with SO. This modification consists on locating the Ahmed valve more tangential to the limbus curvature instead of the usual perpendicular position and inserting the tube in the posterior chamber. The tube can be longer and run parallel to pupil. This technique allows use superotemporal quadrant (fewer complications), avoid corneal touch and decrease SO loss through the tube to subconjunctival space.

  12. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit.

    Science.gov (United States)

    Gietelink, Lieke; Wouters, Michel W J M; Tanis, Pieter J; Deken, Marion M; Ten Berge, Martijn G; Tollenaar, Rob A E M; van Krieken, J Han; de Noo, Mirre E

    2015-09-01

    The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness about CRM in the late 1990s, quality assurance on pathologic reporting was not available until the Dutch Surgical Colorectal Audit (DSCA) started in 2009. The present study describes the rates of CRM reporting and involvement since the start of the DSCA and analyzes whether improvement of these parameters can be attributed to the audit. Data from the DSCA (2009-2013) were analyzed. Reporting of CRM and CRM involvement was plotted for successive years, and variations of these parameters were analyzed in a funnelplot. Predictors of CRM involvement were determined in univariable analysis and the independent influence of year of registration on CRM involvement was analyzed in multivariable analysis. A total of 12,669 patients were included for analysis. The mean percentage of patients with a reported CRM increased from 52.7% to 94.2% (2009-2013) and interhospital variation decreased. The percentage of patients with CRM involvement decreased from 14.2% to 5.6%. In multivariable analysis, the year of DSCA registration remained a significant predictor of CRM involvement. After the introduction of the DSCA, a dramatic improvement in CRM reporting and a major decrease of CRM involvement after rectal cancer surgery have occurred. This study suggests that a national quality assurance program has been the driving force behind these achievements. Copyright © 2015 by the National Comprehensive Cancer Network.

  13. The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit.

    Science.gov (United States)

    Still, Mary D; Cross, Linda C; Dunlap, Martha; Rencher, Rugenia; Larkins, Elizabeth R; Carpenter, David L; Buchman, Timothy G; Coopersmith, Craig M

    2013-03-01

    Pressure ulcers cause significant morbidity and mortality in the surgical intensive care unit (SICU). The purpose of this study was to determine if a dedicated team tasked with turning and repositioning all hemodynamically stable SICU patients could decrease the formation of pressure ulcers. A total of 507 patients in a 20-bed SICU in a university hospital were assessed for pressure ulcers using a point prevalence strategy, between December 2008 and September 2010, before and after implementation of a team tasked with turning and repositioning all hemodynamically stable patients every 2 hours around the clock. At baseline, when frequent turning was encouraged but not required, a total of 42 pressure ulcers were identified in 278 patients. After implementation of the turn team, a total of 12 pressure ulcers were identified in 229 patients (p < 0.0001). The preintervention group included 34 stage I and II ulcers and 8 higher stage ulcers. After implementation of the turn team, there were 7 stage I and II ulcers and 5 higher stage ulcers. The average Braden score was 16.5 in the preintervention group and 13.4 in the postintervention group (p = 0.04), suggesting that pressure ulcers were occurring in higher risk patients after implementation of the turn team. A team dedicated to turning SICU patients every 2 hours dramatically decreased the incidence of pressure ulcers. The majority of stage I and stage II ulcers appear to be preventable with an aggressive intervention aimed at pressure ulcer prevention. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Treatment of complex internal carotid artery aneurysms using radial artery grafts. Surgical technique, perioperative complications, and results in 17 patients

    International Nuclear Information System (INIS)

    Murai, Yasuo; Teramoto, Akira; Mizunari, Takayuki; Kobayashi, Shiro; Kamiyama, Hiroyasu

    2007-01-01

    Complex giant or large internal carotid artery aneurysms present a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict the occurrence of ischemic complications after internal carotid artery ligation. The present study concerns surgical technique, complications, and clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions. Between September 1997 and October 2005, we performed radial artery grafting followed immediately by parent artery occlusion in 17 patients with giant or large complex intracranial carotid aneurysms (3 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative digital subtraction angiography to assess graft patency and aneurysm obliteration. All 17 aneurysms were excluded from the cerebral circulation, with all radial artery grafts patent. Among 4 patients with cranial nerve disturbances, dysfunction was temporary in 5; in the others, oculomotor nerve paresis persisted. No perioperative cerebral infarction occurred. Sensory aphasia reflecting cerebral contusions caused by temporal lobe retraction resolved within 2 months, as did hemiparesis from a postoperative epidural hematoma. With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Graft patency and aneurysm thrombosis were achieved in all patients. Cranial nerve dysfunction (III, VI) caused by altered blood flow from the internal carotid artery after occlusion was the most common complication and typically was temporary. In our experience with these difficult aneurysms, not only clipping but also reconstruction of the internal carotid artery was required, especially for wide-necked symptomatic

  15. A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications.

    Science.gov (United States)

    Vardi, Yoram; Har-Shai, Yaron; Harshai, Yaron; Gil, Tamir; Gruenwald, Ilan

    2008-11-01

    Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). The aim of this review is to describe the various reported techniques and to provide the available scientific data on the success and complication rates of penile enhancement procedures. We performed an extensive systematic review based on a search of the MEDLINE database for articles published between 1965 and 2008. The following key words were used: penis, enhancement, enlargement, phalloplasty, reconstruction, girth, lengthening, and augmentation. Only English-language articles that were related to penile surgery and dysmorphobia were sought. We excluded articles in which fewer than five cases were described and articles in which the type of surgical treatment and the outcome were not clear. Of the 176 papers found, 34 were selected and critically analyzed. We found only a small number of well-designed and comprehensive studies, and most of the published articles reported data that were obtained from small cohorts of patients. The more recently published studies presented better methodologies and descriptions of the surgical techniques than did the older publications. In general, penile enhancement surgery can cause a 1-2-cm increase in penile length and a 2.5-cm augmentation of penile girth. Unwanted outcomes and complications, namely penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction were reported frequently in these studies. Disappointing short- and long-term patient satisfaction rates following these procedures were also reported in most studies. To date, the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high

  16. Recurrent Tricuspid Insufficiency: Is the Surgical Repair Technique a Risk Factor?

    OpenAIRE

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair.

  17. A surgical technique for lengthening tight hamstring muscles in patients with low back pain.

    Science.gov (United States)

    Anglès, F G; Manubens, X B; Anglès, F C

    1997-01-01

    An original technique for lengthening primary tight semitendinosus and semimembranosus muscles in their proximal portion is presented. The authors consider that primary shortening of these muscles rebounds on hip biomechanics and on the spine kinematics chain.

  18. Clinical and Surgical Strategies for Avoiding or Reducing Allogeneic Blood Transfusions

    OpenAIRE

    dos Santos, Antonio Alceu; Baumgratz, Jose Francisco; Vila, Jose Henrique Andrade; Castro, Rodrigo Moreira; Bezerra, Rodrigo Freire

    2016-01-01

    Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was s...

  19. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series.

    Science.gov (United States)

    Ecker, J; Perera, N; Ebert, J

    2015-02-01

    Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques. © The Author(s) 2014.

  20. Surgical techniques for the treatment of carpal ligament injury in the athlete.

    Science.gov (United States)

    Paci, Gabrielle M; Yao, Jeffrey

    2015-01-01

    Treatment of intercarpal ligament injuries in the athlete requires special attention due to several practical and biomechanical considerations. Optimally, the athlete will maintain as much function and range of motion as possible with return to high-impact and load-bearing activity in a timely fashion. Several cutting-edge techniques have arisen in treatment. This article discusses injury patterns in the athlete with scapholunate injury, lunotriquetral injury, scaphotrapezial-trapezoidal injury, and extrinsic ligamentous injury, and the various approaches to addressing these injuries, with a review of the classic as well as newer, innovative techniques. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Reduced cerebral oxygen–carbohydrate index during endotracheal intubation in vascular surgical patients

    DEFF Research Database (Denmark)

    Fabricius-Bjerre, Andreas; Overgaard, Anders; Winther-Olesen, Marie

    2015-01-01

    Brain activation reduces balance between cerebral consumption of oxygen versus carbohydrate as expressed by the so-called cerebral oxygen-carbohydrate-index (OCI). We evaluated whether preparation for surgery, anaesthesia including tracheal intubation and surgery affect OCI. In patients undergoing...... aortic surgery, arterial to internal jugular venous (a-v) concentration differences for oxygen versus lactate and glucose were determined from before anaesthesia to when the patient left the recovery room. Intravenous anaesthesia was supplemented with thoracic epidural anaesthesia for open aortic surgery...

  2. The impact of reduced working hours on surgical training in Australia and New Zealand.

    Science.gov (United States)

    Gough, Ian R

    2011-01-01

    There is a worldwide trend for reduced working hours for doctors, particularly in the developed western countries. This has been led by the introduction of the European Working Time Directive (EWTD) that has had a significant impact on work patterns and training. Australia currently has a more flexible working environment but this is changing. In New Zealand there is a contract for resident doctors defining a maximum 72 h of rostered work per week. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. Two Techniques of Intestinal Wall Suture in Surgical Treatment of Ileus in Dogs and the Importance of Omentalisation

    Directory of Open Access Journals (Sweden)

    M. Crha

    2008-01-01

    Full Text Available Model experimental studies focused on the intestinal suture techniques in relation to healing, postoperative narrowing of the intestinal lumen or adhesion formation can not comprise a number of clinical factors (foreign body presence in the intestine, haematological abnormalities, septic peritonitis, different age of patients, etc. that under clinical practice conditions may have an effect on the healing of the intestinal suture. The aim of this clinical study was to confirm in a group of dogs surgically treated for small bowel obstruction, whether different techniques of its wall suture may affect the frequency of possible dehiscence occurrence. This study compares two different techniques of intestinal wall suture in relation to postoperative dehiscence of the intestinal wall closure. Based on the clinical observation with regard to the risk of postoperative dehiscence and possible complications in form of adhesions, also the importance of omentalisation in the suture of small bowel was evaluated. No significant difference was demonstrated (p > 0.05 in the frequency of postoperative dehiscence at the site of the intestinal wall closure between the two-layer inverting and singlelayer appositional techniques of suture. Likewise, no significant difference was demonstrated (p > 0.05 in the frequency of dehiscence of intestinal wall suture between patients that underwent intestinal suture omentalisation and those whose intestinal wall suture was not complemented with omentalisation. Based on the results of this clinical study it may be stated that both manual single-layer approximation technique and two-layer inverting technique of the intestinal wall suture are equally safe from the viewpoint of possible dehiscence, and it depends on the surgeon's preference, which one of the said techniques he or she chooses. Concurrently it may be assumed that an exactly performed suture of the intestinal wall does not necessarily require omentalisation.

  4. [A new technique for ensuring negative surgical margins during partial nephrectomy: the ex vivo ultrasound control].

    Science.gov (United States)

    Desmonts, A; Tillou, X; Le Gal, S; Secco, M; Orczyk, C; Bensadoun, H; Doerfler, A

    2013-10-01

    To evaluate the feasibility and the efficiency of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by urologist. Patients undergoing partial nephrectomy from July 2010 to November 2012 for T1-T2 renal tumors were included in analysis. Tumor margin status was immediately determined by ex vivo ultrasound done by the surgeon himself. Results were compared with margin status on definitive pathological evaluation. A total of 26 men and 15 women with a median age of 61 (30-82) years old were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 38 cases and positive margins in two. Final pathological results revealed negative margins in all except one case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Mean ultrasound duration was 1minute±1. Mean tumor and margin sizes were 3.4±1.8cm and 2.38±1.76mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by a urologist seemed to be feasible, efficient and easy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. [Pay attention to the standardized application of new techniques in surgical treatment of thyroid disease].

    Science.gov (United States)

    Tian, W; Xi, H Q; Wang, B

    2017-08-01

    The continuous development and application of new technology in thyroid surgery has promoted the rapid improvement of thyroid surgery. New technology in the field of thyroid surgery has developed rapidly. The application of neural monitoring technology has enabled the thyroid surgery to enter an accurate era. Imtraoperative neuromonitoring and continuous intraoperative neuromonitoring have made the recurrent laryngeal nerve protection more secure. Nano-carbon parathyroid gland negative imaging technology could identify parathyroid gland more precise. However, when the nano-carbon was used, the injection time, position and dosage should be grasped so as to achieve the best effect of negative imaging. Endoscopic and robotic thyroid surgery could meet the demand of cosmetic. "Treatment first, beauty second" is still the principle to be strictly followed. Do not blindly expand indications and pursue endoscopic surgery. Energy surgical instruments' update made the operation more efficient, while the instruments have some disadvantages. Thyroid surgeon must correctly understand the working principle of new energy devices and use them rationally. Through grasping the working principle and application skills of new technology in clinical work, definiting its advantages and disadvantages, adhereing to the "reasonable choice, standard application" principle, learning the pioneers' experience, the application of new thyroid diagnosis and treatment technology could be more reasonable and safe.

  6. Numerical Methods Are Feasible for Assessing Surgical Techniques: Application to Astigmatic Keratotomy

    Energy Technology Data Exchange (ETDEWEB)

    Ariza-Gracia, M.A.; Ortilles, A.; Cristobal, J.A.; Rodriguez, J.F.; Calvo, B.

    2016-07-01

    The present study proposes an experimental-numerical protocol whose novelty relies on using both the inflation and the indentation experiments simultaneously to obtain a set of material parameters which accounts for both deformation modes of the cornea: the physiological (biaxial tension) and the non-physiological (bending). The experimental protocol characterizes the corneal geometry and the mechanical response of the cornea when subjected to the experimental tests using an animal model (New Zealand rabbit's cornea). The numerical protocol reproduces the experimental tests by means of an inverse finite element methodology to obtain the set of material properties that minimizes both mechanical responses at the same time. To validate the methodology, an Astigmatic Keratotomy refractive surgery is performed on 4 New Zealand rabbit corneas. The pre and post-surgical topographies of the anterior corneal surface were measured using a MODI topographer (CSO, Italy) to control the total change in astigmatism. Afterwards, the surgery is numerically reproduced to predict the overall change of the cornea. Results showed an acceptable numerical prediction, close to the average experimental correction, validating the material parameters obtained with the proposed protocol. (Author)

  7. Journal of Surgical Technique and Case Report - Vol 5, No 1 (2013)

    African Journals Online (AJOL)

    A Simple Technique for Adjustment of the Femoral Offset at the Site of Hip Spacer Implantation · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. K Anagnostakos, O Lorbach, P Orth, K Koch, 18-20. http://dx.doi.org/10.4103/2006-8808.118605 ...

  8. Surgical Management of Large Periorbital Cutaneous Defects: Aesthetic Considerations and Technique Refinements.

    Science.gov (United States)

    Zou, Yun; Hu, Li; Tremp, Mathias; Jin, Yunbo; Chen, Hui; Ma, Gang; Lin, Xiaoxi

    2018-02-23

    The aim of this study was to repair large periorbital cutaneous defects by an innovative technique called PEPSI (periorbital elevation and positioning with secret incisions) technique with functional and aesthetic outcomes. In this retrospective study, unilateral periorbital cutaneous defects in 15 patients were repaired by the PEPSI technique. The ages of patients ranged from 3 to 46 years (average, 19 years). The outcome evaluations included scars (Vancouver Scar Scale and visual analog scale score), function and aesthetic appearance of eyelids, and patient satisfaction. The repair size was measured by the maximum advancement distance of skin flap during operation. All patients achieved an effective repair with a mean follow-up of 18.3 months. Except one with a small (approximately 0.3 cm) necrosis, all patients healed with no complication. The mean Vancouver Scar Scale and visual analog scale scores were 2.1 ± 1.7 and 8.5 ± 1.2, respectively. Ideal cosmetic and functional outcomes were achieved in 14 patients (93.3%). All patients achieved complete satisfaction except 1 patient with partial satisfaction. The mean maximum advancement distance of skin flap was 20.2 mm (range, 8-50 mm). This study demonstrated that the PEPSI technique is an effective method to repair large periorbital cutaneous defects with acceptable functional and aesthetic outcomes.

  9. Biological limits of the undersized surgical technique: a study in goats

    NARCIS (Netherlands)

    Tabassum, A.; Meijer, G.J.; Walboomers, X.F.; Jansen, J.A.

    2011-01-01

    OBJECTIVE: The purpose of the present study was to investigate the influence of different implant placement techniques on the early bone healing response in an animal model. MATERIAL AND METHODS: In the present study, 24 cylindrical-screw-type implants with a diameter of 4.2 mm (Dyna(R)) were

  10. Comparative evaluation of gingival depigmentation by tetrafluroethane cryosurgery and surgical scalpel technique. A randomized clinical study

    Directory of Open Access Journals (Sweden)

    Suraj D Narayankar

    2017-01-01

    Full Text Available Introduction: Importance of good smile cannot be underestimated in enhancement of beauty, self-confidence and personality of a person. Health and appearance of gingiva is an essential part of attractive smile. Gingival pigmentation gives rise to unesthetic smile line. In present world, with increasing awareness to esthetic, people have become highly concerned about black gums. Various treatment modalities like abrasion, scrapping, scalpel technique, cryosurgery, electrosurgery and laser are available for treatment of gingival pigmentation. The present study was conducted with an objective of comparing efficacy of gingival depigmentation by cryosurgery and scalpel technique. Method: A Randomized control split mouth study was conducted for 25 patients with gingival pigmentation. Gingival pigmentation Index (GPI for pigmentation and Visual Analoug Scale (VAS for pain was evaluated for both test (Cryosurgery and control sites (Scalpel technique at baseline, 1month, 3months and 6 months. Results: GPI score was 3 and 2 for 21/25 and 4/25 control sites and was 22/25 and 3/25 test sites respectively at baseline. Both the groups showed significant reduction in GPI score i.e., 0 at 1 and 3 months interval after treatment. GPI score increased to 1 for 5/25 sites treated with scalpel technique and 2/25 sites treated with cryosurgery at 6 months interval (P=0.0691. This indicates recurrence rate for pigmentation is higher after scalpel treatment. VAS Score was 3 for 10/25 sites treated with scalpel and was 2 for 12/25 sites treated with cryosurgery (P<0.001. Conclusion: It can be concluded that cryosurgery can be effectively and efficiently used for depigmentation by keeping patients acceptance and comfort in mind and also the long term results and ease of use when compared to scalpel technique.

  11. A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery.

    Science.gov (United States)

    Hayashi, Ken; Ogawa, Soichiro; Manabe, Shin-Ichi; Hirata, Akira; Yoshimura, Koichi

    2016-03-01

    The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.

  12. A modified technique for craniospinal irradiation in children designed to reduce acute and late radiation toxicity

    International Nuclear Information System (INIS)

    Phillips, Claire; Sexton, Maree

    2004-01-01

    Craniospinal irradiation is an important technique for the treatment of a number of paediatric malignancies. The conventional technique uses photons for all fields and does not exploit the benefits of CT and computer planning systems. The present paper describes a modification of the conventional technique in which both photons and electrons are used for the spinal field (mixed-beam technique). Computed tomography images and a planning computer are used for the selection of field junctions, electron beam energy and dosimetry. The intention of the technique is to reduce radiotherapy toxicity. A discussion of the potential benefits is presented Copyright (2004) Blackwell Publishing Asia Pty Ltd

  13. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D; Schwarzenberg, Sarah J; Radosevich, David M; Cook, Marie; Dunn, Ty B; Beilman, Gregory J; Freeman, Martin L; Balamurugan, A N; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J; Vickers, Selwyn M; Pruett, Timothy L; Sutherland, David E R

    2014-07-01

    Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients. Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes. Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001). Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.

  14. Esthetic judgments of palatally displaced canines 3 months postdebond after surgical exposure with either a closed or an open technique.

    Science.gov (United States)

    Parkin, Nicola A; Freeman, Jennifer V; Deery, Chris; Benson, Philip E

    2015-02-01

    The aim of this study was to compare the esthetic judgments of orthodontists and laypeople regarding the appearance of palatally displaced canines 3 months after treatment with either a closed or an open surgical exposure and orthodontic alignment. A multicenter randomized controlled trial was undertaken in 3 hospitals in the United Kingdom. Patients with unilateral palatally displaced canines were randomly allocated to receive either a closed or an open surgical exposure. The teeth were aligned with fixed appliances, and 3 months after debond, intraoral photographs were taken. The photographs were projected in random order to 2 panels of judges (orthodontists and laypeople), who completed a questionnaire. The images of 67 participants (closed, 33; open, 34) were included. The laypeople were able to identify the operated tooth only 49.7% of the time (95% CI, 45.3%-54.0%); this was no better than chance (P = 0.880). The orthodontists were more successful but still identified the treated canine with certainty only 60.7% of the time (95% CI, 53.7%-67.8%; P = 0.003). Both panels more frequently assessed the unoperated canine to have a better appearance than the contralateral operated canine; however, there were no differences between the closed and open groups (proportion preferring unoperated canine-laypeople: closed, 58.7%; open, 57.0%; P = 0.43; and orthodontists: closed, 60.9%; open, 60.6%; P = 0.27). There is an esthetic impact to aligning a palatally displaced canine, but it is mostly minor and unlikely to be detectable by laypeople. The esthetic impact was the same, whether the canine was exposed with a closed or an open surgical technique. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  15. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M

    2016-09-01

    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  16. MULTIPLE IMAGING TECHNIQUES DEMONSTRATE THE MANIPULATION OF SURFACES TO REDUCE BACTERIAL CONTAMINATION

    Science.gov (United States)

    Surface imaging techniques were combined to determine appropriate manipulation of technologically important surfaces for commercial applications. Stainless steel surfaces were engineered to reduce bacterial contamination, biofilm formation, and corrosion during product processing...

  17. Acetabular osteotomy for double boarding in lateral decubitus. Anatomical bases and surgical technique

    International Nuclear Information System (INIS)

    Lazennec, J Y; Del Vecchio, R; Saillant, G

    2001-01-01

    The periacetabular osteotomies of reorientation of the eotilo have a reputation of being difficult from the technical point of view. The authors present a technique of juxta acetabular osteotomy that respects the posterior column of the acetabulo the same as the GANZ technique. The osteotomy is of simpler realization thanks to an installation that allows carrying out two simultaneous boarding. The osteotomy lines, their rectilinear and controllable in permanency through of images intensificator and they don't constitute any risk for the essential vascular contribution of the obturatriz artery and their branches. Their other interest comes represented by the possibility of correcting easily the parasitic retroversion associated to the descent of the whole eotilo, that it allows to avoid the bad positions that they affect the center of the articulation and the widths acetabular

  18. Surgical technique for permanent intracoelomic radiotransmitter placement in Anegada iguanas (Cyclura pinguis).

    Science.gov (United States)

    Ferrell, Shannon T; Marlar, Annajane B; Alberts, Allison C; Young, Lee A; Bradley, Kelly; Hurlbut, Sandra L; Lung, Nancy P

    2005-12-01

    Twenty-four juvenile to subadult Anegada iguanas (Cyclura pinguis), captive-reared in a propagation facility, were designated by a coordinated recovery program for release in the summer of 2003. To facilitate postrelease monitoring, a radiotransmitter device was placed within the coelomic cavity of each animal under general anesthesia before release. The equipment sterilization technique and the method of attachment of the transmitters to the coelomic body wall resulted in functional transmitters and acceptably low rates of mortality associated with the procedure.

  19. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    Science.gov (United States)

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  20. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  1. Unstable elbow dislocations: the description and cadaveric feasibility study of a new surgical technique

    Directory of Open Access Journals (Sweden)

    Harris Mark

    2015-01-01

    Full Text Available Introduction: A small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. In this rare situation operative treatment is indicated. We describe a new intra articular reconstruction that utilises a slip of triceps tendon to provide immediate stability to the elbow. Methods: We assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. We then sequentially sectioned the ligamentous stabilisers of an elbow before performing the new technique. We measured the displacement and angulation possible at the elbow before and after the reconstruction. Results: All 20 elbows had sufficient triceps tendon length to complete the new technique. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Following the reconstruction it was not possible to re-dislocate the elbow. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position. Discussion: This novel technique elegantly avoids many of the problems associated with current methods. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs.

  2. Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

    Directory of Open Access Journals (Sweden)

    Elias Jarade

    2017-04-01

    Full Text Available Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.

  3. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients.

    Science.gov (United States)

    Al-Niaimi, Ahmed N; Ahmed, Mostafa; Burish, Nikki; Chackmakchy, Saygin A; Seo, Songwon; Rose, Stephen; Hartenbach, Ellen; Kushner, David M; Safdar, Nasia; Rice, Laurel; Connor, Joseph

    2015-01-01

    SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol. Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics. Copyright © 2014. Published by Elsevier Inc.

  4. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas

    2012-01-01

    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  5. Radiation brain dose to vascular surgeons during fluoroscopically guided interventions is not effectively reduced by wearing lead equivalent surgical caps.

    Science.gov (United States)

    Kirkwood, Melissa L; Arbique, Gary M; Guild, Jeffrey B; Zeng, Katie; Xi, Yin; Rectenwald, John; Anderson, Jon A; Timaran, Carlos

    2018-03-12

    Radiation to the interventionalist's brain during fluoroscopically guided interventions (FGIs) may increase the incidence of cerebral neoplasms. Lead equivalent surgical caps claim to reduce radiation brain doses by 50% to 95%. We sought to determine the efficacy of the RADPAD (Worldwide Innovations & Technologies, Lenexa, Kan) No Brainer surgical cap (0.06 mm lead equivalent at 90 kVp) in reducing radiation dose to the surgeon's and trainee's head during FGIs and to a phantom to determine relative brain dose reductions. Optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, Ill) inside and outside of the cap at the left temporal position were used to measure cap attenuation during FGIs. To check relative brain doses, nanoDot detectors were placed in 15 positions within an anthropomorphic head phantom (ATOM model 701; CIRS, Norfolk, Va). The phantom was positioned to represent a primary operator performing femoral access. Fluorography was performed on a plastic scatter phantom at 80 kVp for an exposure of 5 Gy reference air kerma with or without the hat. For each brain location, the percentage dose reduction with the hat was calculated. Means and standard errors were calculated using a pooled linear mixed model with repeated measurements. Anatomically similar locations were combined into five groups: upper brain, upper skull, midbrain, eyes, and left temporal position. This was a prospective, single-center study that included 29 endovascular aortic aneurysm procedures. The average procedure reference air kerma was 2.6 Gy. The hat attenuation at the temporal position for the attending physician and fellow was 60% ± 20% and 33% ± 36%, respectively. The equivalent phantom measurements demonstrated an attenuation of 71% ± 2.0% (P < .0001). In the interior phantom locations, attenuation was statistically significant for the skull (6% ± 1.4%) and upper brain (7.2% ± 1.0%; P < .0001) but not for the middle brain (1.4% ± 1.0%; P = .15

  6. The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Burhan Özalp

    2018-06-01

    Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

  7. Current surgical treatment option, utilizing robot-assisted laparoscopic surgery in obese women with endometrial cancer: Farghalys technique

    International Nuclear Information System (INIS)

    Farghaly, S.A.

    2013-01-01

    Background: Endometrial cancer is the most prevalent cancer of the female genital tract in North America. Minimally invasive laparoscopic-assisted surgery and panniculectomy in obese women with endometrial cancer are associated with an improved lymph node count, and lower rate of incisional complications than laparotomy. Methods: Technique for robot-assisted laparoscopic surgery for obese women with endometrial cancer is detailed. Results: Robot-assisted laparoscopic surgical staging, pelvic and para-aortic lymphadenectomy and panniculectomy allow us to avoid the use of postoperative pelvic radiation which is recommended in women with histopathology high-risk findings: deep myometrial invasion or high grade histology. The procedure has the advantage of three-dimensional vision, ergonomic, intuitive control, and wristed instrument that approximate the motion of the human hand. Conclusion: Robot-assisted laparoscopic surgical staging, and panniculectomy in these patients are a safe, and effective alternative to laparoscopic, and laparotomy surgery. It is an ideal tool for performing the complex oncologic procedures encountered in endometrial cancer staging that requires delicate retroperitoneal, pelvic and para-aortic lymph node dissection, while maintaining the principles of oncologic surgery but in a minimally invasive fashion.

  8. Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer (CLBC)

    International Nuclear Information System (INIS)

    Moustafa, A.; Fakhr, I.

    2014-01-01

    Background: Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance between good cosmetic outcome and limited risk of locoregional recurrence, by enabling proper resection margins. Aim of study: To present multiple techniques of partial breast reconstruction following the resection of centrally located breast cancer (CLBC) resection. Patients and methods: From January 2011 to August 2014, 21 patients underwent central quadrantectomy for carcinoma of the central region of the breast. Excisions included the nipple/areola complex, in most of the cases, down to the pectoralis fascia with a wide safety margin, and proper axillary management. Oncoplastic approaches included latissimus dorsi flap, inferior pedicle flap, Melon slice, Grisotti and round block techniques. Results: Mean age of patients was 49.5 ± 10.61 years. Tumor size ranged from 1.5 to 4.5 cm. Postoperative pathology revealed a tumor mean safety margin of 2.5± 0.83 cm, with positive axillary lymph nodes in 15 (75.0%) patients. Nineteen (95.0%) patients received postoperative breast radiotherapy, while 9/20 (45.0%) and 3/20 (15.0%) received adjuvant chemotherapy or hormonal therapy, respectively, and only 8/20 (40.0%) patients received both therapies. During a median follow- up period of 14.89 months, neither local nor distant metastasis, were detected. The postoperative cosmetic result evaluated by the patients was excellent in 6/20 patients (30.0%), good in 11/20 patients (55.0%), fair in 3/20 (15.0%) with neither poor nor bad results, with an overall mean of 4.0 ± 0.5 equivalent to 80% satisfaction. Conclusion: Multiple oncoplastic breast surgery techniques can be used for the resection of CLBC with satisfying cosmetic outcomes.

  9. Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis.

    Science.gov (United States)

    DiBartola, Alex C; Everhart, Joshua S; Magnussen, Robert A; Carey, James L; Brophy, Robert H; Schmitt, Laura C; Flanigan, David C

    2016-06-01

    Compare histological outcomes after microfracture (MF), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS). Literature review using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library. Inclusion criteria limited to English language studies International Cartilage Repair Society (ICRS) grading criteria for cartilage analysis after ACI (autologous chondrocyte implantation), MF (microfracture), or OATS (osteochondral autografting) repair techniques. Thirty-three studies investigating 1511 patients were identified. Thirty evaluated ACI or one of its subtypes, six evaluated MF, and seven evaluated OATS. There was no evidence of publication bias (Begg's p=0.48). No statistically significant correlation was found between percent change in clinical outcome and percent biopsies showing ICRS Excellent scores (R(2)=0.05, p=0.38). Percent change in clinical outcome and percent of biopsies showing only hyaline cartilage were significantly associated (R(2)=0.24, p=0.024). Mean lesion size and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Most common lesion location and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Microfracture has poorer histologic outcomes than other cartilage repair techniques. OATS repairs primarily are comprised of hyaline cartilage, followed closely by cell-based techniques, but no significant difference was found cartilage quality using ICRS grading criteria among OATS, ACI-C, MACI, and ACI-P. IV, meta-analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. [TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between techniques].

    Science.gov (United States)

    Torres Zambrano, G; Lujan Galán, M; Martín García, C; García Tello, A; Rodríguez García, N; Berenguer Sánchez, A

    2008-10-01

    Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering "cured" the patient with complete continence and "failure" any type of involuntary stress urine leak, independently of its severity registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated. 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% CI 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.6-21.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%, p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%, p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p = 0.005). Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT.

  11. The results of surgical treatment of oviductal infertility with use of microsurgical technique

    International Nuclear Information System (INIS)

    Cislo, M.; Murawski, M.; Palczynski, B.

    1993-01-01

    40 women were operated on infertility due to oviductal factor. This kind of infertility has been previously diagnosed by hysterosalpingography examination and then verified in 22 cases (55%) by laparoscopy combined with chromotubation. The operations were carried out with use of microsurgical technique and instruments. At the same time the prophylactics of postoperative intraperitoneal adhesions was applied. Seven pregnancies were obtained, that makes 17.5% of success. It is an outcome comparable with results presented by many other world centers of gynecological microsurgery. (author)

  12. Lateral high abdominal ovariopexy: an original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin's disease

    International Nuclear Information System (INIS)

    Gaetini, A.; De Simone, M.; Urgesi, A.; Levis, A.; Resegotti, A.; Ragona, R.; Anglesio, S.

    1988-01-01

    An original surgical method for gonadal protection in young women given pelvic radiation for Hodgkin's disease is presented. Lateral high ovarian transposition (LHAO) consists of the transposition of the ovaries into the paracolic gutter during staging laparotomy, after disconnecting the gonads from the fallopian tubes by dividing the tubo-ovarian vessels. The technique's effectiveness was assessed by a study using clinical investigation, radioimmunoassay (RIA) determination of sex hormones, and dosimetry; of 18 patients treated, 10 participated in the study. All but one have normal menses and hormone values, and one pregnancy occurred. We also calculated the doses absorbed by the ovaries and proved that, during inverted Y irradiation following LHAO, the ovaries are exposed to nearly one-half the dose they receive after traditional medial transposition. During subtotal nodal irradiation after LHAO, the irradiation dose is higher than after medialisation, but absolute values are minimal and castration is not induced

  13. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Science.gov (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H

    2016-04-01

    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  14. Surgical management of first branchial cleft anomaly presenting as infected retroauricular mass using a microscopic dissection technique.

    Science.gov (United States)

    Chan, Kai-Chieh; Chao, Wei-Chieh; Wu, Che-Ming

    2012-01-01

    This is a detailed description of the clinical and anatomical presentation of the first branchial cleft anomaly presenting as retroauricular infected mass. Our experience with a microscopic dissection with control of the sinus lumen from within the cyst is also described. Between 2001 and 2008, patients with the final histologic diagnosis of first branchial cleft anomaly in the retroauricular area were managed with a microscopic dissection technique with control of the sinus lumen from within the cyst. Classifications were done in accordance with Work, Olsen, and Chilla. Outcomes measured intervention as a function of disease recurrence and complications including facial nerve function was used. Eight patients with a mean age of 14.2 years were enrolled, and this included 4 females and 4 males. Four type 1 and 4 type 2 lesions as per the Work's and Chilla's classification were found, and there were 5 sinuses, 2 fistulae, and 1 cyst according to Olsen's classification. All patients presented to the department with acute infection at the time of diagnosis. Five of the 8 patients had previous surgical treatment, 2 of those had up to 3 previous operations. None of the patients were complicated by disease recurrence or had surgical related complications (facial nerve paresis or paralysis, infection, canal stenosis) requiring reoperation with more than 1 year of follow-up. First branchial cleft anomaly presenting as retroauricular infected mass can be effectively treated by adopting a microscopic dissection technique with control of the sinus lumen from within the cyst. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Lorusso, Domenica; Chiappa, Valentina; Donfrancesco, Cristina; Di Donato, Violante; Indini, Alice; Aletti, Giovanni; Raspagliesi, Francesco

    2016-02-01

    Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05-2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09-2.31) were similar after the execution of DPS and DFTR. Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.

  16. AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study

    Directory of Open Access Journals (Sweden)

    Feng-Chih Kuo

    2017-01-01

    Full Text Available The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI after minimally invasive total knee arthroplasty (MIS-TKA is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group or a standard dressing (control group after MIS-TKA. The primary outcome was wound complication (SSI and blister. The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use. In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00–2.48 in the study group compared to 8.3% (95% CI∶ 3.32–13.3 in the control group (p=0.01. There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01–0.58, p=0.01. The study group had longer wear time (5.2±0.7 versus 1.7±0.4 days, p<0.0001 and lower number of dressing changes (1.0±0.2 versus 3.6±1.3 times, p<0.0001. Increased patient satisfaction (p<0.0001 was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.

  17. Fixation of revision implants is improved by new surgical technique to crack the sclerotic endosteal rim.

    Science.gov (United States)

    Kold, S; Soballe, K; Mouzin, O; Chen, Xiangmei; Toft, M; Bechtold, J

    2002-01-01

    We used an experimental model producing a tissue response with a sclerotic endosteal neo-cortical rim associated with implant loosening in humans: a 6 mm PMMA cylinder pistoned 500 m concentrically in a 7.5 mm hole, with polyethylene particles. At a second operation at eight weeks, the standard revision procedure removed the fibrous membrane in one knee, and the crack revision procedure was used to crack the sclerotic endosteal rim in the contralateral knee. Once stability was achieved following the revision procedures, loaded Ti plasma sprayed implants were inserted into the revision cavities of 8 dogs for an additional 4 weeks. Revision implant fixation (ultimate shear strength and energy absorption) was significantly enhanced by cracking the sclerotic endosteal rim. In conclusion, we demonstrated a simple technique of cracking the sclerotic endosteal rim as an additional method for improving revision fixation. (Hip International 2002; 2: 77-9).

  18. Advances in surgical techniques in non-small cell lung cancer.

    Science.gov (United States)

    Kim, Anthony W; Detterbeck, Frank C

    2013-12-01

    Thoracic surgery is a dynamic field, and many scientific, technological, technical, and organizational changes are occurring. A prominent example is the use of less invasive approaches to major resection of non-small cell lung cancer (NSCLC), both thoracoscopic and robotic. Sophisticated technology corroborated by clinical data has led to these approaches becoming accepted additions to the armamentarium. Additionally, improvements in perioperative pain management have also contributed to dramatically changing the experience of patients who undergo modern thoracic surgery. Lung cancer is being detected more often at an early stage. At the same time, advances in techniques, patient care, clinical science, and multidisciplinary treatment support an increased role for aggressive resection in the face of larger locally advanced tumors or for those with limited metastatic disease. These advances, conducted in the setting of multidisciplinary decision making, have resulted in real and palpable advancements for patients with lung cancer. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. Transplantation of infant kidneys - the surgical technique en bloc and transplant position variation: A case report

    Directory of Open Access Journals (Sweden)

    Popović Vladan

    2015-01-01

    Full Text Available Introduction. Due to the ever-present lack of kidney transplant grafts, more and more organs obtained from the so-called “marginal donors” group are accepted, which can provide suboptimal effect of transplantation, depending on their characteristics and/or implantation techniques. Case report. We presented a case with successful variation of kidney position with modified approach of kidney transplantation from an infant to an adult female patient with normal postoperative recovery. Urethral anastomosis was performed without antireflux procedure and this has not led to the development of reflux disease at an early stage. Conclusion. The position of a pair of kidneys proved to be satisfactory despite the growth of the kidney to the expected size and relatively small pelvis. There were no problems with venous stasis and kidney function from the very beginning was good.

  20. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry.

    Science.gov (United States)

    Ebraheim, Nabil A; Ludwig, Todd; Weston, John T; Carroll, Trevor; Liu, Jiayong

    2014-05-01

    Evaluation of operative techniques used for medial malleolar fractures by classifying fracture geometry has not been well documented. One hundred eleven patients with medial malleolar fractures (transverse n = 63, oblique n = 29, vertical n = 7, comminuted n = 12) were included in this study. Seventy-two patients had complicating comorbidities. All patients were treated with buttress plate, lag screw, tension band, or K-wire fixation. Treatment outcomes were evaluated on the basis of radiological outcome (union, malunion, delayed union, or nonunion), need for operative revision, presence of postoperative complications, and AOFAS Ankle-Hindfoot score. For transverse fractures, tension band fixation showed the highest rate of union (79%), highest average AOFAS score (86), lowest revision rate (5%), and lowest complication rate (16%). For oblique fractures, lag screws showed the highest rate of union (71%), highest average AOFAS score (80), lowest revision rate (19%), and lowest complication rate (33%) of the commonly used fixation techniques. For vertical fractures, buttress plating was used in every case but 1, achieving union (whether normal or delayed) in all cases with an average AOFAS score of 84, no revisions, and a 17% complication rate. Comminuted fractures had relatively poor outcomes regardless of fixation method. The results of this study suggest that both tension bands and lag screws result in similar rates of union for transverse fractures of the medial malleolus, but that tension band constructs are associated with less need for revision surgery and fewer complications. In addition, our data demonstrate that oblique fractures were most effectively treated with lag screws and that vertical fractures attained superior outcomes with buttress plating. Level III, retrospective comparative series.

  1. Advances in the Surgical Management of Articular Cartilage Defects: Autologous Chondrocyte Implantation Techniques in the Pipeline.

    Science.gov (United States)

    Stein, Spencer; Strauss, Eric; Bosco, Joseph

    2013-01-01

    The purpose of this review is to gain insight into the latest methods of articular cartilage implantation (ACI) and to detail where they are in the Food and Drug Administration approval and regulatory process. A PubMed search was performed using the phrase "Autologous Chondrocyte Implantation" alone and with the words second generation and third generation. Additionally, clinicaltrials.gov was searched for the names of the seven specific procedures and the parent company websites were referenced. Two-Stage Techniques: BioCart II uses a FGF2v1 culture and a fibrinogen, thrombin matrix, whereas Hyalograft-C uses a Hyaff 11 matrix. MACI uses a collagen I/III matrix. Cartipatch consists of an agarose-alginate hydrogel. Neocart uses a high-pressure bioreactor for culturing with a type I collagen matrix. ChondroCelect makes use of a gene expression analysis to predict chondrocyte proliferation and has demonstrated significant clinical improvement, but failed to show superiority to microfracture in a phase III trial. One Step Technique: CAIS is an ACI procedure where harvested cartilage is minced and implanted into a matrix for defect filling. As full thickness defects in articular cartilage continue to pose a challenge to treat, new methods of repair are being researched. Later generation ACI has been developed to address the prevalence of fibrocartilage with microfracture and the complications associated with the periosteal flap of first generation ACI such as periosteal hypertrophy. The procedures and products reviewed here represent advances in tissue engineering, scaffolds and autologous chondrocyte culturing that may hold promise in our quest to alter the natural history of symptomatic chondral disease.

  2. Real-time Continuous Esophageal High-resolution Manometry (HRM) During Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Achalasia. A Promising Novelty in Regards of Perfecting Surgical Technique: Could It Guide Surgical Technique Toward Excellent Results?

    Science.gov (United States)

    Triantafyllou, Tania; Doulami, Georgia; Papailiou, Joanna; Mantides, Apostolos; Zografos, Georgios; Theodorou, Dimitrios

    2016-12-01

    High-resolution manometry (HRM) is the gold-standard diagnostic tool for achalasia of the esophagus. Laparoscopic Heller-Dor technique is the preferred surgical approach with success rate estimated 90%. The use of intraoperative HRM provides real-time estimation of intraluminal esophageal pressures and identifies the exact points of esophageal luminal pressure during laparoscopy. Ten patients with achalasia underwent surgery. All patients preoperatively completed 1 manometric study and Quality of Life questionnaires (EORTC QLQ-C30 version 3.0) with Eckardt scores. We collected intraoperative manometry data and repeated manometric studies, EORTC QLQ-C30, and Eckardt scores postoperatively. Median Eckardt score was decreased from 7.5 to 0.5, mean resting pressure decreased from 51.4 to 11.9 mm Hg, whereas mean residual pressure diminished from 45.9 to 9.5 mm Hg postoperatively. The simultaneous use of HRM during the Heller-Dor technique may lead to an individualized management of the disease.

  3. Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

    Directory of Open Access Journals (Sweden)

    Guilherme de Almeida Santos

    2012-09-01

    Full Text Available The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases, Ferguson (341 cases and mixed (310 cases in 11,043 patients with hemorrhoidal disease (HD allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8% than men (46.2%, and more accepted by women (26.5% than men (24.8%. Hemorrhoidectomy was more common in patients of the fourth (27.7%, fifth (21.9% and third (21.0% decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%, eighth (35.9% and ninth (34.5% decades of age. The overall incidence of surgical complications was 3.0% (87 cases: anal stenosis (1.8%, bleeding (0.8%, worsening of anal hypotonia (0.2%, sepsis (0.1% and systemic complications (0.1%, with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0% - stenosis (1.9%, bleeding (1.9%, worsening of anal hypotonia (0.2% and systemic complications (0.04%. The incidence of surgical complications by Ferguson's technique was 3.5% - stenosis (1.7%, bleeding (0.6%, worsening of anal hypotonia (0.6% and sepsis (0.6%. And the incidence of surgical complications by mixed techniques was 2.5% - stenosis (1.0%, bleeding (0.3%, worsening of anal hypotonia (0.3%, sepsis (0.3% and systemic complications (0.3%. The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0% and hemorrhage in men (1.1%. Surgical complications were more observed in the eighth (5.1% and seventh (3.8% decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%, with annular stenosis as the most common anatomical shape (70.0%. Anal stenosis was more common among women (2.0% presenting mean age of 38.2 years, with no

  4. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique

    Science.gov (United States)

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-01-01

    Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  5. Reconstruction of the mandible and the maxilla: the evolution of surgical technique.

    Science.gov (United States)

    Genden, Eric M

    2010-01-01

    The upper and lower jaws play an essential role in mastication, articulation, and cosmetic form. The mandible provides support for tongue position and elevation of the larynx during swallowing, while the maxilla provides support for the nasal structures as well as an opposing structure to the mandible during mastication. The evolution of mandibular and maxillary reconstruction dates back to the early 19th century. Before the introduction of free tissue transfer, a variety of local flaps, regional flaps, and prosthetics were introduced, yet each was met with eventual failure. Since the introduction of free tissue transfer, mandibular and maxillary reconstruction has become as much of an art as it has a science. Whether the mandibular or the palatomaxillary defects are a result of trauma, congenital deformity, or tumor extirpation, the resultant effect often disrupts both form and function. With these considerations taken together, jaw reconstruction is a unique undertaking in which the artistic reconstruction of the facial skeleton is met with the science of reestablishing the mechanics of mastication. The site, size, and associated soft-tissue defects represent the 3 most important factors in determining the impact of a given defect on function and aesthetics. There is also an inherent difference between defects that are sustained in a controlled fashion, such as during cancer ablation, and those that result from trauma. The consideration of these complexities in jaw reconstruction is reflected in the wide variety of approaches and techniques that have evolved over the past century.

  6. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask.

    Science.gov (United States)

    Jannu, Anubhav; Shekar, Ashim; Balakrishna, Ramdas; Sudarshan, H; Veena, G C; Bhuvaneshwari, S

    2017-12-01

    The beauty of the laryngeal mask is that it forms an air tight seal enclosing the larynx rather than plugging the pharynx, and avoid airway obstruction in the oropharynx. The goal of its development was to create an intermediate form of airway management face mask and endotracheal tube. Indication for its use includes any procedure that would normally involve the use of a face mask. The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anesthetic practice. Despite wide spread use the definitive role of the laryngeal mask airway is yet to be established. In some situations, such as after failed tracheal intubation or in oral surgery its use is controversial. There are several unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoids pressure prevents placement of mask. We review the techniques of insertion, details of misplacement, and complications associated with use of the laryngeal mask. We then attempt to clarify the role of laryngeal mask in air way management during anesthesia, discussing the advantages and disadvantages as well as indications and contraindications of its use in oral and maxillofacial surgery.

  7. Novel surgical technique for complete traumatic rupture of the pancreas: A case report

    Directory of Open Access Journals (Sweden)

    Jauch Karl-Walter

    2011-09-01

    Full Text Available Abstract Introduction Complete pancreatic rupture is a rare injury. The typical mechanism by which this occurs is overstretching of the pancreas across the vertebral column during blunt abdominal trauma. The management of this injury depends on the location and extent of the injury. Case presentation A 45-year-old Caucasian woman presented with blunt abdominal trauma after she fell onto the end of a handlebar during a bicycle accident. She arrived in the emergency room with stable vital signs and an isolated bruise just above the umbilicus. A computed tomography scan revealed a complete rupture of the pancreas, just ventral to her superior mesenteric vein, and an accompanying hematoma but no additional injuries. An emergency laparotomy was performed; the head of the pancreas was oversewn with interrupted sutures and this was followed by a two-layer pancreaticojejunostomy with the tail of the pancreas. The recovery after surgery was completely uneventful. Conclusions Isolated complete pancreatic rupture is a rare injury that can be managed with complete organ preservation. The combination of suturing the pancreatic head and two-layer pancreaticojejunostomy with the pancreatic tail is a feasible technique to manage this condition.

  8. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

    Directory of Open Access Journals (Sweden)

    Evdokia Chasioti

    2015-01-01

    Full Text Available The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis.

  9. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures.

    Science.gov (United States)

    Tu, Kai-Kai; Zhou, Xian-Ting; Tao, Zhou-Shan; Chen, Wei-Kai; Huang, Zheng-Liang; Sun, Tao; Zhou, Qiang; Yang, Lei

    2015-12-01

    Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

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    Uwe Wollina

    2014-01-01

    Full Text Available Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182, morpheic (79, and micronodular (20, Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%. All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs guarantee a high rate of complete tumour removal and a very low risk of recurrence.

  11. Vertical-to-Horizontal Rotational Myocutaneous Flap for Repairing Cicatricial Lower Lid Ectropion: A Novel Surgical Technique

    Directory of Open Access Journals (Sweden)

    Yu-Fan Chang

    2017-01-01

    Full Text Available Objective. To evaluate the efficacy and complications of a novel surgical technique for cicatricial lower lid ectropion that uses a vertical-to-horizontal (V-to-H rotational myocutaneous flap procedure (Tsai procedure. Methods. We performed the V-to-H rotational myocutaneous flap procedure on 20 eyelids in 20 patients with mild to moderate cicatricial lower lid ectropion. A vertical myocutaneous flap was created from the anterior lamella of the vertical pedicle in the lateral third of the lower eyelid. Following a horizontal relaxing incision from the base of the flap, a vertical myocutaneous flap was created and rotated to horizontal. Two patients with combined cicatricial ectropion and paralytic lagophthalmos simultaneously underwent additional lateral tarsorrhaphy. Results. After a minimum follow-up period of 6 months, all patients showed good anatomical and functional improvement with decreased dependence on topical lubricants and a satisfactory cosmetic appearance. Two patients with combined cicatricial and paralytic ectropion had mild residual asymptomatic lagophthalmos. No patients required further revision surgery and there were no complications or recurrence. Conclusion. The V-to-H rotational myocutaneous flap technique was an effective and simple one-stage procedure for correcting cicatricial lower lid ectropion. It lengthened the anterior lamella and tightened horizontal eyelid laxity without the need for a free skin graft.

  12. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI)

    Science.gov (United States)

    Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; von Deimling, Constantin; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias

    2018-01-01

    coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log). Conclusions Novel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first–clinically most relevant– 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications. PMID:29315313

  13. Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors

    Directory of Open Access Journals (Sweden)

    Stollwerck, Peter. L.

    2016-01-01

    Full Text Available Background: Inguinal lymph node dissection (ILND is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu Surgical Adhesive and ARTISS fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany, from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG, in 8/17 in the ARTISS group (AG, and in 29/65 in the control group (CG. Prolonged drainage and seroma were recorded in four (23.5%, and 26 (40% respectively (non-significant. TG showed less extended drainage vs. CG (p=0.082. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000. With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000. Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001. The mean body mass index (BMI was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000.Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND.(Level of evidence: level IV, retrospective case study

  14. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases

    Directory of Open Access Journals (Sweden)

    Uchiyama Yoshiyasu

    2011-09-01

    Full Text Available Abstract Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33 and 28.8 months (range, 24-36. A rectangular bone trough (about 1 × 4 cm was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM, outcome of treatment, and isometric power were measured at final follow-up. Results There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases or good (1/5. In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. Conclusions Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon.

  15. [Exploration of acupoint combination and needling techniques in the reinforcing and reducing manipulation at different acupoints].

    Science.gov (United States)

    Dai, Qing; Sheng, Xiesun; Chen, Feng

    2017-04-12

    The reinforcing and reducing manipulation at different acupoints is a kind of acupuncture manipulations and has satisfactory clinical therapeutic effects, combined with a proper needling techniques. The reinforcing needling method is used in the upper and the reducing one in the lower, the distal acupoints are combined with the nearby acupoints. The local acupoints or adjcant acupoints of the affected area are regarded as the nearby acupoints, e.g. the acupoints in the upper. The distant acupoints and the acupoints on the hand and foot are named as distal acupoints, e.g. the acupoint in the lower. In the reinforcing manipulation, the needle is inserted shallowly along the running direction of meridian. In the reducing manipulation, the needle is inserted deeply and against the running direction of meridian. The yin - yang couple needling technique is used with the combination of the front- mu and back- shu points. In the first option, the reinforcing and reducing needling method with rotating technique is predominated at the front- mu points, while that with lifting and thrusting technique is at the back- shu points. In the second option, when needling the back- shu points, the needling sensation is transmitted along the transverse segment and far to the chest and abdomen. These two kinds of integration of acupoint combination and needling techniques display a certain clinical significance in improving the therapeutic effects of acupuncture.

  16. A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: ‘Scleral Sleeve Method’

    Directory of Open Access Journals (Sweden)

    Charudutt Kalamkar

    2017-10-01

    Full Text Available Purpose: To present a new surgical technique ‘Scleral Sleeve Method’ which would reduce the risk of Ahmed Glaucoma Valve (AGV tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA for refractory glaucoma. Design: Prospective, Non-Randomized, hospital based interventional case series. Subjects: A total of 16 eyes of adult patients (10 males and 6 females with refractory glaucoma. Methods: Instead of using sutures to fix the AGV tube to sclera, we devised a novel method of intra-scleral tube fixation by creating a scleral tunnel fashioned in form of sleeve. Main outcome measure: Post-operative tube related complications. Result: There were no tube related complications such as exposure, extrusion or retraction in any of the cases. Conclusion: Use of scleral sleeve method for tube fixation, along with graft to cover the tube, will provide additional safety measure and reduce the risks of tube related complications. Keywords: Ahmed Glaucoma Valve, Scleral Sleeve Method, Intra-scleral tube fixation

  17. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

    Science.gov (United States)

    Berger, Cezar Augusto Sarraf; Freitas, Renato da Silva; Malafaia, Osvaldo; Pinto, José Simão de Paula; Macedo Filho, Evaldo Dacheux; Mocellin, Marcos; Fagundes, Marina Serrato Coelho

    2014-01-01

    Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures. PMID:25992149

  18. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

    Directory of Open Access Journals (Sweden)

    Berger, Cezar Augusto Sarraf

    2014-12-01

    Full Text Available Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©. The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%. The most common dorsum technique was hump removal (33.33%, and the predominance of sutures (24.76% was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%. Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures.

  19. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  20. Demonstrating success in reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration.

    Science.gov (United States)

    Chiwera, Lilian; Wigglesworth, Neil; McCoskery, Carol; Lucchese, Gianluca; Newsholme, William

    2018-03-28

    Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative amid reported increased incidence of SSIs. Before this time, infection incidence was unclear because data collection was not standardised. Our aim was to standardise SSI data collection and establish baseline SSI rates to facilitate deployment of evidence based targeted interventions within clinical governance structures to improve quality, safety and efficiency in line with our organisational targets. We standardised local data collection protocols in line with Public Health England recommendations and identified local champions. We undertook prospective SSI surveillance collaboratively to enable us to identify potential practice concerns and address them more effectively through a series of initiatives. Clinical staff completed dedicated surveillance forms intraoperatively and post operatively. Overall adult cardiac SSI rates fell from 5.4% in 2009 to 1.2% in 2016 and Coronary Artery Bypass Graft (CABG) rates from 6.5% in 2009 to 1.7% in 2016, psuccessfully implemented comprehensive, evidence-based infection control practices through a multidisciplinary collaborative approach; an approach we consider to have great potential to reduce Gram negative, Staphylococcus aureus, polymicrobial and overall SSI burden and/or associated costs. We now investigate all SSIs using an established SSI detailed investigation protocol to promote continual quality improvement that aligns us perfectly with global efforts to fight antimicrobial resistance. Copyright © 2018. Published by Elsevier Ltd.

  1. Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of life follow-up.

    Science.gov (United States)

    Campbell, Nicole; Conaglen, Paul; Martin, Katherine; Antippa, Phillip

    2009-09-01

    A variety of operative techniques have been described in the past for the surgical stabilization of fractured ribs. From February 2004 to November 2008, consecutive patients who underwent open reduction and internal fixation of traumatic fractured ribs during their index admission using the Inion orthopedic trauma plating system (OTPS) at a Level I trauma center were retrospectively analyzed. Demographics, Injury Severity Scores, number and site of rib fractures, operative details, and complications were recorded. All patients were followed-up with a questionnaire assessing chest symptoms, disability, and quality of life. Thirty-two patients underwent surgical stabilization with Inion OTPS. Road crashes were the commonest mechanism of injury (81%), followed by falls. Seventy-two percent of patients were male, with a median age at operation of 53 years (interquartile range [IQR], 40-64 years). Median number of ribs fixed was 3 (IQR, 2-4), while median number of fractures was 9 (IQR, 6-13). Median time to fixation was 5 days (IQR, 3-7 days), intensive care unit stay 3 days (IQR, 0.8-6.3 days), and total hospital stay 13.5 days (IQR, 8.8-22 days). Wound infection occurred in 19%, with nonunion of a fixed fracture in one patient. Sixty-three percent of patients completed the survey with a mean time between open reduction and internal fixation and questionnaire of 1,039 days (+/-480 days). Patients reported low levels of pain at rest and with coughing (median at rest 1.0/10 [IQR, 0-2.3/10]; with coughing 1.3/10 [IQR, 0-3.75/10]). Chest wall stiffness was experienced by 60% of patients, while dyspnoea at rest was reported by 20% of patients. Mean return to work (for 55%) was 3.9 months (+/-3.3 months). All patients were satisfied with the results of their operation. Patients demonstrated low levels of pain and satisfactory rehabilitation. The Inion OTPS system has several advantages including gradual transference of stress loads to bone, micromotion across the fracture

  2. A reduced scale two loop PWR core designed with particle swarm optimization technique

    International Nuclear Information System (INIS)

    Lima Junior, Carlos A. Souza; Pereira, Claudio M.N.A; Lapa, Celso M.F.; Cunha, Joao J.; Alvim, Antonio C.M.

    2007-01-01

    Reduced scale experiments are often employed in engineering projects because they are much cheaper than real scale testing. Unfortunately, designing reduced scale thermal-hydraulic circuit or equipment, with the capability of reproducing, both accurately and simultaneously, all physical phenomena that occur in real scale and at operating conditions, is a difficult task. To solve this problem, advanced optimization techniques, such as Genetic Algorithms, have been applied. Following this research line, we have performed investigations, using the Particle Swarm Optimization (PSO) Technique, to design a reduced scale two loop Pressurized Water Reactor (PWR) core, considering 100% of nominal power and non accidental operating conditions. Obtained results show that the proposed methodology is a promising approach for forced flow reduced scale experiments. (author)

  3. The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

    Science.gov (United States)

    Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

    2015-01-01

    The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

  4. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Mueller, Tara C; Loos, Martin; Haller, Bernhard; Mihaljevic, André L; Nitsche, Ulrich; Wilhelm, Dirk; Friess, Helmut; Kleeff, Jörg; Bader, Franz G

    2015-02-01

    Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.

  5. Cement technique for reducing post-operative bursitis after trochanteric fixation.

    Science.gov (United States)

    Derman, Peter B; Horneff, John G; Kamath, Atul F; Garino, Jonathan

    2013-02-01

    Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy. We present a simple technique for use with a bolt-washer system or grip plate in which trochanteric components are covered in bone wax followed by a layer of cement to decrease friction and to diminish the risk of post-operative bursitis.

  6. Keyboarding Instruction at NABTE Institutions: Are We Teaching Techniques to Reduce CTD Incidence?

    Science.gov (United States)

    Blaszczynski, Carol; Joyce, Marguerite Shane

    1996-01-01

    Responses from 157 of 193 business teachers who teach keyboarding indicated that 78.7% were aware of cumulative trauma disorder and 22% had experienced it. Only 13% of classrooms were equipped with wrist rests. About 53% teach techniques to reduce incidence, but 20% did not know whether they taught preventive measures. (SK)

  7. Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques.

    Science.gov (United States)

    Akusoba, Ikemefuna; Birriel, T Javier; El Chaar, Maher

    2016-01-01

    There are no clinical guidelines or published studies addressing excessive weight loss and protein calorie malnutrition following a standard Roux-en-Y gastric bypass (RYGB) to guide nutritional management and treatment strategies. This study demonstrates the presentation, clinical algorithm, surgical technique, and outcomes of patients afflicted and successfully treated with excessive weight loss following a standard RYGB. Three patients were successfully reversed to normal anatomy after evaluation, management, and treatment by multidisciplinary team. Lowest BMI (kg/m(2)) was 18.9, 17.9, and 14.2, respectively. Twelve-month post-operative BMI (kg/m(2)) was 28.9, 22.8, and 26.1, respectively. Lowest weight (lbs) was 117, 128, and 79, respectively. Twelve-month post-operative weight (lbs) was 179, 161, and 145, respectively. Pre-reversal gastrostomy tube was inserted into the remnant stomach to demonstrate weight gain and improve nutritional status prior to reversal to original anatomy. We propose a practical clinical algorithm for the work-up and management of patients with excessive weight loss and protein calorie malnutrition after standard RYGB including reversal to normal anatomy.

  8. Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial.

    Science.gov (United States)

    Moradian, Siamak; Ahmadieh, Hamid; Faghihi, Hooshang; Ramezani, Alireza; Entezari, Morteza; Banaee, Touka; Heidari, Ebadollah; Behboudi, Hassan; Yasseri, Mehdi

    2016-09-01

    To compare the visual and anatomical outcomes of four surgical techniques to manage pseudophakic and aphakic retinal detachment (PARD). In a multicenter randomized clinical trial, 211 eyes of 211 patients with PARD and proliferative vitreoretinopathy (PVR) grade B or less were randomly assigned to one of the four treatment groups: (1) scleral buckling (SB), 50 eyes, (2) vitrectomy without band, 51 eyes, (3) vitrectomy with encircling band (EB), 58 eyes, and (4) triamcinolone acetonide (TA) assisted vitrectomy, 52 eyes. Patients were followed for 12 months after the surgery. The best-corrected visual acuity (BCVA) and retinal reattachment rate at each follow-up time point were considered as the primary outcome measures. PVR, macular pucker, and cystoid macular edema were considered as the secondary outcomes. Visual improvement was achieved in all treatment groups relative to the baseline at all time points (all Ps  0.99). There were no statistically significant differences among the groups in terms of adverse events. SB, TA-assisted vitrectomy, and vitrectomy with and without buckle had comparable outcomes in the management of PARD.

  9. Influence of the surgical technique and surface roughness on the primary stability of an implant in artificial bone with a density equivalent to maxillary bone: a laboratory study.

    NARCIS (Netherlands)

    Tabassum, A.; Meijer, G.J.; Wolke, J.G.C.; Jansen, J.A.

    2009-01-01

    OBJECTIVE: The aim of this biomechanical study was to assess the effect of surgical technique and surface roughness on primary implant stability in low-density bone. MATERIAL AND METHODS: Eighty screw-shaped (Biocomp) implants with machined or etched surface topography were inserted into a

  10. Influence of surgical technique and surface roughness on the primary stability of an implant in artificial bone with different cortical thickness: a laboratory study.

    NARCIS (Netherlands)

    Tabassum, A.; Meijer, G.J.; Wolke, J.G.C.; Jansen, J.A.

    2010-01-01

    OBJECTIVE: The aim of this biomechanical study was to assess the interrelated effect of both surface roughness and surgical technique on the primary stability of dental implants. MATERIAL AND METHODS: For the experiment, 160 screw-designed implants (Biocomp), with either a machined or an etched

  11. Forward treatment planning techniques to reduce the normalization effect in Gamma Knife radiosurgery.

    Science.gov (United States)

    Cheng, Hao-Wen; Lo, Wei-Lun; Kuo, Chun-Yuan; Su, Yu-Kai; Tsai, Jo-Ting; Lin, Jia-Wei; Wang, Yu-Jen; Pan, David Hung-Chi

    2017-11-01

    In Gamma Knife forward treatment planning, normalization effect may be observed when multiple shots are used for treating large lesions. This effect can reduce the proportion of coverage of high-value isodose lines within targets. The aim of this study was to evaluate the performance of forward treatment planning techniques using the Leksell Gamma Knife for the normalization effect reduction. We adjusted the shot positions and weightings to optimize the dose distribution and reduce the overlap of high-value isodose lines from each shot, thereby mitigating the normalization effect during treatment planning. The new collimation system, Leksell Gamma Knife Perfexion, which contains eight movable sectors, provides an additional means to reduce the normalization effect by using composite shots. We propose different techniques in forward treatment planning that can reduce the normalization effect. Reducing the normalization effect increases the coverage proportion of higher isodose lines within targets, making the high-dose region within targets more uniform and increasing the mean dose to targets. Because of the increase in the mean dose to the target after reducing the normalization effect, we can set the prescribed marginal dose at a higher isodose level and reduce the maximum dose, thereby lowering the risk of complications. © 2017 Shuang Ho Hospital-Taipei Medical University. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  12. Comparison of relaxation with counterpressure massage techniques for reduce pain first stage of labor

    Science.gov (United States)

    Lisa, U. F.; Jalina, M.; Marniati

    2017-09-01

    Based on interviews of so me mother who entered the first stage of labor lack of care from health workers to the effort to reducing the acuteof labor. Health care workers appertain hospital in effective in implement maternity nursing interventions in reducing acute the first stage of labor. The reducing acute have two method are pharmacological and non-pharmacological. In this case, has several techniques there are: relaxation and counterpressure massage techniques that capable to reducing acute first stage of labor. The of non-pharmacological is one of authority which must be implemented by midwives especially breathing relaxation techniquesand massage. The research is Quasi Exsperimen with pretes-posttest design. The statistic test has T test paired and unpairedt test. To indicatea reducing the level of acute before and after given relaxation technique result p-value pain. Therefore, the health of workers, especially for a study to apply relaxation and massage to provide of mother care, mainly to the primigravida who in experienced in process of labor.

  13. Heat generation during implant placement in low-density bone: effect of surgical technique, insertion torque and implant macro design.

    Science.gov (United States)

    Marković, Aleksa; Mišić, Tijana; Miličić, Biljana; Calvo-Guirado, Jose Luis; Aleksić, Zoran; Ðinić, Ana

    2013-07-01

    The study aimed to investigate the effect of surgical technique, implant macrodesign and insertion torque on bone temperature changes during implant placement. In the in vitro study, 144 self-tapping (blueSKY(®) 4 × 10 mm; Bredent) and 144 non-self-tapping (Standard implant(®) 4.1 × 10 mm; Straumann) were placed in osteotomies prepared in pig ribs by lateral bone condensing or bone drilling techniques. The maximum insertion torque values of 30, 35 and 40 Ncm were used. Real-time bone temperature measurement during implant placement was performed by three thermocouples positioned vertically, in tripod configuration around every osteotomy, at a distance of 5 mm from it and at depths of 1, 5 and 10 mm. Data were analysed using Kruskal-Wallis, Mann-Whitney U-tests and Regression analysis. Significant predictor of bone temperature at the osteotomy depth of 1 mm was insertion torque (P = 0.003) and at the depth of 10-mm implant macrodesign (P = 0.029), while no significant predictor at depth of 5 mm was identified (P > 0.05). Higher insertion torque values as well as non-self-tapping implant macrodesign were related to higher temperatures. Implant placement in sites prepared by bone drilling induced significantly higher temperature increase (P = 0.021) compared with bone condensing sites at the depth of 5 mm, while no significant difference was recorded at other depths. Compared with 30 Ncm, insertion torque values of 35 and 40 Ncm produced significantly higher temperature increase (P = 0.005; P = 0.003, respectively) at the depth of 1 mm. There was no significant difference in temperature change induced by 35 and 40 Ncm, neither by implant macrodesign at all investigated depths (P > 0.05). Placement of self-tapping implants with low insertion torque into sites prepared by lateral bone condensing technique might be advantageous in terms of thermal effect on bone. © 2012 John Wiley & Sons A/S.

  14. Novel Applications of Modified Ultrafiltration and Autologous Priming Techniques to Reduce Blood Product Exposure on ECMO.

    Science.gov (United States)

    Neal, James R; Blau, Caitlin L; Cornelius, Amanda M; Pike, Roxann B; Dearani, Joseph A; Mora, Bassem N

    2016-03-01

    Patients needing the assistance of extracorporeal membrane oxygenation (ECMO) are at risk of hemodilution and, in some instances, may require exposure to large amounts of allogeneic blood products. Patient outcomes can be improved by taking steps to reduce transfusions and hemodilution. Currently, modified ultrafiltration (MUF) is used across the world to reduce hemodilution after cardiopulmonary bypass (CPB). Another common technique during bypass initiation is autologous priming. By applying modified versions of these techniques, ECMO patients may potentially benefit. Usually, patients requiring immediate transition from CPB to ECMO are not stable enough to tolerate MUF. Through alterations of the CPB and ECMO circuit tubing, MUF can be performed once on ECMO. Another technique to potentially lower the transfusion requirements for ECMO patients is a complete circuit blood transfer during an ECMO circuit exchange. While selective component changes are preferred if possible, occasionally a complete circuit change must be done. To minimize hemodilution or prevent priming with blood products, the original ECMO circuit's blood can be transferred to the new ECMO circuit before connecting to the patient. Both of these techniques, in our opinion, helped to reduce the number of transfusions that our ECMO patients have seen during these critical time periods.

  15. Rotor Pole Shape Optimization of Permanent Magnet Brushless DC Motors Using the Reduced Basis Technique

    Directory of Open Access Journals (Sweden)

    GHOLAMIAN, A. S.

    2009-06-01

    Full Text Available In this paper, a magnet shape optimization method for reduction of cogging torque and torque ripple in Permanent Magnet (PM brushless DC motors is presented by using the reduced basis technique coupled by finite element and design of experiments methods. The primary objective of the method is to reduce the enormous number of design variables required to define the magnet shape. The reduced basis technique is a weighted combination of several basis shapes. The aim of the method is to find the best combination using the weights for each shape as the design variables. A multi-level design process is developed to find suitable basis shapes or trial shapes at each level that can be used in the reduced basis technique. Each level is treated as a separated optimization problem until the required objective is achieved. The experimental design of Taguchi method is used to build the approximation model and to perform optimization. This method is demonstrated on the magnet shape optimization of a 6-poles/18-slots PM BLDC motor.

  16. Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces.

    Science.gov (United States)

    Secker, T J; Pinchin, H E; Hervé, R C; Keevil, C W

    2015-01-01

    Increasing drying time adversely affects attachment of tissue proteins and prion-associated amyloid to surgical stainless steel, and reduces the efficacy of commercial cleaning chemistries. This study tested the efficacy of commercial humidity retention bags to reduce biofouling on surgical stainless steel and to improve subsequent cleaning. Surgical stainless steel surfaces were contaminated with ME7-infected brain homogenates and left to dry for 15 to 1,440 min either in air, in dry polythene bags or within humidity retention bags. Residual contamination pre/post cleaning was analysed using Thioflavin T/SYPRO Ruby dual staining and microscope analysis. An increase in biofouling was observed with increased drying time in air or in sealed dry bags. Humidity retention bags kept both protein and prion-associated amyloid minimal across the drying times both pre- and post-cleaning. Therefore, humidity bags demonstrate a cheap, easy to implement solution to improve surgical instrument reprocessing and to potentially reduce associated hospital acquired infections.

  17. Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

    Science.gov (United States)

    Berberi, Antoine N; Tehini, Georges E; Noujeim, Ziad F; Khairallah, Alexandre A; Abousehlib, Moustafa N; Salameh, Ziad A

    2014-10-01

    Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p sockets reduced marginal bone loss and did not compromise the success rate of the restorations. © 2014 by the American College of Prosthodontists.

  18. External beam radiotherapy (EBRT) techniques used in breast cancer treatment to reduce cardiac exposure

    International Nuclear Information System (INIS)

    Fung, Esther; Hendry, Julie

    2013-01-01

    Radiotherapy in breast cancer treatment has been shown to reduce local recurrence and improve survival rates. However, there is a concern that breast radiotherapy can cause an increase in cardiac mortality, particularly in patients being treated for left-sided breast cancer. This review aims to investigate how cardiac exposure is minimised in breast radiotherapy and determine an optimal method for reducing cardiac dose, using literature from ScienceDirect, Medline and CINAHL. IMRT and breathing-adapted radiotherapy both reduce cardiac exposure but IMRT also increases the irradiated volume at low dose. Several issues were reported with regards to the clinical implementation of these techniques. It is suggested that inspiration breath-hold radiotherapy, is the preferred solution to minimising cardiac exposure but more research is warranted to confirm this. Long-term follow-up is required to determine dose–response relationships. Research needs to focus on breast cancer treatment as a whole in order to effectively reduce cardiac mortality.

  19. Robot-assisted radical prostatectomy: Multiparametric MR imaging-directed intraoperative frozen-section analysis to reduce the rate of positive surgical margins.

    Science.gov (United States)

    Petralia, Giuseppe; Musi, Gennaro; Padhani, Anwar R; Summers, Paul; Renne, Giuseppe; Alessi, Sarah; Raimondi, Sara; Matei, Deliu V; Renne, Salvatore L; Jereczek-Fossa, Barbara A; De Cobelli, Ottavio; Bellomi, Massimo

    2015-02-01

    To investigate whether use of multiparametric magnetic resonance (MR) imaging-directed intraoperative frozen-section (IFS) analysis during nerve-sparing robot-assisted radical prostatectomy reduces the rate of positive surgical margins. This retrospective analysis of prospectively acquired data was approved by an institutional ethics committee, and the requirement for informed consent was waived. Data were reviewed for 134 patients who underwent preoperative multiparametric MR imaging (T2 weighted, diffusion weighted, and dynamic contrast-material enhanced) and nerve-sparing robot-assisted radical prostatectomy, during which IFS analysis was used, and secondary resections were performed when IFS results were positive for cancer. Control patients (n = 134) matched for age, prostate-specific antigen level, and stage were selected from a pool of 322 patients who underwent nerve-sparing robot-assisted radical prostatectomy without multiparametric MR imaging and IFS analysis. Rates of positive surgical margins were compared by means of the McNemar test, and a multivariate conditional logistic regression model was used to estimate the odds ratio of positive surgical margins for patients who underwent MR imaging and IFS analysis compared with control subjects. Eighteen patients who underwent MR imaging and IFS analysis underwent secondary resections, and 13 of these patients were found to have negative surgical margins at final pathologic examination. Positive surgical margins were found less frequently in the patients who underwent MR imaging and IFS analysis than in control patients (7.5% vs 18.7%, P = .01). When the differences in risk factors are taken into account, patients who underwent MR imaging and IFS had one-seventh the risk of having positive surgical margins relative to control patients (adjusted odds ratio: 0.15; 95% confidence interval: 0.04, 0.61). The significantly lower rate of positive surgical margins compared with that in control patients provides

  20. Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

    Directory of Open Access Journals (Sweden)

    Carmelo Saraniti

    Full Text Available Abstract Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71% the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods: A 5 year retrospective analysis of surgical outcomes of 18 patients treated for choanal atresia with a transnasal technique employing a single side-hinged flap without stent placement. All subjects were assessed preoperatively with a nasal endoscopy and a Maxillofacial computed tomography scan. Results: Ten males and eight females with a mean age at the time of surgery of 20.05 ± 11.32 years, underwent surgery for choanal atresia. Fifteen subjects (83.33% had a bony while 3 (26.77% a mixed bony-membranous atretic plate. Two and sixteen cases suffered from bilateral and unilateral choanal atresia respectively. No intra- and/or early postoperative complications were observed. Between 2 and 3 months after surgery two cases (11.11% of partial restenosis were found. Only one of these presented a relapse of the nasal obstruction and was subsequently successfully repaired with a second endoscopic procedure. Conclusion: The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques

  1. A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

    Science.gov (United States)

    Kawase-Koga, Yoko; Mori, Yoshiyuki; Hoshi, Kazuhito; Takato, Tsuyoshi

    2013-11-01

    Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.

  2. New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience.

    Science.gov (United States)

    Waltregny, David; de Leval, Jean

    2012-12-01

    Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure

  3. The trans-frontal-sinus subcranial approach for removal of large olfactory groove meningiomas: surgical technique and comparison to other approaches.

    Science.gov (United States)

    Boari, Nicola; Gagliardi, Filippo; Roberti, Fabio; Barzaghi, Lina Raffaella; Caputy, Anthony J; Mortini, Pietro

    2013-05-01

    Several surgical approaches have been previously reported for the treatment of olfactory groove meningiomas (OGM).The trans-frontal-sinus subcranial approach (TFSSA) for the removal of large OGMs is described, comparing it with other reported approaches in terms of advantages and drawbacks. The TFSSA was performed on cadaveric specimens to illustrate the surgical technique. The surgical steps of the TFSSA and the related anatomical pictures are reported. The approach was adopted in a clinical setting; a case illustration is reported to demonstrate the feasibility of the described approach and to provide intraoperative pictures. The TFSSA represents a possible route to treat large OGMs. The subcranial approach provides early devascularization of the tumor, direct tumor access from the base without traction on the frontal lobes, good overview of dissection of the optic nerves and anterior cerebral arteries, and dural reconstruction with pedicled pericranial flap. Georg Thieme Verlag KG Stuttgart · New York.

  4. Treatment outcomes of the simple bone cyst: A comparative study of 2 surgical techniques using artificial bone substitutes.

    Science.gov (United States)

    Higuchi, Takashi; Yamamoto, Norio; Shirai, Toshiharu; Hayashi, Katsuhiro; Takeuchi, Akihiko; Kimura, Hiroaki; Miwa, Shinji; Abe, Kensaku; Taniguchi, Yuta; Tsuchiya, Hiroyuki

    2018-05-01

    Simple bone cysts (SBCs) are benign lesions of unknown etiology. Because of its high relapse rate, they occasionally need a long period of treatment and restriction of activities in children and adolescent. Although various treatment modalities with variable differing outcomes have been described in the literature, no consensus has been reached regarding the standard treatment. The purpose of this study was to evaluate the outcome of a minimally invasive technique that uses a ceramic hydroxyapatite cannulated pin (HA pin) for the treatment of SBCs.Between 1998 and 2015, we have treated 75 patients with SBCs either with continuous decompression by inserting HA pins after curettage and multiple drilling (group 1, n = 39 patients) or with calcium phosphate cement (CPC) filling after curettage (group 2, n = 36 patients). These patients were retrospectively analyzed for recurrence-free survival (RFS) and factors implicated in SBC recurrence.Seventy-five patients (50 man and 25 females) with a mean age of 17.5 ± 11.6 years and a histopathologically confirmed diagnosis of SBCs were included. The mean follow-up period was 33 ± 25.3 months. RFS were 88% at 1 year and 81% at 5 years. Residual or progressing cysts were observed in 12 patients after the surgery and 10 of them underwent additional surgery. Recurrence rate was significantly higher in patients under the age of 10 years (P = .01), in long bone cysts (P = .01), and in active phase cysts (P = .003) (log-rank test). Multivariate analysis results revealed that age less than 10 years was an independent risk factor of recurrence (P = .04). No significant difference in recurrence rate was observed between groups 1 and 2. However, the mean operating time was significantly shorter in group 1. (62.4 ± 25.6 vs 110.5 ± 48.4 minutes in group 2).Continuous decompression using HA pin is a less invasive surgical technique for the treatment of SBCs compared with CPC filling and has a

  5. Reducing wrong patient selection errors: exploring the design space of user interface techniques.

    Science.gov (United States)

    Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

    2014-01-01

    Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

  6. Mental training, relaxation techniques and pedagogical instructions to reduce Music Performance Anxiety (MPA) in flute students

    OpenAIRE

    Carmen Viejo Llaneza; Ana Laucirica Larrinaga

    2016-01-01

    Music Performance Anxiety (MPA) is, frequently, one of the problems faced by a musical performer in his or her career. This study observes way in which stage fright affects in musicians, which is a possible factor that may later lead to anxiety in public performances and, furthermore, how we can intervene to mitigate or reduce its effects. An initial interview was conducted with four upper division students of transverse flute. This was followed by some training techniques - relaxation techni...

  7. Techniques for Reducing Consistency-Related Communication in Distributed Shared Memory System

    OpenAIRE

    Zwaenepoel, W; Bennett, J.K.; Carter, J.B.

    1995-01-01

    Distributed shared memory 8DSM) is an abstraction of shared memory on a distributed memory machine. Hardware DSM systems support this abstraction at the architecture level; software DSM systems support the abstraction within the runtime system. One of the key problems in building an efficient software DSM system is to reduce the amount of communication needed to keep the distributed memories consistent. In this paper we present four techniques for doing so: 1) software release consistency; 2)...

  8. Kalman filtering techniques for reducing variance of digital speckle displacement measurement noise

    Institute of Scientific and Technical Information of China (English)

    Donghui Li; Li Guo

    2006-01-01

    @@ Target dynamics are assumed to be known in measuring digital speckle displacement. Use is made of a simple measurement equation, where measurement noise represents the effect of disturbances introduced in measurement process. From these assumptions, Kalman filter can be designed to reduce variance of measurement noise. An optical and analysis system was set up, by which object motion with constant displacement and constant velocity is experimented with to verify validity of Kalman filtering techniques for reduction of measurement noise variance.

  9. Experimental verifications of a structural damage identification technique using reduced order finite-element model

    Science.gov (United States)

    Li, Rui; Zhou, Li; Yang, Jann N.

    2010-04-01

    An objective of the structural health monitoring system is to identify the state of the structure and to detect the damage when it occurs. Analysis techniques for the damage identification of structures, based on vibration data measured from sensors, have received considerable attention. Recently, a new damage tracking technique, referred to as the adaptive quadratic sum-square error (AQSSE) technique, has been proposed, and simulation studies demonstrated that the AQSSE technique is quite effective in identifying structural damages. In this paper, the adaptive quadratic sumsquare error (AQSSE) along with the reduced-order finite-element method is proposed to identify the damages of complex structures. Experimental tests were conducted to verify the capability of the proposed damage detection approach. A series of experimental tests were performed using a scaled cantilever beam subject to the white noise and sinusoidal excitations. The capability of the proposed reduced-order finite-element based adaptive quadratic sum-square error (AQSSE) method in detecting the structural damage is demonstrated by the experimental results.

  10. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy.

    Science.gov (United States)

    Butterworth, C J; Rogers, S N

    2017-12-01

    This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease.The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) for the primary management of maxillary malignancy with surgical closure of the resultant maxillary defect and the installation of osseointegrated support for a zygomatic implant-supported maxillary fixed dental prosthesis.The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients.

  11. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.METHODS: Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint.RESULTS: We achieved fracture consolidation in 90%. Fourteen cases (21% evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3% evolved with minor complications of skin granuloma.CONCLUSION: The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint.

  12. A multi coding technique to reduce transition activity in VLSI circuits

    International Nuclear Information System (INIS)

    Vithyalakshmi, N.; Rajaram, M.

    2014-01-01

    Advances in VLSI technology have enabled the implementation of complex digital circuits in a single chip, reducing system size and power consumption. In deep submicron low power CMOS VLSI design, the main cause of energy dissipation is charging and discharging of internal node capacitances due to transition activity. Transition activity is one of the major factors that also affect the dynamic power dissipation. This paper proposes power reduction analyzed through algorithm and logic circuit levels. In algorithm level the key aspect of reducing power dissipation is by minimizing transition activity and is achieved by introducing a data coding technique. So a novel multi coding technique is introduced to improve the efficiency of transition activity up to 52.3% on the bus lines, which will automatically reduce the dynamic power dissipation. In addition, 1 bit full adders are introduced in the Hamming distance estimator block, which reduces the device count. This coding method is implemented using Verilog HDL. The overall performance is analyzed by using Modelsim and Xilinx Tools. In total 38.2% power saving capability is achieved compared to other existing methods. (semiconductor technology)

  13. Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

    Science.gov (United States)

    Bartlett, Frederick R.; Colgan, Ruth M.; Donovan, Ellen M.; Carr, Karen; Landeg, Steven; Clements, Nicola; McNair, Helen A.; Locke, Imogen; Evans, Philip M.; Haviland, Joanne S.; Yarnold, John R.; Kirby, Anna M.

    2014-01-01

    Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery. PMID:25046661

  14. Reducing beam shaper alignment complexity: diagnostic techniques for alignment and tuning

    Science.gov (United States)

    Lizotte, Todd E.

    2011-10-01

    Safe and efficient optical alignment is a critical requirement for industrial laser systems used in a high volume manufacturing environment. Of specific interest is the development of techniques to align beam shaping optics within a beam line; having the ability to instantly verify by a qualitative means that each element is in its proper position as the beam shaper module is being aligned. There is a need to reduce these types of alignment techniques down to a level where even a newbie to optical alignment will be able to complete the task. Couple this alignment need with the fact that most laser system manufacturers ship their products worldwide and the introduction of a new set of variables including cultural and language barriers, makes this a top priority for manufacturers. Tools and methodologies for alignment of complex optical systems need to be able to cross these barriers to ensure the highest degree of up time and reduce the cost of maintenance on the production floor. Customers worldwide, who purchase production laser equipment, understand that the majority of costs to a manufacturing facility is spent on system maintenance and is typically the largest single controllable expenditure in a production plant. This desire to reduce costs is driving the trend these days towards predictive and proactive, not reactive maintenance of laser based optical beam delivery systems [10]. With proper diagnostic tools, laser system developers can develop proactive approaches to reduce system down time, safe guard operational performance and reduce premature or catastrophic optics failures. Obviously analytical data will provide quantifiable performance standards which are more precise than qualitative standards, but each have a role in determining overall optical system performance [10]. This paper will discuss the use of film and fluorescent mirror devices as diagnostic tools for beam shaper module alignment off line or in-situ. The paper will also provide an overview

  15. Some considerations on displacement assumed finite elements with the reduced numerical integration technique

    International Nuclear Information System (INIS)

    Takeda, H.; Isha, H.

    1981-01-01

    The paper is concerned with the displacement-assumed-finite elements by applying the reduced numerical integration technique in structural problems. The first part is a general consideration on the technique. Its purpose is to examine a variational interpretation of the finite element displacement formulation with the reduced integration technique in structural problems. The formulation is critically studied from a standpoint of the natural stiffness approach. It is shown that these types of elements are equivalent to a certain type of displacement and stress assumed mixed elements. The rank deficiency of the stiffness matrix of these elements is interpreted as a problem in the transformation from the natural system to a Cartesian system. It will be shown that a variational basis of the equivalent mixed formulation is closely related to the Hellinger-Reissner's functional. It is presented that for simple elements, e.g. bilinear quadrilateral plane stress and plate bending there are corresponding mixed elements from the functional. For relatively complex types of these elements, it is shown that they are equivalent to localized mixed elements from the Hellinger-Reissner's functional. In the second part, typical finite elements with the reduced integration technique are studied to demonstrate this equivalence. A bilinear displacement and rotation assumed shear beam element, a bilinear displacement assumed quadrilateral plane stress element and a bilinear deflection and rotation assumed quadrilateral plate bending element are examined to present equivalent mixed elements. Not only the theoretical consideration is presented but numerical studies are shown to demonstrate the effectiveness of these elements in practical analysis. (orig.)

  16. Rapid orthodontic treatment after the ridge-splitting technique--a combined surgical-orthodontic approach for implant site development: case report.

    Science.gov (United States)

    Amato, Francesco; Mirabella, A Davide; Borlizzi, Diego

    2012-08-01

    This article presents a clinical case of bilateral partial edentulism in the posterior mandible with severe horizontal and moderate vertical bone atrophy. A new technique using rapid orthodontics after ridge splitting is presented. The split-crest technique was carried out using piezosurgical instruments in the first molar and second premolar areas to widen the bone crest and open a channel for tooth movement. Immediately after, orthodontic appliances were used to move the first premolars distally and the second molars mesially into the surgical site. The rationale was to facilitate and accelerate orthodontic movement of the teeth, which is otherwise difficult in a cortical knife-edged ridge. The bone defect was filled with the alveolar bone of the adjacent teeth that were moved into the surgically opened path. Adequate bone volume for implant placement was generated in the first premolar area. Implants were then inserted, and the patient was rehabilitated.

  17. Using Mitrofanoff's principle and Monti's technique as a surgical option for bladder augmentation with a continent stoma: a case report

    Directory of Open Access Journals (Sweden)

    Martins Antonio CP

    2011-02-01

    Full Text Available Abstract Introduction Hydronephrosis, reflux and renal failure are serious complications that occur in patients with neurogenic bladder associated with myelomeningocele. When the bladder compliance is lost, it is imperative to carry out surgery aimed at reducing bladder storage pressure. An ileocystoplasty, and for patients not suitable for intermittent catheterization, using the Mitrofanoff principle to form a continent stoma and the subsequent closure of the bladder neck, can be used. We report here, for the first time to the best of our knowledge, an association between two previously described techniques (the Mitrofanoff principle and the technique of Monti, that can solve the problem of a short appendix in obese patients. Case presentation A 33-year-old male Caucasian patient with myelomeningocele and neurogenic bladder developed low bladder compliance (4.0 mL/cm H2O while still maintaining normal renal function. A bladder augmentation (ileocystoplasty with continent derivation principle (Mitrofanoff was performed. During surgery, we found that the patient's appendix was too short and was insufficient to reach the skin. We decided to make an association between the Mitrofanoff conduit and the ileal technique of Monti, through which we performed an anastomosis of the distal stump of the appendix to the bladder (with an antireflux valve. Later, the proximal stump of the appendix was anastomosed to an ileal segment of 2.0 cm that was open longitudinally and reconfigured transversally (Monti technique, modeled by a 12-Fr urethral catheter, and finally, the distal stump was sutured at the patient's navel. After the procedure, a suprapubic cystostomy (22 Fr and a Foley catheter (10 Fr through the continent conduit were left in place. The patient had recovered well and was discharged on the tenth day after surgery. He remained with the Foley catheter (through the conduit for 21 days and cystostomy for 30 days. Six months after surgery he was

  18. Sustainable Modular Adaptive Redundancy Technique Emphasizing Partial Reconfiguration for Reduced Power Consumption

    Directory of Open Access Journals (Sweden)

    R. Al-Haddad

    2011-01-01

    Full Text Available As reconfigurable devices' capacities and the complexity of applications that use them increase, the need for self-reliance of deployed systems becomes increasingly prominent. Organic computing paradigms have been proposed for fault-tolerant systems because they promote behaviors that allow complex digital systems to adapt and survive in demanding environments. In this paper, we develop a sustainable modular adaptive redundancy technique (SMART composed of a two-layered organic system. The hardware layer is implemented on a Xilinx Virtex-4 Field Programmable Gate Array (FPGA to provide self-repair using a novel approach called reconfigurable adaptive redundancy system (RARS. The software layer supervises the organic activities on the FPGA and extends the self-healing capabilities through application-independent, intrinsic, and evolutionary repair techniques that leverage the benefits of dynamic partial reconfiguration (PR. SMART was evaluated using a Sobel edge-detection application and was shown to tolerate stressful sequences of injected transient and permanent faults while reducing dynamic power consumption by 30% compared to conventional triple modular redundancy (TMR techniques, with nominal impact on the fault-tolerance capabilities. Moreover, PR is employed to keep the system on line while under repair and also to reduce repair time. Experiments have shown a 27.48% decrease in repair time when PR is employed compared to the full bitstream configuration case.

  19. [Surgical technique and clinical results of total knee arthroplasty in treating endstage gonarthrosis combined with valgus knee deformity].

    Science.gov (United States)

    Wang, Xingshan; Weng, Xisheng; Lin, Jin; Jin, Jin; Qian, Wenwei

    2012-05-01

    To investigate the surgical technique and the clinical results of total knee arthroplasty (TKA) in treating end-stage gonarthrosis combined with valgus knee deformity. Between November 1998 and October 2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years), including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The flexion and extension range of motion (ROM) of the knee joint was (82.2 +/- 28.7) degrees; the femur-tibia angle (FTA) was (18.0 +/- 5.8) degrees; according to Knee Society Score (KSS) criterion, the preoperative clinical score was 31.2 +/- 10.1 and functional score was 37.3 +/- 9.0. According to Krackow's classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior cruciate ligament were used in 7 cases (7 knees), posterior stabilize prosthesis in 54 cases (60 knees), constrained prosthesis in 4 cases (5 knees). Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with haemophilic arthritis, severe valgus deformity (FTA was 41 degrees), and flexion contracture (20 degrees), which was cured after 1 year of conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 +/- 2.5) degrees, showing significant difference when compared with preoperative value (t = 15.502, P = 0.000). The KSS clinical score was 83.0 +/- 6

  20. Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Edward McPherson

    2014-06-01

    Full Text Available This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA procedures utilizing a technique to optimize knee flexion. The main features include: (1the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2 patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4incorporation of a rapid recovery protocol with features to promote knee flexion. Results were categorized into three groups: low pre-op flexion (90 degrees and below, regular pre-op flexion (91-125 degrees, and high pre-op flexion (126 degrees and above. Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years. In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years. Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years. In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.

  1. A new method for reducing DNL in nuclear ADCs using an interpolation technique

    International Nuclear Information System (INIS)

    Vaidya, P.P.; Gopalakrishnan, K.R.; Pethe, V.A.; Anjaneyulu, T.

    1986-01-01

    The paper describes a new method for reducing the DNL associated with nuclear ADCs. The method named the ''interpolation technique'' is utilized to derive the quantisation steps corresponding to the last n bits of the digital code by dividing quantisation steps due to higher significant bits of the DAC, using a chain of resistors. Using comparators, these quantisation steps are compared with the analog voltage to be digitized, which is applied as a voltage shift at both ends of this chain. The output states of the comparators define the n bit code. The errors due to offset voltages and bias currents of the comparators are statistically neutralized by changing the polarity of quantisation steps as well as the polarity of analog voltage (corresponding to last n bits) for alternate A/D conversion. The effect of averaging on the channel profile can be minimized. A 12 bit ADC was constructured using this technique which gives DNL of less than +-1% over most of the channels for conversion time of nearly 4.5 μs. Gatti's sliding scale technique can be implemented for further reduction of DNL. The interpolation technique has a promising potential of improving the resolution of existing 12 bit ADCs to 16 bit, without degrading the percentage DNL significantly. (orig.)

  2. Fast Discrete Fourier Transform Computations Using the Reduced Adder Graph Technique

    Directory of Open Access Journals (Sweden)

    Andrew G. Dempster

    2007-01-01

    Full Text Available It has recently been shown that the n-dimensional reduced adder graph (RAG-n technique is beneficial for many DSP applications such as for FIR and IIR filters, where multipliers can be grouped in multiplier blocks. This paper highlights the importance of DFT and FFT as DSP objects and also explores how the RAG-n technique can be applied to these algorithms. This RAG-n DFT will be shown to be of low complexity and possess an attractively regular VLSI data flow when implemented with the Rader DFT algorithm or the Bluestein chirp-z algorithm. ASIC synthesis data are provided and demonstrate the low complexity and high speed of the design when compared to other alternatives.

  3. Reduced-Complexity Wireless Transceiver Architectures and Techniques for Space-Time Communications

    DEFF Research Database (Denmark)

    Tsakalaki, Elpiniki

    2012-01-01

    The dissertation sheds light on the performance gains of multi-antenna systems when the antenna aspects and the associated signal processing and coding aspects are integrated together in a multidisciplinary approach, addressing a variety of challenging tasks pertaining to the joint design of smart...... wireless transceivers and communication techniques. These tasks are at the intersection of different scientific disciplines including signal processing, communications, antennas and propagation. Specifically, the thesis deals with reduced-complexity space-time wireless transceiver architectures...... and associated communication techniques for multi-input multi-output (MIMO) and cognitive radio (CR) systems as well as wireless sensor networks (WSNs). The low-complexity architectures are obtained by equipping the wireless transceiver with passive control ports which require the minimum amount of RF hardware...

  4. Fast Discrete Fourier Transform Computations Using the Reduced Adder Graph Technique

    Directory of Open Access Journals (Sweden)

    Dempster Andrew G

    2007-01-01

    Full Text Available It has recently been shown that the -dimensional reduced adder graph (RAG- technique is beneficial for many DSP applications such as for FIR and IIR filters, where multipliers can be grouped in multiplier blocks. This paper highlights the importance of DFT and FFT as DSP objects and also explores how the RAG- technique can be applied to these algorithms. This RAG- DFT will be shown to be of low complexity and possess an attractively regular VLSI data flow when implemented with the Rader DFT algorithm or the Bluestein chirp- algorithm. ASIC synthesis data are provided and demonstrate the low complexity and high speed of the design when compared to other alternatives.

  5. Image Processing Based Signature Verification Technique to Reduce Fraud in Financial Institutions

    Directory of Open Access Journals (Sweden)

    Hussein Walid

    2016-01-01

    Full Text Available Handwritten signature is broadly utilized as personal verification in financial institutions ensures the necessity for a robust automatic signature verification tool. This tool aims to reduce fraud in all related financial transactions’ sectors. This paper proposes an online, robust, and automatic signature verification technique using the recent advances in image processing and machine learning. Once the image of a handwritten signature for a customer is captured, several pre-processing steps are performed on it including filtration and detection of the signature edges. Afterwards, a feature extraction process is applied on the image to extract Speeded up Robust Features (SURF and Scale-Invariant Feature Transform (SIFT features. Finally, a verification process is developed and applied to compare the extracted image features with those stored in the database for the specified customer. Results indicate high accuracy, simplicity, and rapidity of the developed technique, which are the main criteria to judge a signature verification tool in banking and other financial institutions.

  6. A new technique of "midline anchoring" in spinal cord stimulation dramatically reduces lead migration.

    Science.gov (United States)

    Mironer, Y Eugene; Brown, Christopher; Satterthwaite, John R; Cohen, Mary; Tonder, Lisa M; Grumman, Steve

    2004-01-01

    Spinal cord stimulation (SCS) is a popular method of treatment of chronic pain. Unfortunately, migration of the lead continues to be a serious complication of this therapy. In an attempt to reduce lateral migration of the SCS lead, we performed a retrospective assessment of a new technique of percutaneous lead placement. This new method of "midline anchoring" of the lead using the plica mediana dorsalis was tested against conventional technique in a retrospective study involving 122 trials and 91 implants of SCS over a period of five years. The use of "midline anchoring" resulted in a decrease in lead migration from 23% to 6% after trial insertion and from 24% to 7% after implantation. We conclude that "midline anchoring" of the SCS lead is an effective method of preventing lead migration.

  7. Open surgical simulation--a review.

    Science.gov (United States)

    Davies, Jennifer; Khatib, Manaf; Bello, Fernando

    2013-01-01

    Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

  8. Reduce of adherence problems in galvanised processes through data mining techniques

    International Nuclear Information System (INIS)

    Martinez de Pison, F. J.; Ordieres, J.; Pernia, A.; Alba, F.; Torre, V.

    2007-01-01

    This paper presents an example of the application of data mining techniques to obtain hidden knowledge from the historical data of a hot dip galvanizing process and to establish rules to improve quality in the final product and to reduce errors in the process. For this purpose, the tuning records of a hot dip galvanizing line where coils with adherence problems in the zinc coating had been identified were used as starting point. From the database of the process, the classical data mining approach was applied to obtain and analyze a number of decision trees hat classified two types of coils, i.e. those with the right adherence and those with irregular adherence. The variables and values that might have influenced the quality of the coating were extracted from these tress. Several rules that may be applied to reduce the number of faulty coils with adherence problems were also established. (Author) 24 refs

  9. Posterior intravaginal slingplasty with preservation of the uterus: a modified surgical technique in a young myelomeningocele patient

    NARCIS (Netherlands)

    Verguts, Jasper; Roovers, Jan-Paul; de Ridder, Dirk; Coremans, Georges; Deprest, Jan

    2007-01-01

    We report a case of uterine prolapse in a young woman, treated by posterior intravaginal slingplasty with preservation of the uterus as a feasible and safe surgical procedure. Posterior intravaginal slingplasty is commonly used to correct vaginal vault prolapse, but may be a valuable alternative to

  10. Surgical Treatment of Renal Cell Carcinoma with Inferior Vena Cava Thrombus: Using Liver Mobilization Technique to Avoid Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Tawatchai Taweemonkongsap

    2008-04-01

    CONCLUSION: These results support the aggressive surgical removal of RCC with IVC thrombus as the initial treatment. Most of the thrombi can be approached and safely controlled by a transabdominal approach without any form of bypass. Tumour thrombus removal provides a high survival chance and offers improvement in quality of life.

  11. The effects of implant surface roughness and surgical technique on implant fixation in an in vitro model.

    NARCIS (Netherlands)

    Shalabi, M.M.; Wolke, J.G.C.; Jansen, J.A.

    2006-01-01

    OBJECTIVES: The aim of the present study was to determine the relationship between implant surface parameters, surgical approach and initial implant fixation. MATERIAL AND METHODS: Sixty tapered, conical, screw-shaped implants with machined or etched surface topography were implanted into the

  12. The value of three-dimensional photogrammetry in isolated sagittal synostosis: Impact of age and surgical technique on intracranial volume and cephalic index─a retrospective cohort study.

    Science.gov (United States)

    Mertens, Christian; Wessel, Eline; Berger, Moritz; Ristow, Oliver; Hoffmann, Jürgen; Kansy, Katinka; Freudlsperger, Christian; Bächli, Heidrun; Engel, Michael

    2017-12-01

    The aim of this study was to compare the outcome of intracranial volume (ICV) and cephalic index (CI) between two different techniques for surgical therapy of sagittal synostosis. Between 2011 and 2015, all patients scheduled for surgical therapy of sagittal synostosis were consecutively enrolled. All patients younger than 6 months underwent early extended strip craniectomy (ESC group), and patients older than 6 months underwent late modified pi-procedure (MPP group). To measure ICV and CI, data acquisition was performed via three-dimensional photogrammetry, 1 day before (T0) and between 10 and 12 weeks after surgery (T1). Results were compared with an age-matched reference group of healthy children. Perioperative parameters, as duration of surgery and the amount of blood loss of both surgical procedures were analyzed. A total of 85 patients were enrolled. Of the patients, 48 underwent an extended strip craniotomy with parietal osteotomies and biparietal widening and 37 patients underwent a late modified pi-procedure. There was no significant difference between the ESC group and the MPP group regarding the efficacy of improving CI (p > 0.05). Both techniques were able to normalize CI and to improve head shape. ICV was normal compared to age-matched norm-groups with both techniques, pre- and postoperatively. However, duration of the surgical procedure and calculated blood loss were significantly lower in the ESC group (p photogrammetry is a valid method to objectively evaluate patients before and after surgery without exposing pediatric patients to ionizing radiation. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Reduced and selective integration techniques in the finite element analysis of plates

    International Nuclear Information System (INIS)

    Hughes, T.J.R.; Cohen, M.; Haroun, M.

    1978-01-01

    Efforts to develop effective plate bending finite elements by reduced integration techniques are described. The basis for the development is a 'thick' plate theory in which transverse shear strains are accounted for. The variables in the theory are all kinematic, namely, displacements and independent rotations. As only C 0 continuity is required, isoparametric elements may be employed, which result in several advantages over thin plate elements. It is shown that the avoidance of shear 'locking' may be facilitated by reduced integration techniques. Both uniform and selective schemes are considered. Conditions under which selective schemes are invariant are identified, and they are found to have an advantage over uniform schemes in the present situation. It is pointed out that the present elements are not subject to the difficulties encountered by thin plate theory elements, concerning boundary conditions. For example, the polygonal approximation of curved, simply supported edges is convergent. Other topics discussed are the equivalence with mixed methods, rank deficiency, convergence criteria and useful mass 'lumping' schemes for dynamics. Numerical results for several thin plate problems indicate the high degree of accuracy attainable by the present elements. (Auth.)

  14. A new circuit technique for reduced leakage current in Deep Submicron CMOS technologies

    Directory of Open Access Journals (Sweden)

    A. Schmitz

    2005-01-01

    Full Text Available Modern CMOS processes in the Deep Submicron regime are restricted to supply voltages below 2 volts and further to account for the transistors' field strength limitations and to reduce the power per logic gate. To maintain the high switching performance, the threshold voltage must be scaled according with the supply voltage. However, this leads to an increased subthreshold current of the transistors in standby mode (VGS=0. Another source of leakage is gate current, which becomes significant for gate oxides of 3nm and below. We propose a Self-Biasing Virtual Rails (SBVR - CMOS technique which acts like an adaptive local supply voltage in case of standby mode. Most important sources of leakage currents are reduced by this technique. Moreover, SBVR-CMOS is capable of conserving stored information in sleep mode, which is vital for memory circuits. Memories are exposed to radiation causing soft errors. This well-known problem becomes even worse in standby mode of typical SRAMs, that have low driving performance to withstand alpha particle hits. In this paper, a 16-transistor SRAM cell is proposed, which combines the advantage of extremely low leakage currents with a very high soft error stability.

  15. Signal Amplification Technique (SAT): an approach for improving resolution and reducing image noise in computed tomography

    International Nuclear Information System (INIS)

    Phelps, M.E.; Huang, S.C.; Hoffman, E.J.; Plummer, D.; Carson, R.

    1981-01-01

    Spatial resolution improvements in computed tomography (CT) have been limited by the large and unique error propagation properties of this technique. The desire to provide maximum image resolution has resulted in the use of reconstruction filter functions designed to produce tomographic images with resolution as close as possible to the intrinsic detector resolution. Thus, many CT systems produce images with excessive noise with the system resolution determined by the detector resolution rather than the reconstruction algorithm. CT is a rigorous mathematical technique which applies an increasing amplification to increasing spatial frequencies in the measured data. This mathematical approach to spatial frequency amplification cannot distinguish between signal and noise and therefore both are amplified equally. We report here a method in which tomographic resolution is improved by using very small detectors to selectively amplify the signal and not noise. Thus, this approach is referred to as the signal amplification technique (SAT). SAT can provide dramatic improvements in image resolution without increases in statistical noise or dose because increases in the cutoff frequency of the reconstruction algorithm are not required to improve image resolution. Alternatively, in cases where image counts are low, such as in rapid dynamic or receptor studies, statistical noise can be reduced by lowering the cutoff frequency while still maintaining the best possible image resolution. A possible system design for a positron CT system with SAT is described

  16. High-Risk Breast Lesions: A Machine Learning Model to Predict Pathologic Upgrade and Reduce Unnecessary Surgical Excision.

    Science.gov (United States)

    Bahl, Manisha; Barzilay, Regina; Yedidia, Adam B; Locascio, Nicholas J; Yu, Lili; Lehman, Constance D

    2018-03-01

    Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer. Traditional features such as age and HRL histologic results were used in the model, as were text features from the biopsy pathologic report. Results One thousand six HRLs were identified, with a cancer upgrade rate of 11.4% (115 of 1006). A machine learning random forest model was developed with 671 HRLs and tested with an independent set of 335 HRLs. Among the most important traditional features were age and HRL histologic results (eg, atypical ductal hyperplasia). An important text feature from the pathologic reports was "severely atypical." Instead of surgical excision of all HRLs, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% (37 of 38) of malignancies would have been diagnosed at surgery, and 30.6% (91 of 297) of surgeries of benign lesions could have been avoided. Conclusion This study provides proof of concept that a machine learning model can be applied to predict the risk of upgrade of HRLs to cancer. Use of this model could decrease unnecessary surgery by nearly one-third and could help guide clinical decision making with regard to surveillance versus surgical excision of HRLs. © RSNA, 2017.

  17. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  18. Preoperative Embolization Reduces the Risk of Cathecolamines Release at the Time of Surgical Excision of Large Pelvic Extra-Adrenal Sympathetic Paraganglioma

    Directory of Open Access Journals (Sweden)

    Nicola Di Daniele

    2012-01-01

    Full Text Available A 30-year-old woman with severe hypertension was admitted to the hospital with a history of headache, palpitations, and diaphoresis following sexual intercourse. Twenty-four hour urinary excretion of free catecholamines and metabolites was markedly increased as was serum chromogranin A. Computed tomography scan revealed a large mass in the left adnex site and magnetic resonance imaging confirmed the computer tomography finding, suggesting the presence of extra-adrenal sympathetic paraganglioma. I-metaiodobenzyl guanidine scintigram revealed an increased uptake in the same area. Transcatheter arterial embolization of the mass resulted in marked decreases in blood pressure and urinary excretion of free catecholamines and metabolites. Surgical excision of the mass was then accomplished without complication. Preoperative embolization is a useful and safe procedure which may reduce the risk of catecholamines release at the time of surgical excision in large pelvic extra-adrenal sympathetic paraganglioma.

  19. Lattice Boltzmann flow simulations with applications of reduced order modeling techniques

    KAUST Repository

    Brown, Donald

    2014-01-01

    With the recent interest in shale gas, an understanding of the flow mechanisms at the pore scale and beyond is necessary, which has attracted a lot of interest from both industry and academia. One of the suggested algorithms to help understand flow in such reservoirs is the Lattice Boltzmann Method (LBM). The primary advantage of LBM is its ability to approximate complicated geometries with simple algorithmic modificatoins. In this work, we use LBM to simulate the flow in a porous medium. More specifically, we use LBM to simulate a Brinkman type flow. The Brinkman law allows us to integrate fast free-flow and slow-flow porous regions. However, due to the many scales involved and complex heterogeneities of the rock microstructure, the simulation times can be long, even with the speed advantage of using an explicit time stepping method. The problem is two-fold, the computational grid must be able to resolve all scales and the calculation requires a steady state solution implying a large number of timesteps. To help reduce the computational complexity and total simulation times, we use model reduction techniques to reduce the dimension of the system. In this approach, we are able to describe the dynamics of the flow by using a lower dimensional subspace. In this work, we utilize the Proper Orthogonal Decomposition (POD) technique, to compute the dominant modes of the flow and project the solution onto them (a lower dimensional subspace) to arrive at an approximation of the full system at a lowered computational cost. We present a few proof-of-concept examples of the flow field and the corresponding reduced model flow field.

  20. Evaluation of two iterative techniques for reducing metal artifacts in computed tomography.

    Science.gov (United States)

    Boas, F Edward; Fleischmann, Dominik

    2011-06-01

    To evaluate two methods for reducing metal artifacts in computed tomography (CT)--the metal deletion technique (MDT) and the selective algebraic reconstruction technique (SART)--and compare these methods with filtered back projection (FBP) and linear interpolation (LI). The institutional review board approved this retrospective HIPAA-compliant study; informed patient consent was waived. Simulated projection data were calculated for a phantom that contained water, soft tissue, bone, and iron. Clinical projection data were obtained retrospectively from 11 consecutively identified CT scans with metal streak artifacts, with a total of 178 sections containing metal. Each scan was reconstructed using FBP, LI, SART, and MDT. The simulated scans were evaluated quantitatively by calculating the average error in Hounsfield units for each pixel compared with the original phantom. Two radiologists who were blinded to the reconstruction algorithms used qualitatively evaluated the clinical scans, ranking the overall severity of artifacts for each algorithm. P values for comparisons of the image quality ranks were calculated from the binomial distribution. The simulations showed that MDT reduces artifacts due to photon starvation, beam hardening, and motion and does not introduce new streaks between metal and bone. MDT had the lowest average error (76% less than FBP, 42% less than LI, 17% less than SART). Blinded comparison of the clinical scans revealed that MDT had the best image quality 100% of the time (95% confidence interval: 72%, 100%). LI had the second best image quality, and SART and FBP had the worst image quality. On images from two CT scans, as compared with images generated by the scanner, MDT revealed information of potential clinical importance. For a wide range of scans, MDT yields reduced metal streak artifacts and better-quality images than does FBP, LI, or SART. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101782/-/DC1. RSNA, 2011

  1. Making mock-FNA smears from fresh surgical pathology specimens to improve smear preparation technique and to create cytohistological correlation series.

    Directory of Open Access Journals (Sweden)

    Tibor Mezei

    Full Text Available Fine needle aspiration (FNA cytology is a well-established diagnostic method based on the microscopic interpretation of often scant cytological material; therefore, experience, good technique and smear quality are equally important in obtaining satisfactory results.We studied the use of fresh surgical pathology specimens for making so-called mock-FNA smears with the potential of cytohistological correlation. Additionally, we studied how this process aids the improvement of preparation technique and smear quality.Cytological aspirates from 32 fresh biopsy specimens from various sites: lung (20, lymph nodes (6, and breast (6 were obtained, all with a clinical diagnosis of tumor. Aspiration was performed from grossly palpable tumors. 25 G needle and Cameco-type syringe holder was used with minimal or no suction.Unfixed surgical specimens provided sufficient cytological material that resulted in good quality smears. After standard processing of specimens into microscopic sections from paraffin embedded tissues, cytohistological case-series were created. No significant alteration was reported in tissue architecture on hematoxylin-eosin stained sections after the aspiration procedure. A gradual, but steady improvement was observed in smear quality just after a few preparations.Our study proved that surgical specimens may be used as a source of cytological material to create cytohistological correlation studies and also to improve FNA cytology skills. The use of very fine gauge needle (25 G, 0,6 mm diameter during the sampling process does not alter tissue architecture therefore the final histopathological diagnosis is not compromised. We conclude that by using fresh surgical specimens useful cytohistological collections can be created both as a teaching resource and as improving experience.

  2. Surgical Assisting

    Science.gov (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  3. Evaluating the effect of river restoration techniques on reducing the impacts of outfall on water quality

    Science.gov (United States)

    Mant, Jenny; Janes, Victoria; Terrell, Robert; Allen, Deonie; Arthur, Scott; Yeakley, Alan; Morse, Jennifer; Holman, Ian

    2015-04-01

    between metal types. Restored sites also showed lower variability in metal concentrations than un-restored sites, which is linked to greater bank stability and hence lower bank erosion rates within restored sites as eroding banks were noted to be a source of metal contaminants. The success of pollutant removal by set-back outfalls was varied due to additional factors including the distance between the set-back outfall and the main channel, vegetation type, density and age. The study highlights the ability of restoration techniques to reduce metal contaminant concentrations at outfalls, and provides an indication of the potential benefits from wider application of similar techniques.

  4. Accurate laser skin perforation technique aimed at promoting bleeding and reducing pain

    Directory of Open Access Journals (Sweden)

    Han-Chao Chang

    2015-11-01

    Full Text Available Laser skin perforation is an effective and promising technique for use in blood collection. In this study, the relation between the perforation profile of skin and laser irradiation at various energies is discussed. Increasing laser energy does not uniformly expand the size and depth of a hole because the shallow depth of field (DOF of the focused light primarily concentrates energy on the skin surface. In practice, the hole gradually transforms from a semielliptical shape to an upside-down avocado shape as the laser energy increases. This phenomenon can increase the amount of bleeding and reduce pain. The findings support the feasibility of developing an accurate laser skin perforation method.

  5. Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality of care?

    Science.gov (United States)

    Marang-van de Mheen, Perla J; van Duijn-Bakker, Nanny; Kievit, Job

    2007-12-01

    Previous research has shown that sicker patients are less satisfied with their healthcare, but specific effects of adverse health outcomes have not been investigated. The present study aimed to assess whether patients who experience adverse outcomes, in hospital or after discharge, differ in their evaluation of quality of care compared with patients without adverse outcomes. In hospital adverse outcomes were prospectively recorded by surgeons and surgical residents as part of routine care. Four weeks after discharge, patients were interviewed by telephone about the occurrence of post-discharge adverse outcomes, and their overall evaluation of quality of hospital care and specific suggestions for improvements in the healthcare provided. Of 2145 surgical patients admitted to the Leiden University Medical Center in 2003, 1876 (88%) agreed to be interviewed. Overall evaluation was less favourable by patients who experienced post-discharge adverse outcomes only (average 19% lower). These patients were also more often dissatisfied (OR 2.02, 95% CI 1.24 to 3.31) than patients without adverse outcomes, and they more often suggested that improvements were needed in medical care (OR 2.07, 1.45 to 2.95) and that patients were discharged too early (OR 3.26, 1.72 to 6.20). The effect of in hospital adverse outcomes alone was not statistically significant. Patients with both in hospital and post-discharge adverse outcomes also found the quality of care to be lower (on average 33% lower) than patients without adverse outcomes. Post-discharge adverse outcomes negatively influence patients' overall evaluation of quality of care and are perceived as being discharged too early, suggesting that patients need better information at discharge.

  6. The Pringle maneuver reduces the infusion rate of rocuronium required to maintain surgical muscle relaxation during hepatectomy.

    Science.gov (United States)

    Kajiura, Akira; Nagata, Osamu; Sanui, Masamitsu

    2018-04-27

    We investigated the continuous infusion rates of rocuronium necessary to obtain the surgical muscle relaxation before, during, and after the Pringle maneuver on patients who underwent hepatectomy. Fifteen patients were induced by total intravenous anesthesia with propofol. After obtaining the calibration of acceleromyography, the patient was intubated with rocuronium 0.6 mg/kg. Fifteen minutes after initial rocuronium injection, the continuous infusion was started at 7.5 µg/kg/min. The infusion rate was adjusted every 15 min so that the first twitch height (% T1) might become from 3 to 10% of control. The infusion rates at the time when the state of surgical muscle relaxation was achieved for more than 15 min were recorded before, during and after the Pringle maneuver. The 25% recovery time was measured after discontinuing the continuous infusion. The infusion rate of rocuronium before, during, and after the Pringle maneuver was 7.2 ± 1.8, 4.2 ± 1.4, and 4.7 ± 1.5 µg/kg/min (mean ± SD), respectively. The rocuronium infusion rate during the Pringle maneuver was decreased about 40% compared to that before this maneuver, and that after completion of the Pringle maneuver was not recovered to that before the Pringle maneuver. The 25% recovery time was 20 ± 7 min. In case of continuous administration of rocuronium during surgery performing the Pringle maneuver, it was considered necessary to regulate the administration of rocuronium using muscle relaxant monitoring in order to deal with the decrease in muscle relaxant requirement by the Pringle maneuver.

  7. Running quietly reduces ground reaction force and vertical loading rate and alters foot strike technique.

    Science.gov (United States)

    Phan, Xuan; Grisbrook, Tiffany L; Wernli, Kevin; Stearne, Sarah M; Davey, Paul; Ng, Leo

    2017-08-01

    This study aimed to determine if a quantifiable relationship exists between the peak sound amplitude and peak vertical ground reaction force (vGRF) and vertical loading rate during running. It also investigated whether differences in peak sound amplitude, contact time, lower limb kinematics, kinetics and foot strike technique existed when participants were verbally instructed to run quietly compared to their normal running. A total of 26 males completed running trials for two sound conditions: normal running and quiet running. Simple linear regressions revealed no significant relationships between impact sound and peak vGRF in the normal and quiet conditions and vertical loading rate in the normal condition. t-Tests revealed significant within-subject decreases in peak sound, peak vGRF and vertical loading rate during the quiet compared to the normal running condition. During the normal running condition, 15.4% of participants utilised a non-rearfoot strike technique compared to 76.9% in the quiet condition, which was corroborated by an increased ankle plantarflexion angle at initial contact. This study demonstrated that quieter impact sound is not directly associated with a lower peak vGRF or vertical loading rate. However, given the instructions to run quietly, participants effectively reduced peak impact sound, peak vGRF and vertical loading rate.

  8. A study of ′cough trick′ technique in reducing vaccination prick pain in adolescents

    Directory of Open Access Journals (Sweden)

    Vikram S. Kumar

    2014-01-01

    Full Text Available Background: The ′cough trick′ (CT technique is used in reducing intramuscular prick (IMP pain during vaccinations and also for brief painful procedures like subcutaneous injection, intravenous cannulation, and so forth. We present the utility study of this technique in male adolescents. Materials and Methods: A Randomized Crossover Volunteer Study of 50 early adolescent male children (age 11-13 receiving immunizations was performed. Participants were recruited from four outpatient pediatric clinics. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain. Results: Paired ′t′ test revealed that the procedure was effective at a statistically and clinically significant level for participants. Children found the procedure acceptable and effective. Conclusions: The results of this study suggest that the CT can be an effective strategy for the reduction of pain for male adolescent children undergoing routine immunizations. However, additional research is needed with a larger sample size with different age groups and also including girl children.

  9. A comparative study of surgical drain placement and the use of kinesiologic tape to reduce postoperative morbidity after third molar surgery.

    Science.gov (United States)

    Genc, Aysenur; Cakarer, Sirmahan; Yalcin, Basak Keskin; Kilic, Beril Berivan; Isler, Sabri Cemil; Keskin, Cengizhan

    2018-04-19

    Our aim was to compare the effects of the surgical drain and kinesiotape applications on postoperative morbidity after mandibular third molar surgery in a split-mouth study design. A single-centre, split-mouth study was performed in 23 patients who needed surgical removal of bilateral mandibular third molars. Each patient was treated with a drain tube on one side of the mandible and Kinesio tape (KT) on the contralateral side. Swelling was significantly greater in the KT group than in the drain group throughout the study period. The groups did not differ significantly in the amount of trismus at any time point. The Visual Analogue Scale (VAS)-measured pain intensity was significantly lower in the drainage group. Patients with KT had greater postoperative discomfort than those with a drain tube. All patients were generally satisfied with their treatments. Although both treatments were useful, a surgical drain was significantly more effective at reducing swelling and pain intensity than Kinesio tape. The effects of both on trismus were similar.

  10. Applying Lean Techniques to Reduce Intravenous Waste Through Premixed Solutions and Increasing Production Frequency.

    Science.gov (United States)

    Lin, Alex C; Penm, Jonathan; Ivey, Marianne F; Deng, Yihong; Commins, Monica

    This study aims to use lean techniques and evaluate the impact of increasing the use of premixed IV solutions and increased IV production frequency on IV waste. Study was conducted at a tertiary hospital pharmacy department in three phases. Phase I included evaluation of IV waste when IV production occurred three times a day and eight premixed IV products were used. Phase II increased the number of premixed IV products to 16. Phase III then increased IV production to five times a day. During Phase I, an estimate of 2,673 IV doses were wasted monthly, accounting for 6.14% of overall IV doses. This accounted for 688 L that cost $60,135. During Phase II, the average monthly IV wastage reduced significantly to 1,069 doses (2.84%), accounting for 447 L and $34,003. During Phase III, the average monthly IV wastage was further decreased to 675 doses (1.69%), accounting for 78 L and $3,431. Hence, a potential annual saving of $449,208 could result from these changes. IV waste was reduced through the increased use of premixed solutions and increasing IV production frequency.

  11. Neutralizing misinformation through inoculation: Exposing misleading argumentation techniques reduces their influence.

    Science.gov (United States)

    Cook, John; Lewandowsky, Stephan; Ecker, Ullrich K H

    2017-01-01

    Misinformation can undermine a well-functioning democracy. For example, public misconceptions about climate change can lead to lowered acceptance of the reality of climate change and lowered support for mitigation policies. This study experimentally explored the impact of misinformation about climate change and tested several pre-emptive interventions designed to reduce the influence of misinformation. We found that false-balance media coverage (giving contrarian views equal voice with climate scientists) lowered perceived consensus overall, although the effect was greater among free-market supporters. Likewise, misinformation that confuses people about the level of scientific agreement regarding anthropogenic global warming (AGW) had a polarizing effect, with free-market supporters reducing their acceptance of AGW and those with low free-market support increasing their acceptance of AGW. However, we found that inoculating messages that (1) explain the flawed argumentation technique used in the misinformation or that (2) highlight the scientific consensus on climate change were effective in neutralizing those adverse effects of misinformation. We recommend that climate communication messages should take into account ways in which scientific content can be distorted, and include pre-emptive inoculation messages.

  12. A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas.

    Science.gov (United States)

    Devendra, Jaya; Agarwal, Smita; Singh, Pankaj Kumar

    2014-11-01

    Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. A prospective randomised controlled trial of cataract patients operated by two different techniques. One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. Unpaired t-test was used to calculate the p- value. The results were evaluated on the following criteria. The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis , while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- was less for SICS group as compared to phaco group. SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL.

  13. 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. ...

  14. A new surgical technique for traumatic dislocation of posterior tibial tendon with avulsion fracture of medial malleolus.

    Science.gov (United States)

    Jeong, Soon-Taek; Hwang, Sun-Chul; Kim, Dong-Hee; Nam, Dae-Cheol

    2015-01-01

    We introduce a case of traumatic dislocation of the posterior tibial tendon with avulsion fracture of the medial malleolus in a 52-year-old female patient who was treated surgically with periosteal flap and suture anchor fixation. Based in the posteromedial ridge of the distal tibia, a quadrilateral periosteal flap was created and folded over the tendon, followed by fixation on the lateral aspect of the groove by use of multiple suture anchors. Clinical and radiological findings 25 months postoperatively showed well-preserved function of the ankle joint with stable tendon gliding.

  15. Behaviour change techniques used in digital interventions to reduce excessive alcohol consumption

    Directory of Open Access Journals (Sweden)

    David Crane

    2015-10-01

    Full Text Available Background: Excessive alcohol consumption is a leading contributor to the global burden of disease. A large number of digital interventions have been developed to help people reduce their consumption. Coding interventions to assess the behaviour change techniques (BCTs they contain may advance understanding of the active ingredients that contribute to intervention effectiveness. Aim: To assess the extent to which BCTs are included in digital interventions to reduce alcohol consumption. Methods: A search of databases including MEDLINE, PsycINFO and the Cochrane Library identified 53 interventions to reduce alcohol consumption evaluated in RCTs. Intervention content was coded for BCTs according to the BCT Taxonomy (v1 using an established method. Results: There were 72 experimental arms in the 53 included studies. The most frequently used BCTs were: ‘Feedback on behaviour’ (70.8%, n=51, ‘Social comparison’ (68.1%, n=49, ‘Feedback on outcomes of behaviour (52.8%, n=38, ‘Social support’ (52.8%, n=38, and ‘Information about social and environmental consequences’ (50.0%, n=36. Of the ninety-three possible BCTs that could have been used, 15 were used in more than 20% of arms, 53 were used at least once and 40 were never used. The mean number of BCTs used was 7.8 (SD=5.6. Conclusions: Digital alcohol interventions have used a broad range of BCTs. However, many BCTs were used infrequently and the evaluations have not been set up to evaluate the effectiveness of individual BCTs or clusters of BCTs.

  16. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, Jakob Hornstrup Frølunde; Rosenberg, J

    2015-01-01

    BACKGROUND AND AIMS: A new technique for the repair of inguinal hernia, called Onstep, has been described. This technique places the mesh in the preperitoneal space medially and between the internal and external oblique muscles laterally. The Onstep technique has not yet been described outside...... repair. Inguinal Pain Questionnaire results: 95.5% reported no pain or pain that was easily ignored. CONCLUSIONS: It seems from this study that the Onstep technique is a safe method for inguinal hernia repair regarding perioperative and postoperative complications. The postoperative pain seems...

  17. All Internal Segmental Bone Transport and Optional Lengthening With a Newly Developed Universal Cylinder-Kombi-Tube Module for Motorized Nails-Description of a Surgical Technique.

    Science.gov (United States)

    Krettek, Christian; El Naga, Ashraf

    2017-10-01

    Segmental transport is an effective method of treatment for segmental defects, but the need for external fixation during the transport phase is a disadvantage. To avoid external fixation, we have developed a Cylinder-Kombi-Tube Segmental Transport (CKTST) module for combination with a commercially available motorized lengthening nail. This CKTST module allows for an all-internal segmental bone transport and also allows for optional lengthening if needed. The concept and surgical technique of CKTST are described and illustrated with a clinical case.

  18. Treatment of lithic tumors of the distal ending of the radius: Results of two surgical techniques in a series of cases

    International Nuclear Information System (INIS)

    Escandon, Santiago; Soto, Camilo; Pulido, Edgar

    2003-01-01

    The distal ending of the radius can bear several tumors with different degrees of aggressiveness that depend on the extension of the tumor. Their treatment varies according to the aggressiveness it and can include curettage only or may require more extensive surgical procedures including, in some cases reconstructive surgery. The present study describes two surgical reconstructive techniques and their results in a series of cases. Five patients underwent radio-carpal, and three Ulnar-carpal arthrodesis with non-vascularized autologous bone graft from the iliac crest. Pathology diagnosis included: six giant cell tumors, one Ewing's sarcoma, and one chondroblastoma. There were five males and three females, with an average age of 34.6 years (rank: 17-52). All the patients underwent wide surgical resection of the tumor, and only the patient with the Ewing's sarcoma received additionally adjuvant chemotherapy and radiotherapy. Five patients had compromise of the surrounding soft tissues. Two had limitation of movement of the fingers, and one hypoesthesia. One patient with ulnar arthrodesis had a fracture of the cubitus, at the proximal ending of the plate, secondary to trauma. AII patients have been followed for an average time of 12.8 months (rank: 0.5-72). There have been no episodes of infection. Neither non-union of the osteotomies, nor failures of fixation or recurrences were observed

  19. The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function

    Directory of Open Access Journals (Sweden)

    Antonio C. Pinto

    2007-12-01

    Full Text Available OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life. MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery. RESULT: Among these 64 patients, 60.94% had regular sexual activity, while 39.06% did not. Among sexually active patients, 59% had urine loss during sexual intercourse and, of these, 87% had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation. CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function.

  20. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

    Science.gov (United States)

    Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

    2018-01-01

    Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

  1. Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques.

    Science.gov (United States)

    Rokito, Andrew S; Birdzell, Maureen Gallagher; Cuomo, Frances; Di Paola, Matthew J; Zuckerman, Joseph D

    2010-06-01

    Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown. The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction. Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1. This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  2. Experiences of reduced work hours for nurses and assistant nurses at a surgical department: a qualitative study

    OpenAIRE

    Gyllensten, Kristina; Andersson, Gunnar; Muller, Helena

    2017-01-01

    Background There is a shortage of registered nurses in the European Union (EU), and job dissatisfaction and perceived high work?family conflict have been identified as causes of nursing staff turnover. Reducing work hours is an organisational intervention that could have a positive effect on nurses? and assistant nurses? job satisfaction, work?life balance, and willingness to stay in the job. An orthopaedic surgery department at a large hospital in Sweden introduced reduced work hours for nur...

  3. Comparison of 2 surgical techniques for reconstructing posterolateral corner of the knee: a cadaveric study evaluated by navigation system.

    Science.gov (United States)

    Ho, Eric Po-Yan; Lam, Mak-Ham; Chung, Mandy Man-Ling; Fong, Daniel Tik-Pui; Law, Billy Kan-Yip; Yung, Patrick Shu-Hang; Chan, Wood-Yee; Chan, Kai-Ming

    2011-01-01

    This study aimed to evaluate the immediate effect on knee kinematics by 2 different techniques of posterolateral corner (PLC) reconstruction. Five intact formalin-preserved cadaveric knees were used in this study. A navigation system was used to measure knee kinematics (posterior translation, varus angulation, and external rotation) after application of a constant force and torque to the tibia. Four different conditions of the knee were evaluated during the biomechanical test: intact knee and PLC-sectioned knee and PLC-reconstructed knee by the double-femoral tunnel technique and single-femoral tunnel technique. Sectioning of the PLC structures resulted in significant increases in external rotation at 30° of flexion from 11.2° (SD, 2.6) to 24.6° (SD, 6.2), posterior translation at 30° of flexion from 3.4 mm (SD, 1.5) to 7.4 mm (SD, 3.8), and varus angulation at 0° of flexion from 2.3° (SD, 2.1) to 7.9° (SD, 5.1). Both reconstruction techniques significantly restored the varus stability. The external rotation and posterior translation at 30° of flexion after reconstruction with the double-femoral tunnel technique were 10.2° (SD, 1.3) and 3.4° (SD, 2.7), respectively, which were significantly better than those of the single-femoral tunnel technique. Both techniques of reconstruction showed improved stability compared with PLC-sectioned knees. The double-femoral tunnel technique in PLC reconstruction showed better rotational stability and resistance to posterior translation than the single-femoral tunnel technique without compromising varus stability. PLC reconstruction by a double-femoral tunnel technique achieves better rotational control and resistance to posterior translation. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Efficacy of two sperm preparation techniques in reducing non-specific bacterial species from human semen

    Directory of Open Access Journals (Sweden)

    Prabath K Abeysundara

    2013-01-01

    Full Text Available Context: Artificial reproductive techniques using seminal preparations with bacteria may cause pelvic inflammatory disease and its sequalae. Aims: To assess efficacy of two sperm preparation techniques to clear bacteria and the effect of bacteriospermia on sperm recovery rates. Settings and Design: A descriptive cross-sectional study was carried out among males of subfertile couples. Subjects and Methods: Semen samples were randomly allocated into swim-up method (group S, n = 68 and density gradient method (group D, n = 50 for sperm preparation. Seminal fluid analysis and bacterial cultures were performed in each sample before and after sperm preparation. Statistical Analysis: McNemar′s chi-squared test and independent samples t-test in SPSS version 16.0 were used. Results: Organisms were found in 86 (72.88% out of 118 samples, before sperm preparation; Streptococcus species (n = 40, 46.51% of which 14 were Group D Streptococcus species, Coagulase negative Staphylococcus species (n = 17, 19.76%, Staphylococcus aureus (n = 13, 15.11%, Coliform species (n = 11, 12.79% of which 09 were Escherichia coli and Corynebacterium species (n = 5, 5.81%. There was a statistically significant reduction of culture positive samples in raw vs. processed samples; in group S, 49 (72.05% vs. 16 (23.52% and in group D, 37 (74% vs. 18 (36%. In group S and D, mean (SD recovery rates of culture positive vs. culture negative samples were 39.44% (SD-14.02 vs. 44.22% (SD-22.38, P = 0.39 and 52.50% (SD-37.16 vs. 49.58% (SD-40.32, P = 0.82 respectively. Conclusions: Both sperm preparation methods significantly reduced bacteria in semen, but total clearance was not achieved. Sperm recovery rate was not affected by bacteriospermia.

  5. The Auckland Cataract Study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service

    Science.gov (United States)

    Riley, Andrew F; Malik, Tahira Y; Grupcheva, Christina N; Fisk, Michael J; Craig, Jennifer P; McGhee, Charles N

    2002-01-01

    Aim: To prospectively assess cataract surgery in a major New Zealand public hospital by defining presenting clinical parameters and surgical and clinical outcomes in a cohort of subjects just below threshold for treatment, based upon a points based prioritisation system. Methods: The prospective observational study comprised 488 eyes of 480 subjects undergoing consecutive cataract operations at Auckland Hospital. All subjects underwent extensive ophthalmic examination before and after surgery. Details of the surgical procedure, including any intraoperative difficulties or complications, were documented. Postoperative review was performed at 1 day and 4 weeks after surgery. Demographic data, clinical outcomes, and adverse events were correlated by an independent assessor. Results: The mean age at surgery was 74.9 (SD 9.6) years with a female predominance (62%). Significant systemic disease affected 80% of subjects, with 20% of the overall cohort exhibiting diabetes mellitus. 26% of eyes exhibited coexisting ocular disease and in 7.6% this affected best spectacle corrected visual acuity (BSCVA). A mean spherical equivalent of −0.49 (1.03) D and mean BSCVA of 0.9 (0.6) log MAR units (Snellen equivalent approximately 6/48) was noted preoperatively. Local anaesthesia was employed in 99.8% of subjects (94.9% sub-Tenon's). The majority of procedures (97.3%) were small incision phacoemulsification with foldable lens implant. Complications included: 4.9% posterior capsule tears, 3.8% cystoid macular oedema, and one case (0.2%) of endophthalmitis. Mean BSCVA after surgery was 0.1 (0.2) log MAR units (6/7.5 Snellen equivalent), with a mean spherical equivalent of −0.46 (0.89) D, and was 6/12 or better in 88% of all eyes. A drop in BSCVA, thought to be directly attributable to the surgical intervention, was recorded in a small percentage of eyes (1.5%) after surgery. Conclusion: This study provides a representative assessment of the management of cataract in the New

  6. SU-E-T-31: Alternative VMAT Technique Reduces Total Monitor Units for Lung SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Happersett, L; Mechalakos, J; Kuo, L; Zhang, P; Rimner, A [Memorial Sloan-Kettering Cancer Center, NY, NY (United States)

    2014-06-01

    Purpose: To investigate an alternative approach to VMAT optimization for hypofractionation lung treatment which increases average aperture opening and results in lower total Monitor Units (MU) without significantly sacrificing plan quality. Methods: Benchmark Volumetric Modulated Arc Therapy (bVMAT) plans were generated for 10 lung Stereotactic Body radiotherapy (SBRT) cases using Eclipse Version 11.0.42 (Varian Medical Systems) without a maximum MU constraint. Prescriptions ranged from 40 to 54Gy in 3 to 5 fractions. AAA dose calculation and PRO fluence based optimization was utilized. Two comparison VMAT plans were generated for each case, one that forced an initial “open” mlc aperture conformal to the tumor as a starting condition (oVMAT) with similar optimization parameters and arc geometries, and one that repeated the bVMAT optimization but added a maximum MU constraint (muVMAT). All plans used two arcs with lengths between 168 to 230 degrees. PTV D 95% and Dmean, lung V20 Gy, chest wall V30 Gy, average aperture opening and MU's were compared. Statistical significance was evaluated using Wilcoxon signed rank test. Results: Average PTV D(95), PTV mean and lung V20Gy over all plans was 99.2 ± 1.7%, 103.3 ± 0.6% and 7.8 ± 2.4% respectively. The average chest wall V30Gy was 61 ± 61 cc and ranged between 0 to 166 cc. There were no significant differences between the three techniques for the dosimetric quantities. MUs were reduced by 11 ±11% (p<0.01) and 25 ± 5% (p<0.01) and the average aperture size was increased by 13.7 ± 14% (p=0.02) and 35.8 ± 10% (p<0.01) with muVMAT and oVMAT, respectively, compared to bVMAT. Conclusion: oVMAT and muVMAT techniques were both able to increase average aperture size and reduce total MU compared to the benchmark VMAT plan, but the magnitude of the changes observed for oVMAT was larger.

  7. Risk-reducing surgery on the uterine adnexa: timing and type of surgical treatment, and pathology report.

    Science.gov (United States)

    Signorelli, Mauro; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Chiappa, Valentina; Lopez, Carlos; Scaffa, Cono; Lorusso, Domenica; Raspagliesi, Francesco

    2016-10-01

    Inherited mutations in BRCA1 and BRCA2 increase significantly the risk of developing breast and ovarian cancers, and they have been associated with increased risks of developing other types of cancer. Although screening programs have been implemented in order to detect cancers at the early stage, they resulted ineffective. To date, risk-reducing bilateral salpingo-oophorectomy represents the only procedure allowing reducing the incidence of ovarian cancer and increasing survival among BRCA1 and -2 mutation carriers. In the present review we will discuss the advantages and disadvantages related to the execution of prophylactic surgery, thus underlying possible beneficial and detrimental effects of this kind of surgery in premenopausal women. Additionally, we will investigate further therapeutic strategies aimed to reduce the risk of developing ovarian cancer, without affected patients' hormonal status.

  8. Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture.

    Science.gov (United States)

    Langenhan, Ronny; Bushuven, Stefanie; Reimers, Niklas; Probst, Axel

    2018-04-01

    The aim of this study was to conduct a re-evaluation of current strategies for peri-operative prophylaxis of infections in orthopaedic surgery of geriatric patients (≥65 years) with proximal femoral fractures (PFF). Between 01/2010 and 08/2014 all post-operative infections after stabilization of PFF of 1,089 geriatric patients were recorded retrospectively. All patients pre-operatively received a single dose of 1.5 g cefuroxime (group 1). These were compared to prospectively determined post-operative rates of surgical site infection (SSI) of 441 geriatric patients, which were operated on between 09/2014 and 03/2017 due to PFF. In this second group we investigated the urinary tract on admission. Bacteriuria was treated with the pre-operative single dose of 1.5 g cefuroxime along with ciprofloxacin for five days, beginning on admission. Level of significance was set to p infection. Multi-resistant pathogens were found in 15 patients and pathogens were cefuroxime-resistant in 37. The differences of SSI after at least three months were 2.1% in group 1 and 0.45% in group 2 for all patients with surgery of PFF (p < 0.02) and for those with arthroplasty (p < 0.037) significant. The immediate antibiotic therapy of a prevalent bacteriuria for five days decreases the risk of SSI after surgery of PFF. Our single-centre study can only point out the problem of prevalent reservoirs of pathogens and the need for treatment. Evidence-based therapy concepts (indications of antibiotics, classes, duration) have to be developed in multi-centric and prospective studies.

  9. Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case.

    Science.gov (United States)

    Townsend, F I; Ralphs, S C; Coronado, G; Sweet, D C; Ward, J; Bloch, C P

    2012-01-01

    To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts. Ex vivo experimental study and a single clinical case report. Four canine cadavers and a single clinical case. Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample. The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens. The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.

  10. Evaluation of a New Surgical Technique for Closing Oroantral Fistula Using Auto-transplanted Upper Third Molar: A 1-Year Follow-Up Study.

    Science.gov (United States)

    Assad, Mounzer; Alkhaled, Maysaa; Alhajj, Mohammed N

    2018-03-01

    Oroantral fistula (OAF) is considered a frequent complication in dental practice. Many surgical techniques/methods have been proposed to close it. The aim of this study was to evaluate the auto-transplantation of upper third molar for closing OAF. Twenty patients participated in this study aged between 20 and 40 years old. The OAF was closed by auto-transplantation of upper third molar placed directly in the socket of the extracted tooth. Results were evaluated clinically and radiographically through the period of observation which lasted for 1 year. Final results showed that the success rate of closing OAF was 95% while the success rate of upper third molar auto-transplantation was 90%. This technique is simple, applicable, provides immediate replacement of the missing tooth, and does not require complicated instruments or procedures.

  11. Evaluating chemical extraction techniques for the determination of uranium oxidation state in reduced aquifer sediments

    Science.gov (United States)

    Stoliker, Deborah L.; Campbell, Kate M.; Fox, Patricia M.; Singer, David M.; Kaviani, Nazila; Carey, Minna; Peck, Nicole E.; Barger, John R.; Kent, Douglas B.; Davis, James A.

    2013-01-01

    Extraction techniques utilizing high pH and (bi)carbonate concentrations were evaluated for their efficacy in determining the oxidation state of uranium (U) in reduced sediments collected from Rifle, CO. Differences in dissolved concentrations between oxic and anoxic extractions have been proposed as a means to quantify the U(VI) and U(IV) content of sediments. An additional step was added to anoxic extractions using a strong anion exchange resin to separate dissolved U(IV) and U(VI). X-ray spectroscopy showed that U(IV) in the sediments was present as polymerized precipitates similar to uraninite and/or less ordered U(IV), referred to as non-uraninite U(IV) species associated with biomass (NUSAB). Extractions of sediment containing both uraninite and NUSAB displayed higher dissolved uranium concentrations under oxic than anoxic conditions while extractions of sediment dominated by NUSAB resulted in identical dissolved U concentrations. Dissolved U(IV) was rapidly oxidized under anoxic conditions in all experiments. Uraninite reacted minimally under anoxic conditions but thermodynamic calculations show that its propensity to oxidize is sensitive to solution chemistry and sediment mineralogy. A universal method for quantification of U(IV) and U(VI) in sediments has not yet been developed but the chemical extractions, when combined with solid-phase characterization, have a narrow range of applicability for sediments without U(VI).

  12. An enhanced technique for mobile cloudlet offloading with reduced computation using compression in the cloud

    Science.gov (United States)

    Moro, A. C.; Nadesh, R. K.

    2017-11-01

    The cloud computing paradigm has transformed the way we do business in today’s world. Services on cloud have come a long way since just providing basic storage or software on demand. One of the fastest growing factor in this is mobile cloud computing. With the option of offloading now available to mobile users, mobile users can offload entire applications onto cloudlets. With the problems regarding availability and limited-storage capacity of these mobile cloudlets, it becomes difficult to decide for the mobile user when to use his local memory or the cloudlets. Hence, we take a look at a fast algorithm that decides whether the mobile user should go for cloudlet or rely on local memory based on an offloading probability. We have partially implemented the algorithm which decides whether the task can be carried out locally or given to a cloudlet. But as it becomes a burden on the mobile devices to perform the complete computation, so we look to offload this on to a cloud in our paper. Also further we use a file compression technique before sending the file onto the cloud to further reduce the load.

  13. Experiences of reduced work hours for nurses and assistant nurses at a surgical department: a qualitative study.

    Science.gov (United States)

    Gyllensten, Kristina; Andersson, Gunnar; Muller, Helena

    2017-01-01

    There is a shortage of registered nurses in the European Union (EU), and job dissatisfaction and perceived high work-family conflict have been identified as causes of nursing staff turnover. Reducing work hours is an organisational intervention that could have a positive effect on nurses' and assistant nurses' job satisfaction, work-life balance, and willingness to stay in the job. An orthopaedic surgery department at a large hospital in Sweden introduced reduced work hours for nurses and assistant nurses in order to improve the working situation. The aim of the study was to investigate the experiences of reduced work hours and no lunch breaks among nurses and assistant nurses at an orthopaedic surgery department at a hospital in Sweden, with a particular focus on recovery and psychosocial working environment. A qualitative design was used in the study. Eleven nurses and assistant nurses working at the particular orthopaedic department took part in the study, and semi-structured interviews were used to collect data. The interviews were analysed by interpretative phenomenological analysis. Four main themes were developed in the analysis of the data: A more sustainable working situation, Improved work-life balance, Consequences of being part of a project, and Improved quality of care. Each theme consisted of subthemes. Overall, reduced work hours appeared to have many, mainly positive, effects for the participants in both work and home life.

  14. How changes in a radiologist's technique can reduce patient dose in barium enema studies

    International Nuclear Information System (INIS)

    Corbett, R.H.

    2001-01-01

    Changes in a radiologist's technique, especially utilising digital technology, can lead to substantial dose savings in barium enema examinations. Data will be provided showing a 20% saving with only minimal change in technique. (author)

  15. Neural tension technique is no different from random passive movements in reducing spasticity in patients with traumatic brain injury

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Nielsen, Dorthe; Holm, Karl

    2012-01-01

    Purpose: Neural tension technique (NTT) is a therapy believed to reduce spasticity and to increase range of motion (ROM). This study compared the ability of NTT and random passive movements (RPMs) to reduce spasticity in the knee flexors in 10 spastic patients with brain injury. Methods: An RCT...

  16. Martial arts fall techniques reduce hip impact forces in naive subjects after a brief period of training.

    NARCIS (Netherlands)

    Weerdesteijn, V.G.M.; Groen, B.E.; Swigchem, R. van; Duysens, J.E.J.

    2008-01-01

    Hip fractures are among the most serious consequences of falls in the elderly. Martial arts (MA) fall techniques may reduce hip fracture risk, as they are known to reduce hip impact forces by approximately 30% in experienced fallers. The purpose of this study was to investigate whether hip impact

  17. Central pancreatectomy: The Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach

    Science.gov (United States)

    Iacono, Calogero; Ruzzenente, Andrea; Bortolasi, Luca; Guglielmi, Alfredo

    2014-01-01

    Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection (SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot (1957) and Letton and Wilson (1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came. PMID:25400451

  18. SURGICAL TREATMENT OF SEVERE (2-3 DEGREE DEFORMING ARTHROSIS OF FIRST METATARSOPHALANGEAL JOINT OF FOOT: TASKS, APPROACHES, TECHNIQUE

    Directory of Open Access Journals (Sweden)

    A. V. Mazalov

    2011-01-01

    Full Text Available Based on the experience of treating 67 patients (98 feet with deforming arthrosis of first metatarsophalangeal joint is shown that the treatment of this disease the distal decompressing osteotomy in combination with maximally radical the separation of the unions and cheilectomy possesses the significant health-improvement potential, which makes it possible to be turned to arthrodesis or arthroplasty only in the limiting cases of that the heavy cases of hallux rigidus. L-osteotomy 1-st metatarsus gives more than possibilities for the correction with the heavy deformations and the degenerate changes, the basic criterion of sufficiency of which is the volume of the intra-operating straightening of 1-st fingers reached. Optimum is reaching the straightening 1-st toes to 65° even above. An indispensable stage of complex operation is maximally radical of cheilectomy. During the formation of arthrodesis 1-st metatarsophalangeal joint in the horizontal plane the axis of 1 finger should be oriented in parallel to axis second metatarsal bones. The sagittal angle of the formation of arthrodesis depends on the manifestation of valgus of rear division. Active postoperative conducting essentially improves the distant results of the surgical treatment of deforming arthrosis of first metatarsophalangeal joint.

  19. A simple technique to reduce small bowel toxicity when irradiating the periaortic area

    International Nuclear Information System (INIS)

    Hernandez, J.C.; Fine, B.; Herman, T.S.; Rothenberg, M.; Nicol, N.

    1996-01-01

    Purpose/Objective: Patients receiving periaortic radiation are normally treated in the supine position. We decided to evaluate whether positioning the patient prone on a modified 'belly-board' can reduce the volume of small bowel within the lateral fields in patients receiving four field periaortic radiation. Materials and Methods: Sixteen consecutive women with gynecologic primaries underwent simulation of the periaortic area using a four-field set up (AP, PA, Lats). The fields extended from the top of the L1 vertebral body to the bottom of L5 and had a mean length of 16.2 cm. The AP and PA fields had a width of 8 cm (centered on the midline of the vertebral bodies) while the right and left lateral fields had a width of 4 cm (2 cm anterior and 2 cm posterior to the anterior margin of the vertebral bodies) and did not include the spinal cord. Following oral ingestion of small bowel contrast, simulation films were obtained in the supine position and in the prone position on a modified 'belly-board' (with the pelvic opening extended superiorly to the superior abdomen). It was hypothesized that the prone position on a modified 'belly-board' would allow the abdominal small bowel to fall by gravity away from the periaortic area. We measured the volume of small bowel irradiated through the lateral fields for both the supine and prone-in-belly-board positions using the method described by Gallagher et al. Results: The volume of small bowel included within the lateral fields in the supine position ranged from 164 to 359.5 cc 3 (mean 285 cc 3 ) while placement in the prone-in-bellyboard position reduced the volume of small bowel within the lateral fields to a range of 35-152 cc 3 (mean 86 cc 3 ), an overall reduction of approximately 70% in the volume of small bowel included within lateral fields. Conclusion: The use of lateral fields in the prone-in-bellyboard position allows for significant small bowel sparing through the lateral component of a four-field periaortic set

  20. Derivation of a reduced kinetic equation using Lie-transform techniques

    International Nuclear Information System (INIS)

    Brizard, A.

    1991-01-01

    The asymptotic elimination of fast time scales from a general kinetic equation, of the form: ∂ t f+z·∂ x f = C[f], facilitates the study of the long time behavior of its solution f(z,t). Here z describe the single-particle Hamiltonian dynamics and the operator C, which may possess nonlinear functional dependence on f, describes processes (such as discrete-particle effects, resonant wave-particle effects, or effects due to external sources) which cause changes in f as it is convectively transported along a Hamiltonian phase-space trajectory. When a fast time scale is associated with z through the dependence on a fast angle θ (whose frequency θ = Ω satisfies ε ≡ 1/Ωτ much-lt 1, where τ is a slow time scale of interest), a near-identity phase-space transformation T ε :z→Z (carried out with Lie-transform techniques) yields reduced Hamiltonian dynamical equations Z ε which are θ-independent. The corresponding transformed kinetic equation is derived. Averaging this equation over the fast angle θ yields a kinetic equation for left-angle F right-angle, the θ-averaged part of F. In general, the θ-dependence of C ε couples the kinetic equations for left-angle F right-angle and F, the θ-dependent part of F. One solves for the Fourier coefficient F l (associated with e ilθ ) as a functional of left-angle F right-angle. One obtains a reduced kinetic equation for left-angle F right-angle: d R left-angle F right-angle/dt = C R [left-angle F right-angle]. General expressions for C R are given, as well as expressions for the guiding-center and oscillation-center phase-space transformations of a linear Fokker-Planck operator. A discussion of the relationship with Mynick's work is presented

  1. Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique.

    NARCIS (Netherlands)

    Schreurs, B.W.; Arts, J.J.C.; Verdonschot, N.J.J.; Buma, P.; Slooff, T.J.J.H.; Gardeniers, J.W.M.

    2006-01-01

    BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem. METHODS: Thirty-three consecutive femoral reconstructions that were

  2. Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review.

    Science.gov (United States)

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alía, J; Urda, A; Marco, F

    The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Surgical management of venous malformations.

    Science.gov (United States)

    Loose, D A

    2007-01-01

    Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

  4. Technique of ICP monitored stepwise intracranial decompression effectively reduces postoperative complications of severe bifrontal contusion

    Directory of Open Access Journals (Sweden)

    Guan eSun

    2016-04-01

    Full Text Available Background Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of ICP monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. Method A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an intracranial pressure (ICP monitored stepwise intracranial decompression group (68 patients each, to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs 6 months after the surgery were compared between the two groups.Results (1 The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05; (2 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05; the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05.Conclusions The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of intracranial pressure and was beneficial to the prognosis of

  5. Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results.

    Science.gov (United States)

    Nikolavsky, Dmitriy; Abouelleil, Mourad; Daneshvar, Michael

    2016-11-01

    To introduce a novel surgical technique for the reconstruction of distal urethral strictures using buccal mucosal graft (BMG) through a transurethral approach. A retrospective institution chart review was conducted of all the patients who underwent a transurethral ventral BMG inlay urethroplasty from March 2014 to March 2016. Patients with greater than one-year follow-up were included. Steps of the procedure: transurethral ventral wedge resection of the stenosed segment and transurethral delivery and spread fixation of appropriate BMG inlay into the resultant urethrotomy. The patients were followed for post-operative complications and stricture recurrence with uroflow, PVR, cystoscopy and outcome questionnaires. Three patients with a minimum of 12-month follow-up are included in this case series. The mean age of the patients was 42 years (35-53); mean stricture length was 2.1 cm (1-4). All patients had at least 2 previous failed procedures. Mean follow-up was 18 months (12-24). There were no stricture recurrences or fistula. Mean pre- and post-operative uroflow values were 4.3 (0-8) and 19 (16-26), respectively. Neither penile chordee nor changes in sexual function were noted in patients on follow-up. Transurethral ventral BMG inlay urethroplasty is a feasible option for treatment of fossa navicularis strictures. This single-stage technique allows for avoiding skin incision or urethral mobilization. It helps to prevent glans dehiscence, fistula formation and avoids the use of genital skin flaps in all patients, especially those affected with LS. This novel surgical technique is an effective treatment alternative for men with distal urethral strictures.

  6. Nirschl surgical technique for concomitant lateral and medial elbow tendinosis: a retrospective review of 53 elbows with a mean follow-up of 11.7 years.

    Science.gov (United States)

    Schipper, Oliver N; Dunn, Jonathan H; Ochiai, Derek H; Donovan, J Skye; Nirschl, Robert P

    2011-05-01

    Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer's elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting. Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures. Case series; Level of evidence 4. Outcome measurements included the Numeric Pain Intensity Scale, the Nirschl tennis elbow scoring system, and the American Shoulder and Elbow Surgeons elbow form. Forty-eight patients (53 clinical elbows) were available by telephone, with a minimum time to follow-up of 5 years (range, 5-19 years; mean, 11.7 years). The average Nirschl tennis elbow score improved from 16.7 preoperatively to 70.8 postoperatively (P Elbow Surgeons elbow score improved from 45.2 to 90.4 (P tennis elbow score, results were rated excellent in 38 elbows, good in 7 elbows, fair in 5 elbows, and poor in 3 elbows, with 85% (45 of 53) good to excellent results. Patient satisfaction with the surgery averaged 8.7 out of 10. Of the 46 patients who played sports, 44 (96%) reported returning to their sports. When nonoperative treatment of lateral and medial elbow tendinosis fails, combined surgical intervention via the Nirschl operative techniques for country club elbow is highly effective, with results similar to those of single-sided intervention.

  7. Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indication, Surgical Techniques, Post Operative Management and Long-Term Outcomes

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D.; Schwarzenberg, Sarah J.; Radosevich, David M.; Cook, Marie; Dunn, Ty B.; Beilman, Gregory J.; Freeman, Martin L.; Balamurugan, A.N.; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J.; Vickers, Selwyn M.; Pruett, Timothy L.; Sutherland, David E.R.

    2014-01-01

    Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management PMID:24509206

  8. Ventral inlay buccal mucosal graft urethroplasty: a novel surgical technique for the management of urethral stricture disease.

    Science.gov (United States)

    Kovell, Robert Caleb; Terlecki, Ryan Patrick

    2015-02-01

    To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.

  9. Three-Dimensional Implant Positioning with a Piezosurgery Implant Site Preparation Technique and an Intraoral Surgical Navigation System: Case Report.

    Science.gov (United States)

    Pellegrino, Gerardo; Taraschi, Valerio; Vercellotti, Tomaso; Ben-Nissan, Besim; Marchetti, Claudio

    This case report describes new implant site preparation techniques joining the benefits of using an intraoral navigation system to optimize three-dimensional implant site positioning in combination with an ultrasonic osteotomy. A report of five patients is presented, and the implant positions as planned in the navigation software with the postoperative scan image were compared. The preliminary results are useful, although further clinical studies with larger populations are needed to confirm these findings.

  10. Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve.

    Science.gov (United States)

    Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio

    2014-07-01

    Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Laparoscopic hysterotomy for a failed termination of pregnancy: a first case report with demonstration of a new surgical technique.

    Science.gov (United States)

    Baekelandt, Jan; Bosteels, Jan

    2015-01-01

    To show a new technique of hysterotomy via laparoscopy for a failed termination of pregnancy as an alternative for a hysterotomy via laparotomy. Step-by-step explanation of the technique using parts of the original video of the procedure (Canadian Task Force classification III). A 39-year-old woman, para 1 gravida 2, was diagnosed with a trisomy 21 pregnancy at 18 weeks' gestation. After 7 days of failed medical and mechanical induction, including misoprostol per vaginam, intravenous sulprostone , intravenous oxytocin, a transcervical Foley catheter, and a transcervical Bakri balloon (Cooke Medical, Bloomington, IN), the decision was made to perform a laparoscopic hysterotomy. A laparoscopic hysterotomy was performed with extraction of the fetus and placenta in an endobag. The uterus was sutured using a double layer of 2 continuous Vicryl 1 sutures (Ethicon, Cincinnati, OH). The umbilical incision was enlarged to 2.5 cm to extract the endobags. The procedure was performed using only standard reusable laparoscopic equipment. The patient's postoperative recovery was uneventful. On the postoperative ultrasound, we suspected that a small piece of placental tissue had been left in the uterine cavity. A hysteroscopy confirmed this and showed a normal uterine cavity. The small placental fragment regressed spontaneously on the follow-up ultrasounds. A 2-year follow-up of the patient has shown no minor or major complications. The patient has used contraception since the procedure because she has no further desire for childbearing. This new technique can help surgeons avoid a laparotomy when a hysterotomy for a failed midtrimester termination of pregnancy is required. The risk of uterine rupture in a next pregnancy needs to be taken into account. This frugally innovative technique may potentially be performed in a low-resource setting because only standard reusable laparoscopic equipment was used. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Two Techniques of Intestinal Wall Suture in Surgical Treatment of Ileus in Dogs and the Importance of Omentalisation

    OpenAIRE

    M. Crha; J. Lorenzová; L. Urbanová; T. Fichtel; A. Nečas

    2008-01-01

    Model experimental studies focused on the intestinal suture techniques in relation to healing, postoperative narrowing of the intestinal lumen or adhesion formation can not comprise a number of clinical factors (foreign body presence in the intestine, haematological abnormalities, septic peritonitis, different age of patients, etc.) that under clinical practice conditions may have an effect on the healing of the intestinal suture. The aim of this clinical study was to confirm in a group of do...

  13. Liver parenchyma transection-first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes.

    Science.gov (United States)

    Kawabata, Yasunari; Hayashi, Hikota; Yano, Seiji; Tajima, Yoshitsugu

    2017-06-01

    Although hemihepatectomy with total caudate lobectomy (hemiHx-tc) is essential for the surgical treatment of hilar cholangiocarcinoma, the advantage of an anterior approach for hemiHx-tc has not been fully discussed technically; the significance of an anterior approach without liver mobilization for preventing infectious complications also remains unknown. The liver parenchyma transection-first approach (Hp-first) technique is an early transection of the hepatic parenchyma without mobilization of the liver that utilizes a modified liver-hanging maneuver to avoid damaging the future remnant liver. Between May 2010 and August 2016, a total of 40 consecutive patients underwent surgery for hilar cholangiocarcinoma. Of these, 19 patients underwent a conventional hemihepatectomy with total caudate lobectomy (cHx), while 21 patients received a Hp-first. The patients in the Hp-first group had significantly less intraoperative blood loss (P hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach. © 2017 Wiley Periodicals, Inc.

  14. Effectiveness of cognitive restructuring technique to reduce academic pracrastination of vocational high school students

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    Wahyu Nanda Eka Saputra

    2017-03-01

    Full Text Available Academic procrastination is a serious problem among student. Academic procrastination refers to delaying in doing assignments and preparing for examinations until the last period of examination time and submission date of assignments. To solve this problem we could use cognitive restructuring technique. The purposes of this research are to gain the description of academic procrastination decrease by implementing the cognitive restructuring technique. This research used a single subject research as the research design. The type of the single subject research which used in this research is multiple baselines. The result of this research shows that academic procrastination had significant decrease by implementation the cognitive restructuring technique. This research gives advice for two parts. First, it will be better if counselor implement the cognitive restructuring technique to decreasing academic procrastination. Second, it will be better if stakeholder of school gives support to counselor for implementation the cognitive restructuring technique to decrease academic procrastination.

  15. High Temperature Elastic Properties of Reduced Activation Ferritic-Martensitic (RAFM) Steel Using Impulse Excitation Technique

    Science.gov (United States)

    Tripathy, Haraprasanna; Raju, Subramanian; Hajra, Raj Narayan; Saibaba, Saroja

    2018-03-01

    The polycrystalline elastic constants of an indigenous variant of 9Cr-1W-based reduced activation ferritic-martensitic (RAFM) steel have been determined as a function of temperature from 298 K to 1323 K (25 °C to 1000 °C), using impulse excitation technique (IET). The three elastic constants namely, Young's modulus E, shear modulus G, and bulk modulus B, exhibited significant softening with increasing temperature, in a pronounced non-linear fashion. In addition, clearly marked discontinuities in their temperature variations are noticed in the region, where ferrite + carbides → austenite phase transformation occurred upon heating. Further, the incidence of austenite → martensite transformation upon cooling has also been marked by a step-like jump in both elastic E and shear moduli G. The martensite start M s and M f finish temperatures estimated from this study are, M s = 652 K (379 °C) and M f =580 K (307 °C). Similarly, the measured ferrite + carbide → austenite transformation onset ( Ac 1) and completion ( Ac 3) temperatures are found to be 1126 K and 1143 K (853 °C and 870 °C), respectively. The Poisson ratio μ exhibited distinct discontinuities at phase transformation temperatures; but however, is found to vary in the range 0.27 to 0.29. The room temperature estimates of E, G, and μ for normalized and tempered microstructure are found to be 219 GPa, 86.65 GPa, and 0.27, respectively. For the metastable austenite phase, the corresponding values are: 197 GPa, 76.5 GPa, and 0.29, respectively. The measured elastic properties as well as their temperature dependencies are found to be in good accord with reported estimates for other 9Cr-based ferritic-martensitic steel grades. Estimates of θ D el , the elastic Debye temperature and γ G, the thermal Grüneisen parameter obtained from measured bulk elastic properties are found to be θ D el = 465 K (192 °C) and γ G = 1.57.

  16. Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused.

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    Shunzhi Yu

    Full Text Available OBJECTIVE: The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. METHODS: A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients, the 3-level group (98 patients and the 4-level group (44 patients. The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA score, Neck Disability Index (NDI score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM, and complications were compared. RESULTS: At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05, and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05. The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05. CONCLUSIONS: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.

  17. Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents?

    Science.gov (United States)

    Unger, Scott R; Hottle, Troy A; Hobbs, Shakira R; Thiel, Cassandra L; Campion, Nicole; Bilec, Melissa M; Landis, Amy E

    2017-01-01

    Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women's Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated

  18. Effects of urinary bladder retroflexion and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia: 41 cases (2002-2009).

    Science.gov (United States)

    Grand, Jean-Guillaume; Bureau, Stéphane; Monnet, Eric

    2013-11-15

    To evaluate the effects of urinary bladder retroflexion (UBR) and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia. Retrospective case series. 41 client-owned dogs with perineal hernia that underwent surgery between November 2002 and November 2009. Medical records were reviewed for information on dog signalment, history, physical examination findings, ultrasonographic findings, surgical techniques, intraoperative complications, duration of hospital stay, postoperative complications, and long-term outcome. 31 dogs had no UBR, and 10 dogs had UBR. Internal obturator muscle transposition (IOMT) was performed in 20 dogs, and a cystopexy or colopexy was performed before the IOMT (LapIOMT) in 21. Postoperative complications included tenesmus (n = 8) and urinary incontinence (1). Rates of postoperative complications were not significantly different between the no-UBR and UBR groups or between the IOMT and LapIOMT groups. Thirty-two dogs were free of clinical signs at the time of the study. The median disease-free interval did not differ significantly between dogs in the no-UBR and UBR groups, but it was significantly lower in the LapIOMT group than in the IOMT group. None of the 7 dogs with UBR that were treated without cystopexy developed recurrence of UBR. UBR was not associated with an increased rate of postoperative complications relative to no UBR and had no effect on the long-term outcome in dogs with perineal hernia. The use of IOMT alone may be recommended for clinical use because LapIOMT offered no clear advantage.

  19. Reducing Postoperative Pterygium Recurrence: Comparison of Free Conjunctival Auto-Graft and Conjunctival Rotation Flap Techniques

    International Nuclear Information System (INIS)

    Akhter, W.; Tayyab, A.; Kausar, A.; Masrur, A.

    2014-01-01

    Objective: To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Study Design: Quasi-experimental study. Place and Duration of Study: Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Methodology: Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group (n=26) cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group (n=31) cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences (SPSS) version 20. Results: The median (and inter-quartile range) age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 (51.50 - 63.00) and 57 (45.00 - 60.00) years, 28.50 (27.00 - 30.50) and 16.00 (15.00 - 17.00) minutes respectively. Recurrence was seen in 2 (7.96%) and 3 (9.76%) cases in auto-graft and rotation flap groups respectively.