Science.gov

Sample records for intraoperative warming comparison

  1. Prevention of hypothermia during orthotopic liver transplantation: comparison of three different intraoperative warming methods.

    PubMed

    Russell, S H; Freeman, J W

    1995-04-01

    Hypothermia is a frequent and sometimes clinically important problem during orthotopic liver transplantation. Numerous methods have been suggested to reduce intraoperative heat loss and promote active warming. In this study we compared an electric under mattress, a warm air under mattress and a forced warm air convective heating blanket. The forced air convective warming system was shown to produce significantly higher patient temperatures than the two other systems. PMID:7734261

  2. The effect of pre-warmed intravenous fluids on prevention of intraoperative hypothermia in cesarean section

    PubMed Central

    Oshvandi, Khodayar; Shiri, Fatemeh Hasan; Fazel, Mohammad Reza; Safari, Mahmoud; Ravari, Ali

    2014-01-01

    Background: Hypothermia is one of the problems occurring during surgery, which can happen due to thermoregulation mechanism disorders and intake of low temperature IV fluids, and may cause increase in blood pressure, heart rate, intracranial pressure, oxygen consumption, pain, and discomfort to the patient. The rate of cesarean section in our country is three times more than the global standard. As one of the responsibilities of the nurse is patient's advocacy, s/he should support them. This study aimed to investigate the effect of pre-warmed intravenous fluids on prevention of hypothermia during general anesthesia in cesarean section. Materials and Methods: Sixty-two women undergoing elective cesarean section by general anesthesia were randomly allocated in two groups of intervention and control. Women in the intervention group received pre-warmed serum (37C) while those in the control group received serum at room temperature (25.5C). The core body temperature and some hemodynamic parameters of the participants were assessed during the operation. Results: The mean of pulse rate, systolic blood pressure, diastolic blood pressure, and arterial O2 saturation in the two groups were not statistically significant (P > 0.05). But the mean of mothers core body temperature at the end of anesthesia in the intervention and control groups were 36 0.5C and 35.34 0.6C, respectively (P < 0.05). Conclusion: Infusion of pre-warmed serum (37C) would prevent intraoperative hypothermia and improve the nursing care for women who undergo cesarean section by general anesthesia. PMID:24554962

  3. Performance comparison of different compact NIR fluorescent imaging systems with goggle display for intraoperative image-guidance

    NASA Astrophysics Data System (ADS)

    Gao, Shengkui; Mondal, Suman; Zhu, Nan; Liang, Rongguang; Achilefu, Samuel; Gruev, Viktor

    2015-03-01

    Near-infrared (NIR) fluorescent imaging system has been widely used for intraoperative image-guided application. In this paper, we present performance comparison from three compact NIR fluorescence imaging system prototypes with goggle display that we developed for intraoperative guidance: threshold detection based two camera system, feature matching based three cameras system and miniature beam-splitter single camera system. Their performance is evaluated according to sensitivity regarding different ICG concentrations, accuracy of image overlay between NIR-visible channels, compactness and practicability in intraoperative use. The comparison results show great potentials of using these NIR fluorescence imaging systems to improve user experience and surgical outcomes in intraoperative use.

  4. Comparison of Folate Receptor Targeted Optical Contrast Agents for Intraoperative Molecular Imaging

    PubMed Central

    De Jesus, Elizabeth; Keating, Jane J.; Kularatne, Sumith A.; Jiang, Jack; Judy, Ryan; Predina, Jarrod; Nie, Shuming; Low, Philip; Singhal, Sunil

    2015-01-01

    Background. Intraoperative imaging can identify cancer cells in order to improve resection; thus fluorescent contrast agents have emerged. Our objective was to do a preclinical comparison of two fluorescent dyes, EC17 and OTL38, which both target folate receptor but have different fluorochromes. Materials. HeLa and KB cells lines were used for in vitro and in vivo comparisons of EC17 and OTL38 brightness, sensitivity, pharmacokinetics, and biodistribution. In vivo experiments were then performed in mice. Results. The peak excitation and emission wavelengths of EC17 and OTL38 were 470/520 nm and 774/794 nm, respectively. In vitro, OTL38 required increased incubation time compared to EC17 for maximum fluorescence; however, peak signal-to-background ratio (SBR) was 1.4-fold higher compared to EC17 within 60 minutes (p < 0.001). Additionally, the SBR for detecting smaller quantity of cells was improved with OTL38. In vivo, the mean improvement in SBR of tumors visualized using OTL38 compared to EC17 was 3.3 fold (range 1.48–5.43). Neither dye caused noticeable toxicity in animal studies. Conclusions. In preclinical testing, OTL38 appears to have superior sensitivity and brightness compared to EC17. This coincides with the accepted belief that near infrared (NIR) dyes tend to have less autofluorescence and scattering issues than visible wavelength fluorochromes. PMID:26491562

  5. Comparison of computed tomography, endosonography, and intraoperative assessment in TN staging of gastric carcinoma.

    PubMed Central

    Ziegler, K; Sanft, C; Zimmer, T; Zeitz, M; Felsenberg, D; Stein, H; Germer, C; Deutschmann, C; Riecken, E O

    1993-01-01

    From 1986 to 1990 a prospective comparative study was undertaken to compare the relative accuracy of computed tomography, endogastric ultrasonography, and intraoperative surgical assessment in evaluating the depth of invasion (T category) and involvement of lymph nodes (N category) of patients with gastric carcinoma. One hundred and eight consecutive patients, who were treated by total gastrectomy and previously evaluated with computed tomography, endogastric ultrasonography, and intraoperative surgical assessment, entered the study. Results (T and N category) were compared with those of histopathological staging (pT and pN category). T categories were correctly staged in 43% of cases with computed tomography, 86% with endogastric ultrasonography, and 56% with intraoperative surgical assessment. Computed tomography scanning correctly staged 51% of all N1 and N2 lymph nodes compared with 74% for endogastric ultrasonography and 54% for intraoperative surgical assessment. In general, computed tomography was more accurate for advanced stages of cancer and showed a tendency to overstage the T category and understage N category of gastric tumours. By contrast, endogastric ultrasonography was equally accurate for all T categories and showed an understaging for N categories. Intraoperative surgical assessment overstaged early T stages, understaged T4 tumours, and was equally accurate for all grades of N categories. Computed tomography scanning and intraoperative surgical assessment of T and N categories were of little value in staging of gastric carcinoma. Endogastric ultrasonography is more accurate than computed tomography scanning and intraoperative surgical assessment. Therefore endogastric ultrasonography should be introduced in the preoperative assessment of patients with gastric carcinoma. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:8504959

  6. Comparison of intraoperative ultrasonography and cholangiography in detection of small common bile duct stones.

    PubMed Central

    Chardavoyne, R; Kumari-Subhaya, S; Auguste, L J; Phillips, G; Stein, T A; Wise, L

    1987-01-01

    High-resolution intraoperative ultrasonography was compared with conventional radiographic imaging in the detection of small common bile duct (CBD) stones (less than 5 mm in diameter). Sixteen mongrel dogs had laparotomy and ligation of distal CBD; 1 week to 10 days later, 0-3 gallstones of varying sizes (2-5 mm) were introduced into the dilated CBD (6-16 mm). High-resolution intraoperative ultrasonography of the CBD and a conventional intraoperative cholangiogram were performed to detect the presence and number of stones. The results of these two tests were evaluated independently by two ultrasonographers and two surgeons. There were 21 true-positive and five false-negative readings by sonogram compared with 17 and 9, respectively, by cholangiogram. Sensitivity of the sonogram was 81% and 65.4% by cholangiogram. Score of accuracy was 1.06 and 1.62 by cholangiogram and 0.81 and 0.87 by ultrasound (p less than 0.05). Intraoperative ultrasonography was found to be more sensitive in detecting small CBD stones when compared with intraoperative cholangiogram. PMID:3300578

  7. Assessing leg lengths intraoperatively in total hip arthroplasty: comparison of two methods.

    PubMed

    Mehra, Akshay; Moriso, Zachary N; Schemitsch, Emil; Waddell, James

    2013-09-01

    Leg length discrepancy post total hip arthroplasty surgery is common. Unequal leg lengths after total hip arthroplasty is the single most common reason for litigation against orthopaedic surgeons. Different methods for leg length assessment are used intraoperatively by surgeons, but no one method is 100% reliable and reproducible. The aim of this study was to compare 2 methods of intraoperative leg length assessment. Leg length discrepancy of 5 mm or less was achieved in 72.5% (37/51) of patients using method 1 and in 67% (34/51) of patients using method 2. Both methods assessed produced a discrepancy of greater than 5 mm in about a quarter of the patients. The difference was not found to be statistically significant (p < 0.05). Assessment of leg lengths intraoperatively is challenging even for experienced surgeons. The leg lengths may be better restored if more than one method of assessment is used during surgery. PMID:24081845

  8. Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid endarterectomy.

    PubMed

    Winkler, Gabor A; Calligaro, Keith D; Kolakowski, Steven; Doerr, Kevin J; McAffee-Bennett, Sandy; Muller, Kathy; Dougherty, Matthew J

    Intraoperative completion studies of the internal carotid artery following carotid endarterectomy are recommended to ensure technical perfection of the repair. Transit time ultrasound flowmeter does not require trained technicians, requires less time than other completion studies such as duplex ultrasonography and contrast arteriography, and is noninvasive. Flowmetry was compared with duplex ultrasonography and contrast arteriography to determine if the relatively simpler flowmetry could replace these two more widely accepted completion studies in the intraoperative assessment of carotid endarterectomy. Comparative intraoperative assessment was performed in 116 carotid endarterectomies using all three techniques between December 1, 2000 and November 30, 2003. Eversion endarterectomy was performed in 51 cases and standard endarterectomy with prosthetic patching in 65 cases. Patients underwent completion flowmetry, duplex ultrasonography, and contrast arteriography studies of the exposed arteries, which were performed by vascular fellows or senior surgical residents under direct supervision of board-certified vascular surgeons. Duplex ultrasonography surveillance was performed 1 and 6 months postoperatively and annually thereafter. Mean follow-up was 18 months (range, 6-42 months). The combined ipsilateral stroke and death rate was 0%. The mean internal carotid artery flow using flowmetry was 249 mL/min (range, 60-750 mL/min). Five (4.3%) patients had flow < 100 mL/min as measured with flowmetry, but completion contrast arteriography and duplex ultrasonography were normal and none of the arteries were re-explored. One carotid endarterectomy was re-explored based on completion duplex ultrasonography that showed markedly elevated internal carotid artery peak systolic velocity (> 500 cm/sec); however, exploration was normal and completion flowmetry and contrast arteriography were normal. Duplex ultrasonography studies revealed internal carotid artery peak systolic velocities > 150 cm/sec in 15 patients, but flowmetry and contrast arteriography were normal in all 15 cases and none of the arteries were re-explored. There was no correlation between flow rates measured using flowmetry and peak systolic velocities measured using duplex ultrasonography. One abnormal contrast arteriogram showed an intimal flap that was revised, but duplex ultrasonography and flowmetry were normal. Severe recurrent internal carotid artery stenosis developed in 2 patients at 6 and 9 months, but all 3 completion intraoperative studies at the time of the original operation were normal. Based on these results, wide variability in flowmetry values limits its potential usefulness to detect non-flow-limiting lesions and replace contrast arteriography or duplex ultrasonography as an intraoperative carotid endarterectomy completion study. Duplex ultrasonography was also of limited to no value, whereas contrast arteriography rarely documented a lesion that required repair. PMID:17202095

  9. Comparison of Intraoperatively Built Custom Linked Seeds Versus Loose Seed Gun Applicator Technique Using Real-Time Intraoperative Planning for Permanent Prostate Brachytherapy

    SciTech Connect

    Zauls, A. Jason; Ashenafi, Michael S.; Onicescu, Georgiana; Clarke, Harry S.; Marshall, David T.

    2011-11-15

    Purpose: To report our dosimetric results using a novel push-button seed delivery system that constructs custom links of seeds intraoperatively. Methods and Materials: From 2005 to 2007, 43 patients underwent implantation using a gun applicator (GA), and from 2007 to 2008, 48 patientsunderwent implantation with a novel technique allowing creation of intraoperatively built custom links of seeds (IBCL). Specific endpoint analyses were prostate D90% (pD90%), rV100% > 1.3 cc, and overall time under anesthesia. Results: Final analyses included 91 patients, 43 GA and 48 IBCL. Absolute change in pD90% ({Delta}pD90%) between intraoperative and postoperative plans was evaluated. Using GA method, the {Delta}pD90% was -8.1Gy and -12.8Gy for I-125 and Pd-103 implants, respectively. Similarly, the IBCL technique resulted in a {Delta}pD90% of -8.7Gy and -9.8Gy for I-125 and Pd-103 implants, respectively. No statistically significant difference in {Delta}pD90% was found comparing methods. The GA method had two intraoperative and 10 postoperative rV100% >1.3 cc. For IBCL, five intraoperative and eight postoperative plans had rV100% >1.3 cc. For GA, the mean time under anesthesia was 75 min and 87 min for Pd-103 and I-125 implants, respectively. For IBCL, the mean time was 86 and 98 min for Pd-103 and I-125. There was a statistical difference between the methods when comparing mean time under anesthesia. Conclusions: Dosimetrically relevant endpoints were equivalent between the two methods. Currently, time under anesthesia is longer using the IBCL technique but has decreased over time. IBCL is a straightforward brachytherapy technique that can be implemented into clinical practice as an alternative to gun applicators.

  10. Comparison of an incremental versus single-step retraction model for intraoperative compensation

    NASA Astrophysics Data System (ADS)

    Platenik, Leah A.; Miga, Michael I.; Roberts, David W.; Kennedy, Francis E.; Hartov, Alex; Lunn, Karen E.; Paulsen, Keith D.

    2001-05-01

    Distortion between the operating field and preoperative images increases as image-guided surgery progresses. Retraction is a typical early-stage event that causes significant tissue deformation, which can be modeled as an intraoperative compensation strategy. This study compares the predictive power of incremental versus single-step retraction models in the porcine brain. In vivo porcine experiments were conducted that involved implanting markers in the brain whose trajectories were tracked in CT scans following known incremental deformations induced by a retractor blade placed interhemispherically. Studies were performed using a 3D consolidation model of brain deformation to investigate the relative predictive benefits of incremental versus single-step retraction simulations. The results show that both models capture greater than 75% of tissue loading due to retraction. We have found that the incremental approach outperforms the single-step method with an average improvement of 1.5%-3%. More importantly it also preferentially recovers the directionality of movement, providing better correspondence to intraoperative surgical events. A new incremental approach to tissue retraction has been developed and shown to improve data-model match in retraction experiments in the porcine brain. Incremental retraction modeling is an improvement over previous single- step models, which does not incur additional computational to overhead. Results in the porcine brain show that even when the overall displacement magnitudes between the two models are similar, directional trends of the displacement field are often significantly improved with the incremental method.

  11. Intra-Operative Tissue Oxygen Tension Is Increased by Local Insufflation of Humidified-Warm CO2 during Open Abdominal Surgery in a Rat Model

    PubMed Central

    Marshall, Jean K.; Lindner, Pernilla; Tait, Noel; Maddocks, Tracy; Riepsamen, Angelique; van der Linden, Jan

    2015-01-01

    Introduction Maintenance of high tissue oxygenation (PtO2) is recommended during surgery because PtO2 is highly predictive of surgical site infection and colonic anastomotic leakage. However, surgical site perfusion is often sub-optimal, creating an obstructive hurdle for traditional, systemically applied therapies to maintain or increase surgical site PtO2. This research tested the hypothesis that insufflation of humidified-warm CO2 into the abdominal cavity would increase sub-peritoneal PtO2 during open abdominal surgery. Materials and Methods 15 Wistar rats underwent laparotomy under general anesthesia. Three sets of randomized cross-over experiments were conducted in which the abdominal cavity was subjected to alternating exposure to 1) humidified-warm CO2 & ambient air; 2) humidified-warm CO2 & dry-cold CO2; and 3) dry-cold CO2 & ambient air. Sub-peritoneal PtO2 and tissue temperature were measured with a polarographic oxygen probe. Results Upon insufflation of humidified-warm CO2, PtO2 increased by 29.8 mmHg (SD 13.3; p<0.001), or 96.6% (SD 51.9), and tissue temperature by 3.0°C (SD 1.7 p<0.001), in comparison with exposure to ambient air. Smaller, but significant, increases in PtO2 were seen in experiments 2 and 3. Tissue temperature decreased upon exposure to dry-cold CO2 compared with ambient air (-1.4°C, SD 0.5, p = 0.001). Conclusions In a rat model, insufflation of humidified-warm CO2 into the abdominal cavity during open abdominal surgery causes an immediate and potentially clinically significant increase in PtO2. The effect is an additive result of the delivery of CO2 and avoidance of evaporative cooling via the delivery of the CO2 gas humidified at body temperature. PMID:25835954

  12. Comparison of Standard and Low Dose Intraoperative Mitomycin C in Prevention of Corneal Hazeafter Photorefractive Keratectomy

    PubMed Central

    Razmjoo, Hassan; Kooshanmehr, Mohammad Reza; Peyman, Alireza; Kor, Zahra; Mohammadesmaeil, Erfan

    2013-01-01

    Background: This study aimed to compare two doses of Mitomycin C in reducing haze formation after photorefractive keratectomy. Methods: 170 eyes of 85 patients enrolled; in each patient one eye randomly assigned to be treated by low dose intraoperative MMC (LDMMC) and other eye by standard dose MMC (SDMMC). Then the patients were followed up to 6 months and refraction, Uncorrected Distant Visual Acuity (UCDVA), Best Corrected Distant Visual Acuity (BCDVA) and haze formation submitted in each postoperative exam. Results: The mean preoperative refraction in LDMMC eyes was ?3.08 (SD 1.65) sphere and 0.92 (SD 0.88) cylinder. These values for SDMMC eyes were ?3.25 (SD 1.80) sphere and 0.81 (SD 0.84) cylinder. Mean postoperative sphere in LDMMC group was ?0.132 (SD 0.503) and ?0.138 (SD 0.484) in 3 and 6 months after PRK. These results was ?0.041 (SD 0.501) and ?0.076 (SD 0.489) for SDMMC group. Mean postoperative cylinder 3 and 6 month after PRK was 0.435 (SD 0.218) and 0.423 (SD 0.255). In LDMMC group and 0.435 (SD 0.247) and 0.426 (SD 0.261) in SDMMC group. In third month 14 eyes in LDMMC group presented with grade 1 score of clinical haze. From these eyes only 2 still had this haze after 6 month. 7 eyes in SDMMC group had grade 1 clinical haze at third month- but no clinical haze was seen at the end of 6th month. Conclusion: The results of the two doses of Mitomycin C were not significant. We suggest to use the lower dose to reduce its side effects. PMID:23543763

  13. Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation.

    PubMed

    Norton, J A; Cromack, D T; Shawker, T H; Doppman, J L; Comi, R; Gorden, P; Maton, P N; Gardner, J D; Jensen, R T

    1988-02-01

    The purpose of the present study was to evaluate prospectively the value of intraoperative ultrasound scanning (IOUS) in localizing islet cell tumors by comparing results of IOUS to those of palpation during 44 consecutive laparotomies for gastrinoma (36) or insulinoma (8). All patients had preoperative radiographic imaging studies and selective venous sampling for hormones, which guided the subsequent laparotomy. Any suspicious finding by palpation and/or IOUS was resected. Pathologic evidence of islet cell neoplasm served as the reference standard. Five patients were excluded from analysis because neither palpation nor IOUS had suspicious findings and no islet cell tumor was found. Seven pancreatic insulinomas were found in seven patients. IOUS was as sensitive as palpation at localizing insulinomas. Twenty-three pancreatic gastrinomas were found in 19 patients. IOUS was equal to palpation in the ability to localize gastrinomas. Gastrinomas that were successfully imaged by IOUS were significantly larger than gastrinomas that were not imaged. Twelve extrapancreatic gastrinomas were found in nine patients, and palpation was more sensitive than IOUS at localizing these small duodenal wall tumors. Five patients (11%) had their surgical management changed by IOUS. Two patients had pancreatic tumors (one gastrinoma and insulinoma) enucleated that would not have been found without IOUS, and three patients had resections of pathologically proven malignant islet cell tumors based on sonographic findings. All five patients were cured with short follow-up. The present results demonstrate that palpation and IOUS are complementary because IOUS can image tumors that are not palpable and IOUS can provide additional information concerning malignant potential not detected by palpation. PMID:2829761

  14. Comparisons between warm and cold water swim stress in mice.

    PubMed

    O'Connor, P; Chipkin, R E

    1984-08-01

    The following experiments evaluated the effects of warm- or cold-water swim stress on tail-flick latencies (TFL) in mice. To first determine the appropriate control group, the TFL's of dry-vs-dunked mice were compared. Dry mice had significantly shorter TFL's than dunked mice, implying that the dampness of the mouse's tail contributed to the increase in the TFL. Therefore, dunked mice were used as the relevant control for the swum mice. Cold water swimming (2 degrees C) produced a significant increase in the TFL; this was not blocked by the opiate antagonist naloxone (3 mg/kg sc) or potentiated by the enkephalinase inhibitor thiorphan (100 mg/kg sc). Warm water swimming (32 degrees C) up to 3 min produced an inconsistent effect on TFL's, implying that the effects were at the threshold of detectability. Naloxone attenuated and thiorphan modestly potentiated the effects of warm water swimming on TFL's. This suggests that warm water swim stress-induced increases in mouse TFL's may involve opioid pathways, whereas cold water swim stress-induced changes in mice TFL's appear not to be opioid mediated. PMID:6589457

  15. Are active warming measures required during paediatric cleft surgeries?

    PubMed Central

    Rajan, Sunil; Halemani, Kusuma Ramachandra; Puthenveettil, Nitu; Baalachandran, Ramasubramanian; Gotluru, Priyanka; Paul, Jerry

    2013-01-01

    Background: During paediatric cleft surgeries intraoperative heat loss is minimal and hence undertaking all possible precautions available to prevent hypothermia and use of active warming measures may result in development of hyperthermia. This study aims to determine whether there will be hyperthermia on active warming and hypothermia if no active warming measures are undertaken. The rate of intraoperative temperature changes with and without active warming was also noted. Methods: This study was conducted on 120 paediatric patients undergoing cleft lip and palate surgeries. In Group A, forced air warming at 38°C was started after induction. In Group B, no active warming was done. Body temperature was recorded every 30 min starting after induction until 180 min or end of surgery. Intragroup comparison of variables was done using Paired sample test and intergroup comparison using independent sample t-test. Results: In Group A, all intraoperative temperature readings were significantly higher than baseline. In Group B, there was a significant reduction in temperature at 30 and 60 min. Temperature at 90 min did not show any significant difference, but further readings were significantly higher. Maximum rise in temperature occurred in Group A between 120 and 150 min and maximum fall in temperature in Group B was seen during first 30 min. Conclusion: In pediatric cleft surgeries, we recommend active warming during the first 30 minutes if the surgery is expected to last for <2h, and no such measures are required if the expected duration is >2h. PMID:24163452

  16. Warm prestress modeling: Comparison of models and experimental results

    SciTech Connect

    Stonesifer, R.B.; Rybicki, E.F.; McCabe, D.E.

    1989-04-01

    Warm prestress (WPS) behavior is the term commonly used to describe an apparent increase in material toughness of pressure vessel steels resulting from previous loading at a higher temperature. Such load histories are of interest largely due to the fact that loss of coolant accident (LOCA) and pressurized thermal shock (PTS) related load histories are expected to result in WPS behavior. While previous experimental work has demonstrated WPS behavior, insufficient attention has been given to separating material toughness variability for the WPS effect. There also appears to be a basic lack of understanding of the mechanism by which WPS behavior occurs and as a result, there is no generally accepted model or fracture criterion for predicting WPS behavior. The objectives of this study were to develop WPS data for which the enhanced toughness due to WPS could be separated from the K/sub Ic/ variability of the virgin material and to evaluate several candidate WPS models. 33 refs., 17 figs., 5 tabs.

  17. [Intraoperative awareness].

    PubMed

    Schneider, G

    2003-02-01

    The first cases of general anesthesia were already cases with awareness. Until today, case reports of patients with awareness are published. These published cases are likely to be the top of the iceberg, as most patients with postoperative recall do not inform their anesthesiologist. Incidence of awareness with recall is between 0.1 and 0.2 %. In a large multicenter-study, incidence of recall was 0.1 % without, and 0.18 % with the use of muscle relaxants. The risk is increased with decreased doses of anesthetics, e.g. in patients with hemodynamic instability (trauma cases), patients undergoing cesarean section or cardiac surgery. Intraoperative awareness does not necessarily cause explicit (conscious) memory. Even in the absence of explicit memory, implicit (unconscious) memory can still have consequences for the patient. In the worst case, it can cause post-traumatic stress disorder. There is doubt whether patients may profit from positive suggestions given during intraoperative awareness. Recommendations to administer benzodiazepines to prevent explicit memory must be reconsidered. Complete neuromuscular block should be avoided whenever possible. If a patient is thought to be aware, he should be contacted, his situation should be explained and affirming comments should be given until consciousness is lost again. Postoperative visit should include questions about awareness and recall. The anesthetist should not disbelieve reported recall. Explanation of what had happened and referral to an experienced psychologist must be offered. Thus, the incidence of severe sequelae should decrease. PMID:12557119

  18. Intraoperative endovascular ultrasonography

    NASA Astrophysics Data System (ADS)

    Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

    1991-05-01

    The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

  19. Comparison of Effects of Labetalol and Nitroglycerine on Intraoperative Blood Loss and Surgical Field Quality in Rhinoplasty Surgery

    PubMed Central

    Hadavi, Mohamad Reza; Zarei, Yadollah; Tarogh, Shojaolhagh

    2015-01-01

    BACKGROUND Rhinoplasty is one of the most common surgeries of the plastic surgery and as well as ear, throat and nose. Intra-operative bleeding during surgery is one of the most important factors that may impair the surgeons job. Providing a clean blood-free surgical filed makes the operation faster, easier and with a better quality. One way to achieve this goal is to induce hypotension. This study aimed to compare the impacts and outcomes of administration of labetalol or nitroglycerin for this purpose. METHODS In this randomized clinical trial, 60 ASA I and ASA II patients who were referred for rhinoplasty were enrolled. Patients were randomly assigned to two groups. Labetalol was given to the first and nitroglycerin to the second group of patients. Blood pressure and the amount of intra-operative bleeding during surgery and surgeon satisfaction were measured. RESULTS The average age of patients was 25.97.52 years. The average amount of bleeding among all patients was 117.87324.86 ml, and the average quality of the surgical site was 1.654.48, considering all patients. The average quality and average surgical site bleeding between the two groups was not significant. CONCLUSION There was a little difference between labetalol and nitroglycerine on the effect of intraoperative blood loss and surgical field quality in rhinoplasty surgery. PMID:25606478

  20. Simulations of the February 1979 stratospheric sudden warming: Model comparisons and three-dimensional evolution

    SciTech Connect

    Manney, G.L. ); Farrara, J.D.; Mechoso, C.R. )

    1994-06-01

    The evolution of the stratospheric flow during the major stratospheric sudden warming of February 1979 is studied using two primitive equation models of the stratosphere and mesosphere. The United Kingdom Meteorological Office Stratosphere-Mesosphere Model (SMM) uses log pressure as a vertical coordinate. A spectral, entropy coordinate version of the SMM (entropy coordinate model, or ECM) that has recently been developed is also used. The ECM produces a more realistic recombination and recovery of the polar vortex in the midstratosphere after the warming. Comparison of SMM simulations with forecasts performed using the University of California, Los Angeles general circulation model confirms the previously noted sensitivity of stratospheric forecasts to tropospheric forecast and emphasizes the importance of adequate vertical resolution in modeling the stratosphere. The ECM simulations provide a schematic description of the three-dimensional evolution of the polar vortex and the motion of air through it. During the warming, the two cyclonic vortices tilt westward and equatorward with height. Strong upward velocities develop in the lower stratosphere on the west (cold) side of a baroclinic zone as it forms over Europe and Asia. Strong downward velocities appear in the upper stratosphere on the east (warm) side, strengthening the temperature gradients. After the peak of the warming, vertical velocities decrease, downward velocities move into the lower stratosphere, and upward velocities move into the upper stratosphere. Transport calculations show that air with high ozone mixing ratios is advected toward the pole from low latitudes during the warming, and air with low ozone mixing ratios is transported to the midstratosphere from both higher and lower altitudes along the baroclinic zone in the polar regions. 32 refs., 23 figs., 1 tab.

  1. How warm was the last interglacial? New model-data comparisons.

    PubMed

    Otto-Bliesner, Bette L; Rosenbloom, Nan; Stone, Emma J; McKay, Nicholas P; Lunt, Daniel J; Brady, Esther C; Overpeck, Jonathan T

    2013-10-28

    A Community Climate System Model, Version 3 (CCSM3) simulation for 125?ka during the Last Interglacial (LIG) is compared to two recent proxy reconstructions to evaluate surface temperature changes from modern times. The dominant forcing change from modern, the orbital forcing, modified the incoming solar insolation at the top of the atmosphere, resulting in large positive anomalies in boreal summer. Greenhouse gas concentrations are similar to those of the pre-industrial (PI) Holocene. CCSM3 simulates an enhanced seasonal cycle over the Northern Hemisphere continents with warming most developed during boreal summer. In addition, year-round warming over the North Atlantic is associated with a seasonal memory of sea ice retreat in CCSM3, which extends the effects of positive summer insolation anomalies on the high-latitude oceans to winter months. The simulated Arctic terrestrial annual warming, though, is much less than the observational evidence, suggesting either missing feedbacks in the simulation and/or interpretation of the proxies. Over Antarctica, CCSM3 cannot reproduce the large LIG warming recorded by the Antarctic ice cores, even with simulations designed to consider observed evidence of early LIG warmth in Southern Ocean and Antarctica records and the possible disintegration of the West Antarctic Ice Sheet. Comparisons with a HadCM3 simulation indicate that sea ice is important for understanding model polar responses. Overall, the models simulate little global annual surface temperature change, while the proxy reconstructions suggest a global annual warming at LIG (as compared to the PI Holocene) of approximately 1()C, though with possible spatial sampling biases. The CCSM3 SRES B1 (low scenario) future projections suggest high-latitude warmth similar to that reconstructed for the LIG may be exceeded before the end of this century. PMID:24043870

  2. A Prospective Quasi-Randomized Comparison of Intraoperatively Built Custom-Linked Seeds Versus Loose Seeds for Prostate Brachytherapy

    SciTech Connect

    Ishiyama, Hiromichi; Satoh, Takefumi; Kawakami, Shogo; Tsumura, Hideyasu; Komori, Shouko; Tabata, Ken-ichi; Sekiguchi, Akane; Takahashi, Ryo; Soda, Itaru; Takenaka, Kouji; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-09-01

    Purpose: To compare dosimetric parameters, seed migration rates, operation times, and acute toxicities of intraoperatively built custom-linked (IBCL) seeds with those of loose seeds for prostate brachytherapy. Methods and Materials: Participants were 140 patients with low or intermediate prostate cancer prospectively allocated to an IBCL seed group (n=74) or a loose seed group (n=66), using quasirandomization (allocated by week of the month). All patients underwent prostate brachytherapy using an interactive plan technique. Computed tomography and plain radiography were performed the next day and 1 month after brachytherapy. The primary endpoint was detection of a 5% difference in dose to 90% of prostate volume on postimplant computed tomography 1 month after treatment. Seed migration was defined as a seed position >1 cm from the cluster of other seeds on radiography. A seed dropped into the seminal vesicle was also defined as a migrated seed. Results: Dosimetric parameters including the primary endpoint did not differ significantly between groups, but seed migration rate was significantly lower in the IBCL seed group (0%) than in the loose seed group (55%; P<.001). Mean operation time was slightly but significantly longer in the IBCL seed group (57 min) than in the loose seed group (50 min; P<.001). No significant differences in acute toxicities were seen between groups (median follow-up, 9 months). Conclusions: This prospective quasirandomized control trial showed no dosimetric differences between IBCL seed and loose seed groups. However, a strong trend toward decreased postimplant seed migration was shown in the IBCL seed group.

  3. Comparison of global warming impacts of automobile air-conditioning concepts

    SciTech Connect

    1995-12-31

    The global warming impacts of conventional vapor compression automobile air conditioning using HFC-134a are compared with the potential impacts of four alternative concepts. Comparisons are made on the basis of total equivalent warming impact (TEWI) which accounts for the effects of refrigerant emissions, energy use to provide comfort cooling, and fuel consumed to transport the weight of the air conditioning system. Under the most favorable assumptions on efficiency and weight, transcritical compression using CO{sub 2} as the refrigerant and adsorption cooling with water and zeolite beds could reduce TEWI by up to 18%rlative to HFC-134a compression air conditioning. Other assumptions on weight and efficiency lead to significant increases in TEWI relative to HFC-134a, and it is impossible to determine which set of assumptios is valid from existing data, Neither Stirling cycle or thermoelectric cooling will reduce TEWI relative to EFC-134a. Brief comments are also made concerning technical barriers that must be overcome for succesful development of the new technologies.

  4. Comparison of the findings on preoperative dipyridamole perfusion scintigraphy and intraoperative transesophageal echocardiography: Implications regarding the identification of myocardium at ischemic risk

    SciTech Connect

    Watters, T.A.; Botvinick, E.H.; Dae, M.W.; Cahalan, M.; Urbanowicz, J.; Benefiel, D.J.; Schiller, N.B.; Goldstone, G.; Reilly, L.; Stoney, R.J. )

    1991-07-01

    The evidence of myocardium at potential ischemic risk on preoperative dipyridamole perfusion scintigraphy was compared with that of manifest ischemia on intraoperative transesophageal echocardiography in 26 patients at high risk of a coronary event undergoing noncardiac surgery. The clinical outcome was also assessed. Induced intraoperative wall motion abnormalities were more common in patients and myocardial segments with, than in those without, a preoperative reversible perfusion defect (both p less than 0.05). Conversely, a preoperative reversible perfusion defect was more common in patients and segments with, than in those without, a new intraoperative wall motion abnormality (both p less than 0.05). Six patients, five with a reversible scintigraphic defect but only three with a new wall motion abnormality, had a hard perioperative ischemic event. Events occurred more often among patients with, than in those without, a reversible perioperative scintigraphic defect (5 (33%) of 15 vs. 1 (9%) of 11) but this difference did not reach significance (p = 0.14), probably owing to the sample size. Intraoperative wall motion abnormalities were all reversible and did not differentiate between risk groups; these findings were possibly influenced by treatment. These preliminary data support the known relation between reversible scintigraphic defects and perioperative events and identify another manifestation of ischemic risk in the relation between reversible scintigraphic defects and induced intraoperative wall motion abnormalities. The value of intraoperative echocardiography in identifying ischemia and guiding therapy in patients with a reversible scintigraphic abnormality should be further assessed.

  5. Predictability of the stratospheric sudden warming and its impact on the tropospheric climate in January 2009 -Comparison with the warmings of 2004 and 2006-

    NASA Astrophysics Data System (ADS)

    Kuroda, Y.

    2010-12-01

    Predictability of the stratospheric sudden warming (SSW) and its following Northern Annular Mode (NAM) variability in the troposphere is examined for the winter of 2009, and comparison is made with other warmings of 2004 and 2006. The predictability was examined using sets of ensemble runs of a climate model of our institute. The SSW of 2009 is very unusual in the sense that it is caused by almost pure planetary wave of zonal-wavenumber 2 and such SSW is the only one that appears in the past. So it will be interesting to see how extend can we predict the occurrence of the SSW and following impact on the troposphere with the climate model. The result shows that the occurrence of the SSW can be predicted if prediction is initialized within 8 days before the peaked day. The limit is rather short compared with the one found in the previous studies, which shows limit longer than about 2 weeks. The predictability of the downward propagating tropospheric NAM variability following the SSW shows that very long predictability of a few months cannot be obtained even if the forecast is performed before the occurrence of the SSW. Predictability is limited to almost half months regardless of the initial time of the prediction. The situation was very different to the typical PJO-type warmings of 2004 and 2006.

  6. Comparison of stratospheric warming following Agung, El Chichon and Pinatubo volcanic eruptions

    NASA Astrophysics Data System (ADS)

    Angell, J. K.

    1993-04-01

    Based on a 63-station radiosonde network and using 9-season-average temperatures to minimize the influence of the quasi-biennial oscillation, the 16-20 km warming following Agung and El Chichon was greatest in the equatorial zone and least in polar zones. The warming was not symmetric with respect to the equator, however, with greater warming south than north of the equator. In north extratropics and tropics, the warming following Pinatubo is indicated to be comparable to the warming following Agung and El Chichon. However, in south temperate and polar zones the warming is considerably greater following Pinatubo, perhaps reflecting a contribution from the eruption of Cerro Hudson in Chile. Globally, therefore, the low-stratospheric warming following Pinatubo is greater than following Agung or El Chichon. Based on a 10-station tropical radiosonde network with data to greater heights, the warming following El Chichon exceeded the warming following Agung to a height of at least 31 km, the difference in warming increasing with height. The warming following Pinatubo is similar to that following Agung to a height of 24 km, but thereafter is indicated to become less, an unexpected result to be reexamined as more data become available.

  7. Comparison of laparoscopic versus conventional open cryptorchidectomies on intraoperative and postoperative complications and duration of surgery, anesthesia, and hospital stay in horses.

    PubMed

    Cribb, Nicola C; Koenig, Judith; Sorge, Ulrike

    2015-04-15

    Objective-To compare surgical preparation time, surgery and anesthesia times, hospitalization duration, and intra- and postoperative complications between laparoscopic and conventional open cryptorchidectomy in horses. Design-Retrospective cohort study. Animals-60 horses that underwent cryptorchidectomy. Procedures-Medical records were reviewed to identify horses that had undergone cryptorchidectomy from 1991 to 2012. Thirty horses that underwent laparoscopic cryptorchidectomy (case horses) were matched with 30 control horses that had undergone open cryptorchidectomy (ie, inguinal and parainguinal surgical approaches). Horses were matched according to history of previous surgery, testicle location, and type of closure following removal of an undescended unilateral testicle. Duration of surgery, surgical preparation and anesthesia times, hospitalization duration, and number of intra- and postoperative complications were compared between horses that underwent laparoscopic cryptorchidectomy versus open cryptorchidectomy. Comparisons were also made between horses in terms of whether there was a history of previous failed cryptorchidectomy or unknown location of testicle prior to surgery. Results-Horses that underwent laparoscopic cryptorchidectomy had significantly longer surgery and anesthesia times overall, compared with horses that underwent open cryptorchidectomy. No difference in surgery time was found between case and control horses that had a previous surgical attempt to remove an undescended testicle or in which the testicle location was unknown prior to surgery. Overall, horses undergoing laparoscopy had a nonsignificant increase in intraoperative complications, compared with control horses, and had significantly more postoperative complications. Conclusions and Clinical Relevance-Horses undergoing laparoscopic cryptorchidectomy had increased surgical preparation time, increased surgery and anesthesia times, and more postoperative complications, compared with horses undergoing open cryptorchictomy. Laparoscopy may be advantageous for a second attempt at cryptorchidectomy or if the testicle location is unknown prior to surgery. PMID:25835173

  8. Tidal Variability during Stratospheric Sudden Warmings: Comparison between a Whole Atmosphere Model and Satellite Observations

    NASA Astrophysics Data System (ADS)

    Jin, H.; Miyoshi, Y.; Pancheva, D.; Mukhtarov, P.; Fujiwara, H.; Shinagawa, H.; Murata, T.

    2012-12-01

    We compare results from a whole atmosphere-ionosphere coupled model, GAIA, and from the COSMIC and TIMED/SABER observations during 2008/2009 northern winter season. The GAIA model has assimilated meteorological reanalysis data by a nudging method. The comparison shows general agreements in the major features from the stratosphere to the ionosphere including the growth and decay of the major stratospheric sudden warming (SSW) event in 2009. During the major SSW period, a pronounced semidiurnal variation in the F-region electron density and its local-time phase shift similar to the previous observations are reproduced by the model and COSMIC observation. The model suggests that the TEC variation is caused by an enhanced semidiurnal variation in the EXB drift, which is probably related to an amplified semidiurnal migrating tide (SW2) in the lower thermosphere. The model and TIMED/SABER observation show that the SW2 tide amplifies at low latitudes from the stratosphere to the thermosphere as well as the phase variation. Possible sources of the SW2 variability could be related to the changing background wind and temperature distributions and/or to the stratospheric ozone variability. Cases of other SSWs are also studied.

  9. Warm up of automotive catalyst substrates: Comparison of measurements with predictions

    SciTech Connect

    Benjamin, S.F.; Roberts, C.A.

    1998-01-01

    An understanding of the warm up of automotive catalysts is important for accurate prediction of light off. This work describes some experimental studies on warm up in the absence of chemical reactions. In parallel with these experiments, the temperatures of the warmed substrate have been predicted. The problem of warm up is a simple one, capable of analytical description, but since the complete problem of catalyst performance with chemical reactions will ultimately require CFD coding, the simple case is dealt with 9in this way to form the basis of a more complete model. The studies have found measured heat transfer coefficients which are in the range 15 to 20 W/(m{sup 2}K) for metallic substrates with sinusoidal channels. This is much lower than standard Nu values suggest. The predictions have also illustrated the significance of the heat transfer coefficient in obtaining accurate agreement with measurements in the simple case of warm up.

  10. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.; Hoeth, Brian; Blottman, Peter F.

    2007-01-01

    Mesoscale weather conditions can significantly affect the space launch and landing operations at Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS). During the summer months, land-sea interactions that occur across KSC and CCAFS lead to the formation of a sea breeze, which can then spawn deep convection. These convective processes often last 60 minutes or less and pose a significant challenge to the forecasters at the National Weather Service (NWS) Spaceflight Meteorology Group (SMG). The main challenge is that a "GO" forecast for thunderstorms and precipitation is required at the 90 minute deorbit decision for End Of Mission (EOM) and at the 30 minute Return To Launch Site (RTLS) decision at the Shuttle Landing Facility. Convective initiation, timing, and mode also present a forecast challenge for the NWS in Melbourne, FL (MLB). The NWS MLB issues such tactical forecast information as Terminal Aerodrome Forecasts (TAFs), Spot Forecasts for fire weather and hazardous materials incident support, and severe/hazardous weather Watches, Warnings, and Advisories. Lastly, these forecasting challenges can also affect the 45th Weather Squadron (45 WS), which provides comprehensive weather forecasts for shuttle launch, as well as ground operations, at KSC and CCAFS. The need for accurate mesoscale model forecasts to aid in their decision making is crucial. Both the SMG and the MLB are currently implementing the Weather Research and Forecasting Environmental Modeling System (WRF EMS) software into their operations. The WRF EMS software allows users to employ both dynamical cores - the Advanced Research WRF (ARW) and the Non-hydrostatic Mesoscale Model (NMM). There are also data assimilation analysis packages available for the initialization of the WRF model- the Local Analysis and Prediction System (LAPS) and the Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS). Having a series of initialization options and WRF cores, as well as many options within each core, provides SMG and NWS MLB with a lot of flexibility. It also creates challenges, such as determining which configuration options are best to address specific forecast concerns. The goal of this project is to assess the different configurations available and to determine which configuration will best predict warm season convective initiation in East-Central Florida. Four different combinations of WRF initializations will be run (ADAS-ARW, ADAS-NMM, LAPS-ARW, and LAPS-NMM) at a 4-km resolution over the Florida peninsula and adjacent coastal waters. Five candidate convective initiation days using three different flow regimes over East-Central Florida will be examined, as well as two null cases (non-convection days). Each model run will be integrated 12 hours with three runs per day, at 0900, 1200, and 1500 UTe. ADAS analyses will be generated every 30 minutes using Level II Weather Surveillance Radar-1988 Doppler (WSR-88D) data from all Florida radars to verify the convection forecast. These analyses will be run on the same domain as the four model configurations. To quantify model performance, model output will be subjectively compared to the ADAS analyses of convection to determine forecast accuracy. In addition, a subjective comparison of the performance of the ARW using a high-resolution local grid with 2-way nesting, I-way nesting, and no nesting will be made for select convective initiation cases. The inner grid will cover the East-Central Florida region at a resolution of 1.33 km. The authors will summarize the relative skill of the various WRF configurations and how each configuration behaves relative to the others, as well as determine the best model configuration for predicting warm season convective initiation over East-Central Florida.

  11. Intraoperative aortic dissection.

    PubMed

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  12. Intraoperative custom press-fit and standard press-fit femoral components in total hip arthroplasty. A comparison of surgery, charges, and early complications.

    PubMed

    Mathur, S K; Mont, M A; McCutchen, J W

    1996-07-01

    A consecutive group of 60 patients who had intraoperative custom press-fit total hip arthroplasties (67 hips; Identifit, Thackray, London, United Kingdom) was compared with a similar group of 60 patients who had standard press-fit arthroplasties (66 hips; McCutchen, Wright Medical Technologies, Arlington, Tennessee) to determine if there were differences in operative time and charges, as well as early complications and early radiographic results. The unilateral intraoperative custom group had an average anesthesia time of 3 hours, 39 minutes, an operating time of 2 hours and 26 minutes, and a blood loss of 725 mL. The averages for the standard group included an anesthesia time of 2 hours, 19 minutes, a surgical time of 1 hour, 25 minutes, and a blood loss of 480 mL. By 6 months after surgery, 49 (73%) in the custom group had subsidence of 2 mm or more, compared with 10 hips (15%) in the standard group. The custom group had 17 early postoperative complications versus 3 in the standard group. The charge for the hospital stay averaged $19,950 for the custom group and $14,322 for the standard group. At the present time, the high incidence of complications and the increased charges make the intraoperative custom hip replacement an unlikely first choice of recommendation. PMID:8831891

  13. Comparison between preoperative and intraoperative injection of 99mTc Dextran-500 for sentinel lymph node localization in breast cancer

    PubMed Central

    Dambros Gabbi, Maria C; Masiero, Paulo R; Uchoa, Diego; Moraes, Ilza V; Biazus, Jorge V; Edelweiss, Maria IA

    2014-01-01

    A retrospective study was conducted from a review of the medical records of patients with early-stage, invasive breast cancer who underwent surgical treatment and sentinel node biopsy with a radiotracer from January 2008 to August 2012 at a single institution (221 patients included). The patients were grouped according to the time of 99mTc Dextran-500 injection, which was preoperatively (with lymphoscintigraphy) (81 patients) or intraoperatively (140 patients). The purpose of the report is to compare the results of sentinel node biopsy of early-stage breast cancer patients who were subjected to intraoperative 99mTc Dextran-500 injections with the patients who received preoperative injections. The following parameters were analyzed: clinical tumor staging, histological and pathological results, size and number of tumor foci, peritumoral vascular invasion, number of lymph nodes removed, size of lymph node metastasis and hormone receptor expression.There were no differences in sentinel lymph node localization whether 99mTc Dextran-500 was injected preoperatively or intraoperatively. PMID:25250208

  14. Ecohydrological Consequences of Grasses Invading Shrublands: A Comparison of Cold and Warm Deserts

    NASA Astrophysics Data System (ADS)

    Wilcox, B. P.; Turnbull, L.; Young, M.; Williams, C. J.; Ravi, S.; Seyfried, M. S.; Bowling, D. R.; Scott, R. L.; Caldwell, T. G.; Wainwright, J.; Germino, M. J.

    2010-12-01

    Exotic grasses are altering native savannas and woodlands across the globe. In this paper, we summarize the current state of knowledge concerning the ecohydrological consequences of native-shrubland-to-grassland conversion. Our objectives are to understand ecohydrological changes at the local scale, such as soil-water content or hillslope erosion; and whether these small-scale changes have consequences for larger-scale phenomena such as flooding, sedimentation in rivers, groundwater recharge, energy budgets, and weather patterns. In addition, we are interested in identifying gaps in our knowledge and research priorities. Our analysis is based on a synthesis of relevant literature complemented by simulation modeling using HYDRUS-1D and MAHLERAN. In terms of runoff and erosion, we find that the influence of grass invasion on surface runoff and erosion is different for the cold and warm deserts. For cold deserts, runoff and erosion will increase while for the warm deserts the opposite is likely to occur. In particular, erosion the erosion hazard will be greatly amplified on steep slopes (>20%) following burning. In warm deserts, grass invasion may actually reduce runoff and erosion. In terms of the vertical fluxes of evaporation and soil water recharge we find that grass invasion will likely lead to higher soil water recharge in cold deserts but not to the extent that groundwater will be affected for many, many decades and then likely not very much. In warm deserts grass invasion likely has little affect on evapotranspiration fluxes or soil water.

  15. Accounting for carbon cycle feedbacks in a comparison of the global warming effects of greenhouse gases

    NASA Astrophysics Data System (ADS)

    Gillett, Nathan P.; Damon Matthews, H.

    2010-07-01

    Greenhouse gases other than CO2 make a significant contribution to human-induced climate change, and multi-gas mitigation strategies are cheaper to implement than those which limit CO2 emissions alone. Most practical multi-gas mitigation strategies require metrics to relate the climate warming effects of CO2 and other greenhouse gases. Global warming potential (GWP), defined as the ratio of time-integrated radiative forcing of a particular gas to that of CO2 following a unit mass emission, is the metric used in the Kyoto Protocol, and we define mean global temperature change potential (MGTP) as an equivalent metric of the temperature response. Here we show that carbon-climate feedbacks inflate the GWPs and MGTPs of methane and nitrous oxide by ~ 20% in coupled carbon-climate model simulations of the response to a pulse of 50 × 1990 emissions, due to a warming-induced release of CO2 from the land biosphere and ocean. The magnitude of this effect is expected to be dependent on the model, but it is not captured at all by the analytical models usually used to calculate metrics such as GWP. We argue that the omission of carbon cycle dynamics has led to a low bias of uncertain but potentially substantial magnitude in metrics of the global warming effect of other greenhouse gases, and we suggest that the carbon-climate feedback should be considered when greenhouse gas metrics are calculated and applied.

  16. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.

    2007-01-01

    This report describes the work done by the Applied Meteorology Unit (AMU) in assessing the success of different model configurations in predicting warm season convection over East-Central Florida. The Weather Research and Forecasting Environmental Modeling System (WRF EMS) software allows users to choose among two dynamical cores - the Advanced Research WRF (ARW) and the Non-hydrostatic Mesoscale Model (NMM). There are also data assimilation analysis packages available for the initialization of the WRF model - the Local Analysis and Prediction System (LAPS) and the Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS). Besides model core and initialization options, the WRF model can be run with one- or two-way nesting. Having a series of initialization options and WRF cores, as well as many options within each core, creates challenges for local forecasters, such as determining which configuration options are best to address specific forecast concerns. This project assessed three different model intializations available to determine which configuration best predicts warm season convective initiation in East-Central Florida. The project also examined the use of one- and two-way nesting in predicting warm season convection.

  17. Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade.

    PubMed

    Ilaria, Giovannacci; Marco, Meleti; Elisabetta, Merigo; Giovanni, Mergoni; Carlo, Fornaini; Maddalena, Manfredi; Mauro, Bonanini; Paolo, Vescovi

    2015-09-01

    The aim of this study is to evaluate the possible intraoperative advantages of Nd:YAG laser and quantic molecular resonance (QMR) scalpel in oral soft tissue surgery. One hundred sixty-three interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser, group 2 (G2) 45 with QMR scalpel, and group 3 (G3) 41 with cold blade. Parameters analyzed were as follows: speed of incision, time of intervention, intraoperative bleeding, number of stitches, patient compliance, and operator comfort. Data were analyzed using software STATA 12 (StataCorp LP, College Station, TX, USA). Mean speed of incision was 0.54 mm/s in G1, 2.83 mm/s in G2, and 1.58 mm/s in G3, Nd:YAG laser being the slowest. However, no significant differences among times of intervention were found. In particular, interventions in G1 (221.15??220.89 s) have a mean duration lower than G2 (280.56??248.31 s) and G3 (316.10??248.69 s). Intraoperative bleeding occurred in 29.9 % (n?=?23/77) of interventions in G1, 97.8 % (n?=?44/45) in G2, and 97.6 % (n?=?40/41) in G3 (p?

  18. Do cities simulate climate change? A comparison of herbivore response to urban and global warming

    USGS Publications Warehouse

    Youngsteadt, Elsa; Dale, Adam G.; Terando, Adam J.; Dunn, Robert R.; Frank, Steven D.

    2014-01-01

    Cities experience elevated temperature, CO2, and nitrogen deposition decades ahead of the global average, such that biological response to urbanization may predict response to future climate change. This hypothesis remains untested due to a lack of complementary urban and long-term observations. Here, we examine the response of an herbivore, the scale insect Melanaspis tenebricosa, to temperature in the context of an urban heat island, a series of historical temperature fluctuations, and recent climate warming. We survey M. tenebricosa on 55 urban street trees in Raleigh, NC, 342 herbarium specimens collected in the rural southeastern United States from 1895 to 2011, and at 20 rural forest sites represented by both modern (2013) and historical samples. We relate scale insect abundance to August temperatures and find that M. tenebricosa is most common in the hottest parts of the city, on historical specimens collected during warm time periods, and in present-day rural forests compared to the same sites when they were cooler. Scale insects reached their highest densities in the city, but abundance peaked at similar temperatures in urban and historical datasets and tracked temperature on a decadal scale. Although urban habitats are highly modified, species response to a key abiotic factor, temperature, was consistent across urban and rural-forest ecosystems. Cities may be an appropriate but underused system for developing and testing hypotheses about biological effects of climate change. Future work should test the applicability of this model to other groups of organisms.

  19. Do cities simulate climate change? A comparison of herbivore response to urban and global warming.

    PubMed

    Youngsteadt, Elsa; Dale, Adam G; Terando, Adam J; Dunn, Robert R; Frank, Steven D

    2015-01-01

    Cities experience elevated temperature, CO2 , and nitrogen deposition decades ahead of the global average, such that biological response to urbanization may predict response to future climate change. This hypothesis remains untested due to a lack of complementary urban and long-term observations. Here, we examine the response of an herbivore, the scale insect Melanaspis tenebricosa, to temperature in the context of an urban heat island, a series of historical temperature fluctuations, and recent climate warming. We survey M. tenebricosa on 55 urban street trees in Raleigh, NC, 342 herbarium specimens collected in the rural southeastern United States from 1895 to 2011, and at 20 rural forest sites represented by both modern (2013) and historical samples. We relate scale insect abundance to August temperatures and find that M. tenebricosa is most common in the hottest parts of the city, on historical specimens collected during warm time periods, and in present-day rural forests compared to the same sites when they were cooler. Scale insects reached their highest densities in the city, but abundance peaked at similar temperatures in urban and historical datasets and tracked temperature on a decadal scale. Although urban habitats are highly modified, species response to a key abiotic factor, temperature, was consistent across urban and rural-forest ecosystems. Cities may be an appropriate but underused system for developing and testing hypotheses about biological effects of climate change. Future work should test the applicability of this model to other groups of organisms. PMID:25163424

  20. Intraoperative virtual brain counseling

    NASA Astrophysics Data System (ADS)

    Jiang, Zhaowei; Grosky, William I.; Zamorano, Lucia J.; Muzik, Otto; Diaz, Fernando

    1997-06-01

    Our objective is to offer online real-tim e intelligent guidance to the neurosurgeon. Different from traditional image-guidance technologies that offer intra-operative visualization of medical images or atlas images, virtual brain counseling goes one step further. It can distinguish related brain structures and provide information about them intra-operatively. Virtual brain counseling is the foundation for surgical planing optimization and on-line surgical reference. It can provide a warning system that alerts the neurosurgeon if the chosen trajectory will pass through eloquent brain areas. In order to fulfill this objective, tracking techniques are involved for intra- operativity. Most importantly, a 3D virtual brian environment, different from traditional 3D digitized atlases, is an object-oriented model of the brain that stores information about different brain structures together with their elated information. An object-oriented hierarchical hyper-voxel space (HHVS) is introduced to integrate anatomical and functional structures. Spatial queries based on position of interest, line segment of interest, and volume of interest are introduced in this paper. The virtual brain environment is integrated with existing surgical pre-planning and intra-operative tracking systems to provide information for planning optimization and on-line surgical guidance. The neurosurgeon is alerted automatically if the planned treatment affects any critical structures. Architectures such as HHVS and algorithms, such as spatial querying, normalizing, and warping are presented in the paper. A prototype has shown that the virtual brain is intuitive in its hierarchical 3D appearance. It also showed that HHVS, as the key structure for virtual brain counseling, efficiently integrates multi-scale brain structures based on their spatial relationships.This is a promising development for optimization of treatment plans and online surgical intelligent guidance.

  1. How do surgeons make intraoperative decisions?

    PubMed Central

    Flin, Rhona; Youngson, George; Yule, Steven

    2007-01-01

    Surgeons' intraoperative decision making is a key element of clinical practice, yet has received scant attention in the surgical literature. In recent years, serial changes in the configuration of surgical training in the UK have reduced the time spent by trainees in the operating theatre. The opportunity to replace this lost experience with active teaching of decision making is important, but there seem to have been very few studies that have directly examined the cognitive skills underlying surgical decision making during operations. From the available evidence in surgery, and drawing from research in other safety‐critical occupations, four decision‐making strategies that surgeons may use are discussed: intuitive (recognition‐primed), rule based, option comparison and creative. Surgeons' decision‐making processes should be studied to provide a better evidence base for the training of cognitive skills for the intraoperative environment. PMID:17545353

  2. Weather Research and Forecasting Model Sensitivity Comparisons for Warm Season Convective Initiation

    NASA Technical Reports Server (NTRS)

    Watson, Leela R.; Hoeth, Brian; Blottman, Peter F.

    2007-01-01

    Mesoscale weather conditions can significantly affect the space launch and landing operations at Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS). During the summer months, land-sea interactions that occur across KSC and CCAFS lead to the formation of a sea breeze, which can then spawn deep convection. These convective processes often last 60 minutes or less and pose a significant challenge to the forecasters at the National Weather Service (NWS) Spaceflight Meteorology Group (SMG). The main challenge is that a "GO" forecast for thunderstorms and precipitation at the Shuttle Landing Facility is required at the 90 minute deorbit decision for End Of Mission (EOM) and at the 30 minute Return To Launch Site (RTLS) decision. Convective initiation, timing, and mode also present a forecast challenge for the NWS in Melbourne, FL (MLB). The NWS MLB issues such tactical forecast information as Terminal Aerodrome Forecasts (TAF5), Spot Forecasts for fire weather and hazardous materials incident support, and severe/hazardous weather Watches, Warnings, and Advisories. Lastly, these forecasting challenges can also affect the 45th Weather Squadron (45 WS), which provides comprehensive weather forecasts for shuttle launch, as well as ground operations, at KSC and CCAFS. The need for accurate mesoscale model forecasts to aid in their decision making is crucial. This study specifically addresses the skill of different model configurations in forecasting warm season convective initiation. Numerous factors influence the development of convection over the Florida peninsula. These factors include sea breezes, river and lake breezes, the prevailing low-level flow, and convergent flow due to convex coastlines that enhance the sea breeze. The interaction of these processes produces the warm season convective patterns seen over the Florida peninsula. However, warm season convection remains one of the most poorly forecast meteorological parameters. To determine which configuration options are best to address this specific forecast concern, the Weather Research and Forecasting (WRF) model, which has two dynamical cores - the Advanced Research WRF (ARW) and the Non-hydrostatic Mesoscale Model (NMM) was employed. In addition to the two dynamical cores, there are also two options for a "hot-start" initialization of the WRF model - the Local Analysis and Prediction System (LAPS; McGinley 1995) and the Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS; Brewster 1996). Both LAPS and ADAS are 3- dimensional weather analysis systems that integrate multiple meteorological data sources into one consistent analysis over the user's domain of interest. This allows mesoscale models to benefit from the addition of highresolution data sources. Having a series of initialization options and WRF cores, as well as many options within each core, provides SMG and MLB with considerable flexibility as well as challenges. It is the goal of this study to assess the different configurations available and to determine which configuration will best predict warm season convective initiation.

  3. Comparison of Warm Blood Cardioplegia Delivery With or Without the Use of a Roller Pump

    PubMed Central

    Faber, Mizja M.; Noordzij, Peter G.; Hennink, Simon; Kelder, Hans; de Vroege, Roel; Waanders, Frans G.; Daeter, Edgar; Stehouwer, Marco C.

    2015-01-01

    Abstract: Various techniques for administration of blood cardioplegia are used worldwide. In this study, the effect of warm blood cardioplegia administration with or without the use of a roller pump on perioperative myocardial injury was studied in patients undergoing coronary artery bypass grafting using minimal extra-corporeal circuits (MECCs). Sixty-eight patients undergoing elective coronary bypass surgery with an MECC system were consecutively enrolled and randomized into a pumpless group (PL group: blood cardioplegia administration without roller pump) or roller pump group (RP group: blood cardioplegia administration with roller pump). No statistically significant differences were found between the PL group and RP group regarding release of cardiac biomarkers. Maximum postoperative biomarker values reached at T1 (after arrival intensive care unit) for heart-type fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal pro-brain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6; 3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175] ?g/mL PL group vs. 129 [105; 161] ?g/mL RP group, p = .65). Besides this, blood cardioplegia flow, blood cardioplegia line pressure, and aortic root pressure during blood cardioplegia administration were similar between the two groups. Administration of warm blood cardioplegia with or without the use of a roller pump results in similar clinically acceptable myocardial protection. PMID:26834282

  4. Localisation of motor areas in brain tumour patients: a comparison of preoperative [18F]FDG-PET and intraoperative cortical electrostimulation.

    PubMed

    Schreckenberger, M; Spetzger, U; Sabri, O; Meyer, P T; Zeggel, T; Zimny, M; Gilsbach, J; Buell, U

    2001-09-01

    Assessment of the exact spatial relation between tumour and adjacent functionally relevant brain areas is a primary tool in the presurgical planning in brain tumour patients. The purpose of this study was to compare a preoperative fluorine-18 fluorodeoxyglucose positron emission tomography ([18F]FDG PET) activation protocol in patients with tumours near the central area with the results of intraoperative direct cortical electrostimulation, and to determine whether non-invasive preoperative PET imaging can provide results equivalent to those achieved with the invasive neurosurgical "gold standard". In this prospective study, we examined 20 patients with various tumours of the central area, performing two PET scans (each 30 min after i.v. injection of 134-341 MBq [18F]FDG) in each patient: (1) a resting baseline scan and (2) an activation scan using a standardised motor task (finger tapping, foot stretching). Following PET/MRI realignment and normalisation to the whole brain counts, parametric images of the activation versus the rest study were calculated and pixels above categorical threshold values were projected to the individual MRI for bimodal assessment of morphology and function (PET/MRI overlay). Intraoperative direct cortical electrostimulation was performed using a Viking IV probe (5 pulses, each of 100 micros) and documented using a dedicated neuro navigation system. Results were compared with the preoperative PET findings. PET revealed significant activation of the contralateral primary motor cortex in 95% (19/20) of the brain tumour patients (hand activation 13/13, foot activation 6/7), showing a mean increase in normalised [18F]FDG uptake of 20.5% +/- 5.2% (hand activation task) and 17.2% +/- 2.5% (foot activation task). Additionally detected activation of the ipsilateral primary motor cortex was interpreted as a metabolic indication for interhemispheric compensational processes. Evaluation of the PET findings by cortical stimulation yielded a 94% sensitivity and a 95% specificity for identification of motor-associated brain areas. In conclusion, the findings indicate that a relatively simple and clinically available [18F]FDG PET activation protocol enables a sufficiently precise assessment of the local relation between the intracranial tumour and the adjacent motor cortex areas and may facilitate the presurgical planning of tumour resection. PMID:11585300

  5. SU-E-T-537: Comparison of Intra-Operative Soft X-Rays to Low Energy Electron Beams for Treatment of Superficial Lesions

    SciTech Connect

    Chinsky, B; Diak, A; Gros, S; Sethi

    2014-06-01

    Purpose: Superficial soft x-ray applicators have recently been designed for use with existing intra-operative radiotherapy systems. These applicators may be used in treating superficial lesions which are conventionally treated with electron beams. The purpose of this abstract is to compare dose distributions of an intra-operative 50kV x-ray unit with low energy electrons for the treatment of superficial lesions. Methods: Dosimetric parameters for 1 and 3-cm diameter Intrabeam superficial x-ray applicators were measured with EBT3 Gafchromic film in a solid water phantom. Depth dose distributions and profiles (d=2, 5, 10 and 15mm) were obtained by prescribing a dose of 400cGy at 5mm depth below the phantom surface. Corresponding dose profiles for 6-MeV electrons were acquired from a Varian Clinac 21EX at 100 SSD. H and D calibration curves were generated for each modality for 0-800cGy. Results: Dose coverage, penumbra, dose uniformity, surface dose, and dose fall-off were examined. Compared to electrons, Intrabeam lateral dose coverage at 5mm depth was 70% larger with a much sharper (1/4) penumbra. Electron isodose levels bulged with depth, whereas Intrabeam isodose levels exhibited a convex cone shape. The Intrabeam dose profiles demonstrated horns in the dose distribution up to a 5mm depth and an exponential dose fall-off. Relative surface dose was higher for the Intrabeam applicators. Treatment times were comparable for both modalities. Conclusions: The very small penumbra of Intrabeam at shallow depths could be useful in treating superficial lesions adjacent to critical structures. The exponential dose fall-off of Intrabeam makes it appealing in the sparing of structures beyond the lesion. However, for lesions past a depth of 5mm, electrons would be desirable as they penetrate farther and provide skin sparing. Intrabeam may be preferable for sites that are difficult to treat with electrons due to mechanical and physical limitations.

  6. Infrared absorption spectra, radiative efficiencies, and global warming potentials of perfluorocarbons: Comparison between experiment and theory

    NASA Astrophysics Data System (ADS)

    Bravo, IvN.; Aranda, Alfonso; Hurley, Michael D.; Marston, George; Nutt, David R.; Shine, Keith P.; Smith, Kevin; Wallington, Timothy J.

    2010-12-01

    Experimentally and theoretically determined infrared spectra are reported for a series of straight-chain perfluorocarbons: C2F6, C3F8, C4F10, C5F12, C6F14, and C8F18. Theoretical spectra were determined using both density functional (DFT) and ab initio methods. Radiative efficiencies (REs) were determined using the method of Pinnock et al. (1995) and combined with atmospheric lifetimes from the literature to determine global warming potentials (GWPs). Theoretically determined absorption cross sections were within 10% of experimentally determined values. Despite being much less computationally expensive, DFT calculations were generally found to perform better than ab initio methods. There is a strong wavenumber dependence of radiative forcing in the region of the fundamental C-F vibration, and small differences in wavelength between band positions determined by theory and experiment have a significant impact on the REs. We apply an empirical correction to the theoretical spectra and then test this correction on a number of branched chain and cyclic perfluoroalkanes. We then compute absorption cross sections, REs, and GWPs for an additional set of perfluoroalkenes.

  7. Comparison of the Effects on Dynamic Balance Ability of Warming up in Water Versus on the Ground.

    PubMed

    Lim, Kyoung Il; Hwnagbo, Gak; Nam, Hyung Chun; Cho, Yong Ho

    2014-04-01

    [Purpose] This research was designed to find out how the so-called "dynamic balance" is affected by doing different types of warm up exercises. In particular, the research is focused on the difference in the effect on dynamic Balance of warming up in water versus on the ground. [Subjects and Methods] Twenty healthy adults were the subjects of this study, with 10 people assigned each to two groups, one warming up in water and another warming up on the ground. The dynamic balance was measured for all subjects before the warming up. The group warming up on the ground conducted active stretching on the ground, and the group warming up in water conducted stretching in water by using water as resistance. [Results] The results indicate that warming up in water has a more powerful effect on a subject's dynamic balance than warming up on the ground. [Conclusion] The group warming up in water, who made use of the viscosity and flow of the water, showed better balance than the group warming up on the ground. Warming up in water, which entails an element of resistance, should be implemented in warm-up routines in the future. PMID:24764636

  8. Intraoperative dynamic dosimetry for prostate implants

    NASA Astrophysics Data System (ADS)

    Todor, D. A.; Zaider, M.; Cohen, G. N.; Worman, M. F.; Zelefsky, M. J.

    2003-05-01

    This paper describes analytic tools in support of a paradigm shift in brachytherapy treatment planning for prostate cancer - a shift from standard pre-planning to intraoperative planning using dosimetric feedback based on the actual deposited seed positions within the prostate. The method proposed is guided by several desiderata: (a) bringing both planning and evaluation in the operating room (i.e. make post-implant evaluation superfluous) therefore making rectifications - if necessary - still achievable; (b) making planning and implant evaluation consistent by using the same imaging system (ultrasound); and (c) using only equipment commonly found in a hospital operating room. The intraoperative dosimetric evaluation is based on the fusion between ultrasound images and 3D seed coordinates reconstructed from fluoroscopic projections. Automatic seed detection and registration of the fluoroscopic and ultrasound information, two of the three key ingredients needed for the intraoperative dynamic dosimetry optimization (IDDO), are explained in detail. The third one, the reconstruction of 3D coordinates from projections, was reported in a previous article. The algorithms were validated using a custom-designed phantom with non-radioactive (dummy) seeds. Also, fluoroscopic images were taken at the conclusion of an actual permanent prostate implant and compared with data on the same patient obtained from radiographic-based post-implant evaluation. To offset the effect of organ motion the comparison was performed in terms of the proximity function of the two seed distributions. The agreement between the intra- and post-operative seed distributions was excellent.

  9. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions.

    PubMed

    Hammerstingl, Renate; Huppertz, Alexander; Breuer, Josy; Balzer, Thomas; Blakeborough, Anthony; Carter, Rick; Fust, Lluis Castells; Heinz-Peer, Gertraud; Judmaier, Werner; Laniado, Michael; Manfredi, Riccardo M; Mathieu, Didier G; Mller, Dieter; Mortel, Koenraad; Reimer, Peter; Reiser, Maximilian F; Robinson, Philip J; Shamsi, Kohkan; Strotzer, Michael; Taupitz, Matthias; Tombach, Bernd; Valeri, Gianluca; van Beers, Bernhard E; Vogl, Thomas J

    2008-03-01

    A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT. PMID:18058107

  10. Innovations in Intraoperative Tumor Visualization.

    PubMed

    Visgauss, Julia D; Eward, William C; Brigman, Brian E

    2016-01-01

    In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection. PMID:26614939

  11. Climatology of Warm Boundary Layer Clouds at the ARM SGP Site and Their Comparison to Models

    SciTech Connect

    Sengupta, Manajit; Clothiaux, Eugene E.; Ackerman, Thomas P.

    2004-12-01

    A four-year climatology (1997-2000) of warm boundary layer cloud properties is developed for the U.S. Department of Energy Atmospheric Radiation (ARM) Program Southern Great Plains (SGP) site. Parameters in the climatology include cloud liquid water path, cloud base height and surface solar flux. These parameters are retrieved from measurements produced by a dual-channel microwave radiometer, a millimeter-wave cloud radar, a micropulse lidar, a Belfort ceilometer, shortwave radiometers and atmospheric temperature profiles amalgamated from multiple sources, including radiosondes. No significant interannual differences are observed, but nighttime liquid water paths are consistently higher than daytime values. The summer months of June, July and August have the lowest liquid water paths and the highest cloud base heights. Model outputs of cloud liquid water paths from the European Center for Medium Range Weather Forecasting (ECMWF) model and the Early Eta Model for 104 Model Output Location Time Series (MOLTS) stations in the environs of the SGP central facility are compared to observations. The ECMWF and MOLTS mean and median liquid water paths are 3 and 4 times greater, respectively, than the observed values. The MOLTS data show lower liquid water paths in summer, which is consistent with observations, while the ECMWF data exhibit the opposite tendency. A parameterization of normalized cloud forcing that requires only cloud liquid water path and solar zenith angle is developed from the observations. The parameterization, which has a correlation coefficient of 0.81 with the observations, provides estimates of surface solar flux that are comparable to values obtained from explicit radiative transfer calculations based on plane-parallel theory. This parameterization is used to estimate the impact on the surface solar flux of differences in the liquid water paths between models and observations. Overall, there is a low bias of 50% in modeled normalized cloud forcing resulting from the excess liquid water paths in the two models. Splitting the liquid water path into two components, cloud thickness and liquid water content, shows that the higher liquid water path in the model outputs is primarily a result of higher liquid water content. On the other hand the cloud thickness in both observations and models is comparable.

  12. Tidal variability during stratospheric sudden warming in 2009: Comparison between GAIA model and COSMIC and TIMED/SABER observations

    NASA Astrophysics Data System (ADS)

    Jin, Hidekatsu; Miyoshi, Yasunobu; Fujiwara, Hitoshi; Shinagawa, Hiroyuki; Pancheva, Dora; Mukhtarov, Plamen

    2012-07-01

    We compare results from a whole atmosphere-ionosphere coupled model, GAIA, and from the COSMIC and TIMED/SABER observations during 2008/2009 northern winter season. The GAIA model has assimilated meteorological reanalysis data by a nudging method. The comparison shows excellent agreements in the major features from the stratosphere to the ionosphere including the growth and decay of the major stratospheric sudden warming (SSW) event in 2009. During the major SSW period, a pronounced semidiurnal variation in the F-region electron density and its local-time phase shift similar to the previous observations are reproduced by the model and COSMIC observation. The model suggests that the TEC variation is caused by an enhanced semidiurnal variation in the EXB drift, which is probably related to an amplified semidiurnal migrating tide (SW2) in the lower thermosphere. The model and TIMED/SABER observation show that the SW2 tide amplifies at low latitudes from the stratosphere to the thermosphere as well as the phase variation. Possible mechanisms will be discussed in the presentation.

  13. Dosimetry for electron Intra-Operative RadioTherapy: Comparison of output factors obtained through alanine/EPR pellets, ionization chamber and Monte Carlo-GEANT4 simulations for IORT mobile dedicate accelerator

    NASA Astrophysics Data System (ADS)

    Marrale, Maurizio; Longo, Anna; Russo, Giorgio; Casarino, Carlo; Candiano, Giuliana; Gallo, Salvatore; Carlino, Antonio; Brai, Maria

    2015-09-01

    In this work a comparison between the response of alanine and Markus ionization chamber was carried out for measurements of the output factors (OF) of electron beams produced by a linear accelerator used for Intra-Operative Radiation Therapy (IORT). Output factors (OF) for conventional high-energy electron beams are normally measured using ionization chamber according to international dosimetry protocols. However, the electron beams used in IORT have characteristics of dose per pulse, energy spectrum and angular distribution quite different from beams usually used in external radiotherapy, so the direct application of international dosimetry protocols may introduce additional uncertainties in dosimetric determinations. The high dose per pulse could lead to an inaccuracy in dose measurements with ionization chamber, due to overestimation of ks recombination factor. Furthermore, the electron fields obtained with IORT-dedicated applicators have a wider energy spectrum and a wider angular distribution than the conventional fields, due to the presence of electrons scattered by the applicator's wall. For this reason, a dosimetry system should be characterized by a minimum dependence from the beam energy and from angle of incidence of electrons. This become particularly critical for small and bevelled applicators. All of these reasons lead to investigate the use of detectors different from the ionization chamber for measuring the OFs. Furthermore, the complete characterization of the radiation field could be accomplished also by the use of Monte Carlo simulations which allows to obtain detailed information on dose distributions. In this work we compare the output factors obtained by means of alanine dosimeters and Markus ionization chamber. The comparison is completed by the Monte Carlo calculations of OFs determined through the use of the Geant4 application "iort _ therapy" . The results are characterized by a good agreement of response of alanine pellets and Markus ionization chamber and Monte Carlo results (within about 3%) for both flat and bevelled applicators.

  14. Comparison between natural Rain drop size distributions and corresponding models near equilibrium state during warm rain

    NASA Astrophysics Data System (ADS)

    Barthes, Laurent; Mallet, Cécile

    2010-05-01

    Keywords: Rain Drop Size Distribution, Breakup, coalescence, disdrometer The study of the vertical evolution of raindrop size distributions (DSDs) during rainfall, from the freezing level isotherm to ground level, is a key to improving our understanding of the microphysics of rain. In numerous domains such as remote sensing, telecommunications, soil erosion, and the study of the rain's efficiency in 'washing' the atmosphere, the DSD plays an important role. Among the different processes affecting the evolution of DSD, breakup and coalescence are two of the most significant. Models of coalescence and breakup lead to equilibrium of the raindrop size distribution (DSD) after a fall through sufficient vertical height. At equilibrium, the DSD no longer evolves, and its shape is unique whatever the rain rate or LWC. This implies that the DSD is known, to within a multiplication constant. These models based on experimental measurements have been developed over the past 40 years. The Low and List (1982a,b) parameterization (hereinafter LL82) and the Greg M. McFarquhar (2004) model are both based on the same laboratory experiments, which lead to an equilibrium drop size distribution (EDSD) with two or three peaks, and an exponential tail with a slope of approximately Λ=65 cm-1. Numerous measurements using disdrometer collected in different climatic areas: Paris, France (Mars to October 2000), Iowa-City (April to October 2002), and Djougou (Benin June to September 2006) corresponding to 537 hours of rain period have shown that for high rain rates, close to a state of equilibrium, this slope lies between Λ=20 - 22 cm-1. This latter value is corroborated by others measurements found in the literature (Hu & Srivastava, 1995). Hu & Srivastava suggested that the Low and List parameterization may overestimate the effects of the breakup process. This hypothesis is in adequation with recent laboratory experiments (A.P. Barros 2008) in which the authors conclude that the number of fragments droplets produced when small drops and large drops collide is overestimate. As new parameterization of LL82 is not possible due to the lack of new sufficient large experimental dataset, we have simply tried in the present study to 'compensate' the problem previously mentioned by replacing the coalescence/breakup model proposed in LL82 by another one in which the breakup process is less dominant. In order to evaluate the relevance of this modification, some of the DSD parameters such as slope, mean volume diameter, and relation between moments are calculated, and comparisons with experimental DSD are made. Simulations at equilibrium lead to a DSD tail with a slope of 23 cm-1 and a mean volume diameter equal to 2.5 mm. These values are in good agreements with experimental data. Similarly, the linear relationship between No* and the rainfall rate is also in good agreement. In the last part, the modified parameterization is then used to study the evolution of an initially gamma-like DSD in a 1D vertical rain shaft. References Barros, A. P., O. P. Prat, P. Shrestha, F. Y. Testik, and L. F. Bliven, 2008. Revisiting Low and List (1982): evaluation of raindrop collision using laboratory observations and modeling. Journal of the Atmospheric Sciences. Vol. 65(9), pp. 2983-2993. Hu, Z., and R. C. Srivastava: 1995: Evolution of raindrop size distribution by coalescence, breakup, and evaporation: Theory and observations. J. Atmos. Sci., 52, 1761-1783. Low, T. B. and R. List, 1982a: Collision, coalescence, and breakup of raindrops. Part I: Experimentally established coalescence efficiencies and fragment size distributions in breakup. J. Atmos. Sci., 39, 1591-1606. ___ 1982b: Collision, coalescence, and breakup of raindrops. Part II: Parameterization of fragment size distributions. J. Atmos. Sci., 39, 1607-1618. McFarquhar, G. M, 2004: A new representation of collision-induced breakup of raindrops and its implications for the shapes of raindrop size distributions, J. Atmos. Sci., 61(7), 777-794.

  15. Comparison of warm and cold years on the southeastern Bering Sea shelf and some implications for the ecosystem

    NASA Astrophysics Data System (ADS)

    Stabeno, Phyllis J.; Kachel, Nancy B.; Moore, Sue E.; Napp, Jeffrey M.; Sigler, Michael; Yamaguchi, Atsushi; Zerbini, Alexandre N.

    2012-06-01

    The southeastern, middle shelf of the Bering Sea has exhibited extreme variability in sea ice extent, temperature, and the distribution and abundance of species at multiple trophic levels over the past four decades. From 1972-2000, there was high interannual variability of areal extent of sea ice during spring (March-April). In 2000, this shifted to a 5-year (2001-2005) period of low ice extent during spring, which transitioned to a 4-year (2007-2010) period of extensive sea ice. High (low) areal extent of sea ice in spring was associated with cold (warm) water column temperatures for the following 6-7 months. The ocean currents also differed between warm and cold years. During cold years, the monthly-mean currents over the shelf were largely westward, while in warm years the direction of currents was more variable, with northward flow during December-February and relatively weak flow during the remainder of the year. The types and abundance of zooplankton differed sharply between warm and cold years. This was especially true during the prolonged warm period (2001-2005) and cold period (2007-2010), and was less evident during the years of high interannual variability. During the warm period, there was a lack of large copepods and euphausiids over the shelf; however, their populations rebounded during cold period. Small crustacean zooplankton taxa did not appear to vary between and warm and cold years. For both walleye pollock and Pacific cod, year-class strength (recruitment) was low during the prolonged warm period, but improved during the following cold period. Year-class strength did not appear to vary as a function of warm and cold years during the period of high year-to-year variability. Also, recruitment of arrowtooth flounder (a predator of pollock and cod) did not appear influenced by the warm or cold years. Finally, the distribution and relative abundance of fin whales appeared to differ in warm and cold years, with fewer whales on the southeastern, middle shelf during warm years.

  16. Intraoperative fracture of phacoemulsification tip.

    PubMed

    Angmo, Dewang; Khokhar, Sudarshan K; Ganguly, Anasua

    2014-01-01

    Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery. PMID:24669153

  17. A national dosimetry audit of intraoperative radiotherapy

    PubMed Central

    Earner, B; Faulkner, P; Dancer, N

    2013-01-01

    Objective: National dosimetry audits are a fundamental part of quality assurance in radiotherapy, especially for new techniques. Intraoperative radiotherapy with a compact mobile kilovoltage X-ray source is a novel approach for the treatment of breast and other cancers. All seven current clinical sites in the UK were audited by a single visiting group and set of measurement equipment. Methods: Measurements of output, isotropy and depth doses were performed using an ion chamber in solid water, thermoluminescent dosemeters and radiochromic film, respectively. Results: The mean difference between measured and planned dose across all centres was ?3.22.7%. Measured isotropy was within 3% around the lateral plane of the X-ray source and +114% in the forward direction compared with the lateral plane. Measured depth doses were agreed within 52% of manufacturer-provided calibration values or a mean gamma index of 97% at a tolerance of 7%/0.5?mm. Conclusion: Agreement within measurement uncertainties was found for all three parameters except forward anisotropy, which is unlikely to be clinically significant. Steep dose gradients increase the sensitivity to small variations in positioning, but these tests are practical for use in interdepartmental audits and local baseline comparison. Advances in knowledge: The first UK interdepartmental audit of intraoperative radiotherapy builds confidence in the delivery of this treatment. PMID:24133058

  18. Intraoperative transfusion practices in Europe

    PubMed Central

    Meier, J.; Filipescu, D.; Kozek-Langenecker, S.; Llau Pitarch, J.; Mallett, S.; Martus, P.; Matot, I.

    2016-01-01

    Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl−1 and increased to 9.8 (1.8) g dl−1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusion. Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7–9 g dl−1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. Clinical trial registration. NCT 01604083. PMID:26787795

  19. A Comparison of Symmetric and Asymmetric Warming Regimes on the Soil Carbon and Nitrogen Dynamics of Grassland Ecosystems

    NASA Astrophysics Data System (ADS)

    Wig, J.; Lajtha, K.; Gregg, J. W.

    2010-12-01

    Global mean temperatures have increased 0.10 to 0.16C per decade over the last 50 years, and continued increases in atmospheric greenhouse gas concentrations are expected to cause temperatures to increase by more than 3C by the middle of the 21st century. While many warming experiments have been performed, most have determined impacts of equal increases in day and night temperatures on production, diversity, or ecosystem carbon dynamics. However, there have been faster increases in daily minimum temperature (Tmin) than daily maximum temperature (Tmax), a phenomenon commonly referred to as asymmetric warming. Photosynthesis and respiration are differentially affected by altered day and night temperatures, and thus the ecological effects of alterations in Tmin could differ from alterations in Tmax. Therefore, it is imperative that we expand our understanding of potential impacts of global warming to include the effects of asymmetrically elevated temperature profiles. To examine the affects of asymmetric vs. symmetric warming, we used Terracosm chambers with planted grassland communities native to Oregons Willamette Valley. The warmed chambers are subjected to an average increase of +3.5C/day, with asymmetrically warmed chambers having an increase of dawn Tmin of +5C, and an increase of midday Tmax of +2C; and with symmetrically warmed chambers having a constant increase of +3.5C. The goals of this project are to assess (1) whether patterns of increased NPP, changes in species composition and altered C, H2O and nutrient cycles shown for symmetric warming are similar in the asymmetric profiles, or whether entirely different patterns emerge unique to the asymmetrically elevated temperature treatments, and (2) whether the impacts of asymmetric and symmetric warming differ for soil C stabilization and destabilization processes. Our data indicate that whole ecosystem carbon balance was negative, with higher respiration than photosynthesis, for both symmetric and asymmetric treatments after four years. Here we present the most recent data collected from the Terracosms, focusing on soil carbon and nitrogen dynamics.

  20. Active layer warming and deepening at Thule, Greenland during past decade: a comparison of a Polar Desert and a Polar Semi-desert site

    NASA Astrophysics Data System (ADS)

    Sletten, R. S.; Hagedorn, B.; Hallet, B.; Burnham, J. L.

    2013-12-01

    Microclimate and soil temperature/moisture monitoring at a Polar Desert and a Polar Semi-Desert site at Thule, Greenland reveals recent warming trends and distinct differences between these two sites. Approximately 5 C of warming occurred at the Polar Desert site from 2004 to 2009, while the Polar Semi-desert site warmed only about 3.5 C. Since 2009, the temperatures remain higher but stable. This warming trend is also reflected in the active layer, both in warming of the soil and in deepening of the active layer. Trends in soil temperatures and active layer depth are controlled substantially by the snow cover. For the Polar Semi-desert site, soil temperatures are measured both under natural snow accumulation conditions and under enhanced snow accumulation where a snow fence was installed. The insulating effect of the snow cover is effective and results in significantly warmer winter soils, as has been shown in other artificial snow cover studies. The warmer winter soils may allow greater respiration during the transition seasons thereby releasing more of the accumulated soil carbon in these sites than that we have previously documented. The trends in temperature and moisture may in part be controlled by the higher wind velocities at the Polar Desert site. These conditions are likely to be dominant controls on the ecosystem, along with differences in lithology which affects the cryoturbation of the soils. This in-depth microclimate study, along with our studies of the soils and soil water chemistry provides a detailed comparison of the adjacent ecosystems and may allow us to better predict how slight changes in climatic conditions may influence these systems and their subsequent feedback on carbon cycling.

  1. Global Warming.

    ERIC Educational Resources Information Center

    Hileman, Bette

    1989-01-01

    States the foundations of the theory of global warming. Describes methodologies used to measure the changes in the atmosphere. Discusses steps currently being taken in the United States and the world to slow the warming trend. Recognizes many sources for the warming and the possible effects on the earth. (MVL)

  2. Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000

    PubMed Central

    Han, Sangbin; Choi, Junghee; Ko, Justin Sangwook; Gwak, Misook; Lee, Suk-Koo

    2014-01-01

    Background Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. Methods Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. Results Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122). Conclusions A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings. PMID:25368785

  3. Comparison of net global warming potential and greenhouse gas intensity affected by management practices in two dryland cropping sites

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Little is known about the effect of management practices on net global warming potential (GWP) and greenhouse gas intensity (GHGI) that account for all sources and sinks of greenhouse gas (GHG) emissions in dryland cropping systems. The objective of this study was to compare the effect of a combinat...

  4. Comparison of mesozooplankton communities from a pair of warm- and cold-core eddies off the coast of Western Australia

    NASA Astrophysics Data System (ADS)

    Strzelecki, J.; Koslow, J. A.; Waite, A.

    2007-04-01

    We examined the abundance and biomass, size, trophic and community structure of the mesozooplankton within a pair of warm- and cold-core eddies off the west coast of Australia in October 2003, about five months after their initial formation. Zooplankton assemblages were highly diverse in both eddies, with little dominance by any taxa. Assemblages were significantly different in the two eddies, and night assemblages differed from day. Contrary to initial expectation, mesozooplankton abundance and biomass were twice as high in the warm-core eddy as in the cold-core eddy. This was consistent with the higher phytoplankton and microzooplankton biomass and higher primary production in the warm-core eddy. The source water for the warm-core eddy was Leeuwin Current water with about a 10% admixture of shelf water. The plankton biomass and productivity of these water masses are substantially higher than of subtropical Indian Ocean water, the source water for the mixed layer of the cold-core eddy. Five months after eddy formation, the abundance and biomass of zooplankton in the eddies continued to reflect the values generally observed in their parent water masses. The trophic structure of the zooplankton in both eddies was dominated by carnivores (mostly chaetognaths). Although this apparent trophic structure may be an artefact of sampling oligotrophic waters with coarse-meshed (335 μm) nets, it points to a 'lumpiness' in the Sheldon particle spectrum.

  5. Comparison of "warm and wet" and "cold and icy" scenarios for early Mars in a 3-D climate model

    NASA Astrophysics Data System (ADS)

    Wordsworth, Robin D.; Kerber, Laura; Pierrehumbert, Raymond T.; Forget, Francois; Head, James W.

    2015-06-01

    We use a 3-D general circulation model to compare the primitive Martian hydrological cycle in "warm and wet" and "cold and icy" scenarios. In the warm and wet scenario, an anomalously high solar flux or intense greenhouse warming artificially added to the climate model are required to maintain warm conditions and an ice-free northern ocean. Precipitation shows strong surface variations, with high rates around Hellas basin and west of Tharsis but low rates around Margaritifer Sinus (where the observed valley network drainage density is nonetheless high). In the cold and icy scenario, snow migration is a function of both obliquity and surface pressure, and limited episodic melting is possible through combinations of seasonal, volcanic, and impact forcing. At surface pressures above those required to avoid atmospheric collapse (0.5 bar) and moderate to high obliquity, snow is transported to the equatorial highland regions where the concentration of valley networks is highest. Snow accumulation in the Aeolis quadrangle is high, indicating an ice-free northern ocean is not required to supply water to Gale crater. At lower surface pressures and obliquities, both H2O and CO2 are trapped as ice at the poles and the equatorial regions become extremely dry. The valley network distribution is positively correlated with snow accumulation produced by the cold and icy simulation at 41.8 obliquity but uncorrelated with precipitation produced by the warm and wet simulation. Because our simulations make specific predictions for precipitation patterns under different climate scenarios, they motivate future targeted geological studies.

  6. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernndez-Pello; Rodrguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodrguez; Mendez, Begoa Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  7. Urban warming

    SciTech Connect

    Kukla, G.; Gavin, J.; Karl, T.R.

    1986-09-01

    Meteorological stations located in an urban environment in North America warmed between 1941 and 1980, compared to the countryside, at an average rate of about 0,12 /sup 0/C per decade. Secular trends of surface air temperature computed predominately from such station data are likely to have a serious warm bias.

  8. Genome Dissection of Traits Related to Domestication in Azuki Bean (Vigna angularis) and Comparison with other Warm-season Legumes

    PubMed Central

    Isemura, Takehisa; Kaga, Akito; Konishi, Saeko; Ando, Tsuyu; Tomooka, Norihiko; Han, Ouk Kyu; Vaughan, Duncan A.

    2007-01-01

    Background The objective of this study was to dissect into quantitative trait loci (QTLs) the large morphological and physiological differences between cultivated azuki bean (Vigna angularis) and a wild relative and to infer the commonalities of the QTLs for domestication-related traits across the Asian Vigna and with other warm-season legumes. Methods Two linkage maps, for the BC1F1 and F2 populations, respectively, from the same cross between azuki bean and V. nepalensis were developed. Using these linkage maps QTLs for 33 domestication-related traits were analysed and mapped. The location of mapped QTLs was compared with locations of similar QTLs in other warm-season legumes. Key Results QTLs were detected for seed-, pod-, stem- and leaf-related traits. Most traits were controlled by between two and nine QTLs but several traits, such as pod dehiscence, were controlled by single genes. QTLs for domestication-related traits were restricted to particular regions of the azuki bean genome, especially linkage groups 1, 2, 4, 7 and 9. Linkage groups 1 and 2 had QTLs for a suite of traits including pod size, germination, seed size and lower stem length. QTLs on linkage groups 7 and 9 were associated with upper stem length, maximum leaf size and pod and seed size. Pleiotropy or close linkage of genes for domestication-related traits is suggested in these regions. While some QTLs are common to azuki bean and other warm-season legumes, many are recorded for the first time in azuki bean. Conclusions QTLs for a large number of domestication-related traits have been mapped for the first time in azuki bean. QTLs with unexpected effect and new QTLs for traits such as seed size have been found. The results provide a foundation that will be useful for improvement of azuki bean and related legumes. PMID:17728336

  9. Early experience of intraoperative autotransfusion.

    PubMed Central

    Wilson, A J; Cuddigan, B J; Wyatt, A P

    1988-01-01

    Intraoperative autotransfusion of whole blood was performed using the Solcotrans device in 45 patients undergoing major vascular surgery or other procedures in which there was a clean operative field. Overall, 60% of the blood shed during these operations was reinfused. Approximately 50% of patients avoided the potential complications of homologous transfusion. There were no complications attributable to the use of this device although in a sample of 13 patients, 30% of the erythrocytes were haemolysed and there were other minor haematological abnormalities. In conclusion this device provides a simple method of autotransfusing 2 or 3 litres of blood aspirated from an uncontaminated operative field. PMID:3411587

  10. Intraoperative cholangiography and bile duct injury.

    PubMed

    Sarli, L; Costi, R; Roncoroni, L

    2006-01-01

    We are not in agreement with the opinion that the credit for excellent results after laparoscopic cholecystectomy is to be attributed to the routine performing of intraoperative cholangiography. We performed 2538 laparoscopic cholecystectomies without routine intraoperative cholangiography and we obtained very low rate and severity of common bile duct injuries: there was a total of four common bile duct injuries (0.16%), in no case was the injury a major transaction, and injuries were detected intraoperatively and easily repaired with a T-tube. Cholangiography could prevent bile duct transaction, but that it is not necessary for intraoperative cholangiography to be routinely performed for this purpose. It is sufficient for intraoperative cholangiography to be performed whenever the surgeon is in doubt as to the biliary anatomy or common bile duct clearance, and that when dissection of the cholecystic peduncle proves difficult he does not hesitate to convert to open access. PMID:16333543

  11. Intraoperative OCT in Surgical Oncology

    NASA Astrophysics Data System (ADS)

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  12. Intraoperative biomarkers in renal transplantation.

    PubMed

    Lohkamp, Laura-Nanna; Öllinger, Robert; Chatzigeorgiou, Antonios; Illigens, Ben Min-Woo; Siepmann, Timo

    2016-03-01

    The emerging need for biomarkers in the management of renal transplantation is highlighted by the severity of related complications such as acute renal failure and ischaemia/reperfusion injury (IRI) and by the increasing efforts to identify novel markers of these events to predict and monitor delayed graft function (DGF) and long-term outcome. In clinical studies candidate markers such as kidney injury molecule-1, neutrophil gelatinase-associated lipocalin and interleukin-18 have been demonstrated to be valid biomarkers with high predictive value for DFG in a post-transplant setting. However, studies investigating biomarkers for early diagnosis of IRI and assumable DGF as well as identification of potential graft recipients at increased risk at the time point of transplantation lack further confirmation and translation into clinical practice. This review summarizes the current literature on the value of IRI biomarkers in outcome prediction following renal transplantation as well their capacity as surrogate end points from an intraoperative perspective. PMID:26132511

  13. Intraoperative radiotherapy for breast cancer

    PubMed Central

    Williams, Norman R.; Pigott, Katharine H.; Brew-Graves, Chris

    2014-01-01

    Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique. PMID:25083504

  14. INTRAOPERATIVE USE OF HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING IN MACULAR SURGERY

    PubMed Central

    DAYANI, POUYA N.; MALDONADO, RAMIRO; FARSIU, SINA; TOTH, CYNTHIA A.

    2012-01-01

    Purpose To describe the intraoperative use of handheld spectral domain optical coherence tomography (SDOCT) imaging in macular surgery. Design Prospective, observational case series. Methods A handheld SDOCT device was used to obtain preincision optical coherence tomography imaging in patients undergoing vitrectomy for macular diseases. After removal of the internal limiting membrane or the epiretinal membrane, repeat intraoperative imaging was obtained. Spectral domain optical coherence tomography findings were characterized. Results An efficient technique was established for obtaining intraoperative SDOCT imaging. A total of eight patients were included in the study. Four patients underwent surgery for macular hole, three patients for epiretinal membrane, and one for vitreomacular traction. Comparison of the preincision and intraoperative SDOCT images demonstrated distinct changes in retinal contour and macular hole configuration. Intraoperative SDOCT imaging identified additional membranes in two patients. Conclusion The intraoperative use of handheld SDOCT imaging provides an efficient method for visualizing macular pathology. This technology may, in certain cases, help confirm or identify diseases that may be difficult to visualize during surgery. PMID:19823107

  15. Comparison of different cooling regimes within a shortened liquid cooling/warming garment on physiological and psychological comfort during exercise

    NASA Technical Reports Server (NTRS)

    Leon, Gloria R.; Koscheyev, Victor S.; Coca, Aitor; List, Nathan

    2004-01-01

    The aim of this study was to compare the effectiveness of different cooling regime intensities to maintain physiological and subjective comfort during physical exertion levels comparable to that engaged in during extravehicular activities (EVA) in space. We studied eight subjects (six males, two females) donned in our newly developed physiologically based shortened liquid cooling/warming garment (SLCWG). Rigorous (condition 1) and mild (condition 2) water temperature cooling regimes were compared at physical exertion levels comparable to that performed during EVA to ascertain the effectiveness of a lesser intensity of cooling in maintaining thermal comfort, thus reducing energy consumption in the portable life support system. Exercise intensity was varied across stages of the session. Finger temperature, rectal temperature, and subjective perception of overall body and hand comfort were assessed. Finger temperature was significantly higher in the rigorous cooling condition and showed a consistent increase across exercise stages, likely due to the restriction of heat extraction because of the intensive cold. In the mild cooling condition, finger temperature exhibited an overall decline with cooling, indicating greater heat extraction from the body. Rectal temperature was not significantly different between conditions, and showed a steady increase over exercise stages in both rigorous and mild cooling conditions. Ratings of overall comfort were 30% higher (more positive) and more stable in mild cooling (p<0.001). The mild cooling regime was more effective than rigorous cooling in allowing the process of heat exchange to occur, thus maintaining thermal homeostasis and subjective comfort during physical exertion.

  16. Cold and Dry vs. Warm and Wet: 3D Modelling of the Late Noachian Climate and Comparison with the Geological Evidence

    NASA Astrophysics Data System (ADS)

    Wordsworth, R.; Pierrehumbert, R.; Kerber, L.; Forget, F.; Head, J.

    2014-07-01

    We present 3D climate simulations of Mars during the late Noachian / early Hesperian period. Rain and snow deposition patterns in episodically warm and warm, wet scenarios are compared with the observed spatial distribution of valley networks.

  17. Comparison of Obturation Quality in Modified Continuous Wave Compaction, Continuous Wave Compaction, Lateral Compaction and Warm Vertical Compaction Techniques

    PubMed Central

    Aminsobhani, Mohsen; Ghorbanzadeh, Abdollah; Sharifian, Mohammad Reza; Namjou, Sara; Kharazifard, Mohamad Javad

    2015-01-01

    Objectives: The aim of this study was to introduce modified continuous wave compaction (MCWC) technique and compare its obturation quality with that of lateral compaction (LC), warm vertical compaction (WVC) and continuous wave compaction techniques (CWC). The obturation time was also compared among the four techniques. Materials and Methods: Sixty-four single-rooted teeth with 05 root canal curve and 64 artificially created root canals with 15 curves in acrylic blocks were evaluated. The teeth and acrylic specimens were each divided into four subgroups of 16 for testing the obturation quality of four techniques namely LC, WVC, CWC and MCWC. Canals were prepared using the Mtwo rotary system and filled with respect to their group allocation. Obturation time was recorded. On digital radiographs, the ratio of area of voids to the total area of filled canals was calculated using the Image J software. Adaptation of the filling materials to the canal walls was assessed at three cross-sections under a stereomicroscope (X30). Data were statistically analyzed using ANOVA, Tukeys post hoc HSD test, the Kruskal Wallis test and t-test. Results: No significant difference existed in adaptation of filling materials to canal walls among the four subgroups in teeth samples (P ? 0.139); but, in artificially created canals in acrylic blocks, the frequency of areas not adapted to the canal walls was significantly higher in LC technique compared to MCWC (P ? 0.02). The void areas were significantly more in the LC technique than in other techniques in teeth (P < 0.001). The longest obturation time belonged to WVC technique followed by LC, CW and MCWC techniques (P<0.05). The difference between the artificially created canals in blocks and teeth regarding the obturation time was not significant (P = 0.41). Conclusion: Within the limitations of this in vitro study, MCWC technique resulted in better adaptation of gutta-percha to canal walls than LC at all cross-sections with fewer voids and faster obturation time compared to other techniques. PMID:26056519

  18. Anesthesia for intraoperative radiation therapy in children

    SciTech Connect

    Friesen, R.H.; Morrison, J.E. Jr.; Verbrugge, J.J.; Daniel, W.E.; Aarestad, N.O.; Burrington, J.D.

    1987-06-01

    Intraoperative radiation therapy (IORT) is a relatively new mode of cancer treatment which is being used with increasing frequency. IORT presents several challenges to the anesthesiologist, including patients who are debilitated from their disease or chemotherapy, operations involving major tumor resections, intraoperative interdepartmental transport of patients, and remote monitoring of patients during electron beam therapy. This report discusses the anesthetic management of ten children undergoing IORT. With adequate preparation and interdepartmental communication, complications can be avoided during these challenging cases.

  19. Global Warming?

    ERIC Educational Resources Information Center

    Eichman, Julia Christensen; Brown, Jeff A.

    1994-01-01

    Presents information and data on an experiment designed to test whether different atmosphere compositions are affected by light and temperature during both cooling and heating. Although flawed, the experiment should help students appreciate the difficulties that researchers face when trying to find evidence of global warming. (PR)

  20. Virtual intraoperative surgical photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Lee, Changho; Lee, Donghyun; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

    2015-07-01

    A virtual intraoperative surgical photoacoustic microscopy at 1064 nm wavelength (VISPAM) system was designed and fabricated by integrating a commercial type surgical microscope and laser scanning photoacoustic microscopy (PAM) with a 1064 nm pulsed laser. Based on simple augmented reality device, VISPAM could simultaneously provide 2D depth-resolved photoacoustic and magnified microscope images of surgery regions on the same vision of surgeon via an eyepiece of the microscope. The invisible 1064 nm laser removed the interruption of surgical sight due to visible laser scanning of previous report, and decreased the danger of tissue damage caused by over irradiated laser. In addition, to approach the real practical surgery application, a needle-type transducer was utilized without a water bath for PA signal coupling. In order to verify our system's performance, we conducted needle guiding as ex vivo phantom study and needle guiding and injection of carbon particles mixtures into a melanoma tumor region as in vivo study. We expect that VISPAM can be essential tool of brain and ophthalmic microsurgery.

  1. Global warming

    NASA Astrophysics Data System (ADS)

    Houghton, John

    2005-06-01

    'Global warming' is a phrase that refers to the effect on the climate of human activities, in particular the burning of fossil fuels (coal, oil and gas) and large-scale deforestation, which cause emissions to the atmosphere of large amounts of 'greenhouse gases', of which the most important is carbon dioxide. Such gases absorb infrared radiation emitted by the Earth's surface and act as blankets over the surface keeping it warmer than it would otherwise be. Associated with this warming are changes of climate. The basic science of the 'greenhouse effect' that leads to the warming is well understood. More detailed understanding relies on numerical models of the climate that integrate the basic dynamical and physical equations describing the complete climate system. Many of the likely characteristics of the resulting changes in climate (such as more frequent heat waves, increases in rainfall, increase in frequency and intensity of many extreme climate events) can be identified. Substantial uncertainties remain in knowledge of some of the feedbacks within the climate system (that affect the overall magnitude of change) and in much of the detail of likely regional change. Because of its negative impacts on human communities (including for instance substantial sea-level rise) and on ecosystems, global warming is the most important environmental problem the world faces. Adaptation to the inevitable impacts and mitigation to reduce their magnitude are both necessary. International action is being taken by the world's scientific and political communities. Because of the need for urgent action, the greatest challenge is to move rapidly to much increased energy efficiency and to non-fossil-fuel energy sources.

  2. Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

    PubMed Central

    Jah-Kabba, Ann-Marie Bintu Munda; Kukuk, Guido Matthias; Hadizadeh, Dariusch Reza; Trber, Frank; Koscielny, Arne; Kabba, Mustapha Sundifu; Verrel, Frauke; Schild, Hans Heinz; Willinek, Winfried Albert

    2014-01-01

    Background Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. Methods 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 4488 years) underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium. Apart from primary arterial assessment images were evaluated in order to determine great saphenous vein diameters at three levels: below the saphenofemoral junction, mid thigh and 10 cm above the knee joint (usability: diameter range: >3 and <10 mm at one level and >3.5 and <10 mm at a neighboring level). Duplex ultrasound was performed by an independent examiner providing diameter measurements at the same levels. Additionally, vessel usability was determined intraoperatively by the vascular surgeon during subsequent bypass surgery. Results Mean venous diameters for MR angiography/duplex ultrasound were 5.42.6/5.52.8 mm (level 1), 4.72.7/4.62.9 mm (level 2) and 4.42.2/4.52.3 mm (level 3), respectively, without significant differences between the modalities (P?=?0.207/0.806/0.518). Subsequent surgery was performed in 27/38 patients. A suitable saphenous vein was diagnosed in 25 and non-usability was diagnosed in 2 of the 27 patients based on MR angiography/duplex ultrasound, respectively. Usability was confirmed by intraoperative assessment in all of the 24 patients that received a venous bypass graft in subsequent bypass surgery. In 1 case, in which the great saphenous vein was assessed as useable by both MR angiography and duplex ultrasound, it was not used during subsequent bypass surgery due to the patients clinical condition and comorbidities. Conclusion Simultaneous mapping of the great saphenous vein as an imaging adjunct to peripheral MR angiography with a blood pool contrast agent is an alternative to additive duplex ultrasound in patients undergoing subsequent peripheral bypass grafting. PMID:25405867

  3. Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey

    PubMed Central

    Deng, Xiaoming; Fan, Ting; Fu, Runqiao; Geng, Wanming; Guo, Ruihong; He, Nong; Li, Chenghui; Li, Lei; Li, Min; Li, Tianzuo; Tian, Ming; Wang, Geng; Wang, Lei; Wang, Tianlong; Wu, Anshi; Wu, Di; Xue, Xiaodong; Xu, Mingjun; Yang, Xiaoming; Yang, Zhanmin; Yuan, Jianhu; Zhao, Qiuhua; Zhou, Guoqing; Zuo, Mingzhang; Pan, Shuang; Zhan, Lujing; Yao, Min; Huang, Yuguang

    2015-01-01

    Background/Objective Inadvertent intraoperative hypothermia (core temperature <360 C) is a recognized risk in surgery and has adverse consequences. However, no data about this complication in China are available. Our study aimed to determine the incidence of inadvertent intraoperative hypothermia and its associated risk factors in a sample of Chinese patients. Methods We conducted a regional cross-sectional survey in Beijing from August through December, 2013. Eight hundred thirty patients who underwent various operations under general anesthesia were randomly selected from 24 hospitals through a multistage probability sampling. Multivariate logistic regression analyses were applied to explore the risk factors of developing hypothermia. Results The overall incidence of intraoperative hypothermia was high, 39.9%. All patients were warmed passively with surgical sheets or cotton blankets, whereas only 10.7% of patients received active warming with space heaters or electric blankets. Pre-warmed intravenous fluid were administered to 16.9% of patients, and 34.6% of patients had irrigation of wounds with pre-warmed fluid. Active warming (OR = 0.46, 95% CI 0.260.81), overweight or obesity (OR = 0.39, 95% CI 0.280.56), high baseline core temperature before anesthesia (OR = 0.08, 95% CI 0.040.13), and high ambient temperature (OR = 0.89, 95% CI 0.790.98) were significant protective factors for hypothermia. In contrast, major-plus operations (OR = 2.00, 95% CI 1.323.04), duration of anesthesia (12 h) (OR = 3.23, 95% CI 2.194.78) and >2 h (OR = 3.44, 95% CI 1.906.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.454.12) significantly increased the risk of hypothermia. Conclusions The incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major operations, requiring long periods of anesthesia, and receiving un-warmed intravenous fluids. PMID:26360773

  4. Radiation safety consideration during intraoperative radiation therapy.

    PubMed

    Mobit, Paul N; Rajaguru, Priyadarshini; Brewer, Michael; Baird, Michael; Packianathan, Satyaseelan; Yang, Claus Chunli

    2015-04-01

    Using in-house-designed phantoms, the authors evaluated radiation exposure rates in the vicinity of a newly acquired intraoperative radiation therapy (IORT) system: Axxent Electronic Brachytherapy System. The authors also investigated the perimeter radiation levels during three different clinical intraoperative treatments (breast, floor of the mouth and bilateral neck cancer patients). Radiation surveys during treatment delivery indicated that IORT using the surface applicator and IORT using balloons inserted into patient body give rise to exposure rates of 200 mR h(-1), 30 cm from a treated area. To reduce the exposure levels, movable lead shields should be used as they reduce the exposure rates by >95%. The authors' measurements suggest that intraoperative treatment using the 50-kVp X-ray source can be administered in any regular operating room without the need for radiation shielding modification as long as the operators utilise lead aprons and/or stand behind lead shields. PMID:25267855

  5. [Intraoperative verification of colorectal anastomotic integrity].

    PubMed

    Martnek, L; Bergamaschi, R; Hoch, J

    2015-05-01

    Early postoperative anastomotic complications have serious clinical implications for the patients morbidity, mortality as well as long-term results. A number of measures can be undertaken to reduce the risk of anastomotic complications, including intraoperative colorectal anastomotic integrity assessment. Methods used to assess anastomotic reliability have gradually developed from basic mechanical techniques, direct visual endoluminal inspection, to microperfusion assessment of perianastomotic tissue. Moderate benefit in terms of reduced postoperative anastomotic complications has been shown with mechanical patency testing and partly with intraoperative endoscopic visualization of colorectal anastomoses. More recently, indocyanine green (ICG) fluorescence imaging methods have emerged as major contributions to anastomotic patency assessment and intraoperative decision making during surgical colorectal procedures including decreased numbers of ileostomies. PMID:26112682

  6. Intraoperative cerebral blood flow imaging of rodents

    NASA Astrophysics Data System (ADS)

    Li, Hangdao; Li, Yao; Yuan, Lu; Wu, Caihong; Lu, Hongyang; Tong, Shanbao

    2014-09-01

    Intraoperative monitoring of cerebral blood flow (CBF) is of interest to neuroscience researchers, which offers the assessment of hemodynamic responses throughout the process of neurosurgery and provides an early biomarker for surgical guidance. However, intraoperative CBF imaging has been challenging due to animal's motion and position change during the surgery. In this paper, we presented a design of an operation bench integrated with laser speckle contrast imager which enables monitoring of the CBF intraoperatively. With a specially designed stereotaxic frame and imager, we were able to monitor the CBF changes in both hemispheres during the rodent surgery. The rotatable design of the operation plate and implementation of online image registration allow the technician to move the animal without disturbing the CBF imaging during surgery. The performance of the system was tested by middle cerebral artery occlusion model of rats.

  7. Intraoperative detection of traumatic coagulopathy using the activated coagulation time.

    PubMed

    Aucar, John A; Norman, Peter; Whitten, Elizabeth; Granchi, Thomas S; Liscum, Kathleen R; Wall, Matthew J; Mattox, Kenneth L

    2003-05-01

    Traumatic coagulopathy manifests as a hypocoagulable state associated with hypothermia, acidosis, and coagulation factor dilution. The diagnosis must be made clinically because traditional coagulation tests are neither sensitive nor specific and take too long to be used for intraoperative monitoring. We hypothesized that the activated coagulation time (ACT) would reflect the global coagulation status of traumatized patients and would become elevated as coagulation reserves become exhausted. A prospective protocol was used to study 31 victims of major trauma who underwent immediate surgical Intervention. Victims of major head trauma were excluded and patients were selected at random over an 8-month period. At least two serial intraoperative blood samples were obtained at 15-min intervals via indwelling arterial catheters. A Hemochron model 801 coagulation monitor was used to measure the ACT. Of the 31 patients studied, 7 became clinically coagulopathic and 24 did not. The ACT measurements of coagulopathic and noncoagulopathic trauma patients were significantly different by multiple statistical comparisons. Both groups differed from normal, nontraumatized patients. The coagulopathic trauma patients had significantly elevated values when compared with other trauma patients or to normal values. We conclude that a low ACT reflects the initial hypercoagulability associated with major trauma and an elevated ACT is an objective indicator that the coagulation system reserve is near exhaustion. An elevated ACT may represent an indication for considering damage control maneuvers or more aggressive resuscitation. PMID:12744481

  8. Insulinoma. The value of intraoperative ultrasonography.

    PubMed

    Grant, C S; van Heerden, J; Charboneau, J W; James, E M; Reading, C C

    1988-07-01

    After establishing the diagnosis of an insulinoma, most surgeons prefer preoperative localization. Selective arteriography has long remained the gold standard for this purpose, but its use has been met with variable success. Despite various attempts at localization, insulinomas remain undetected in 10% to 20% of patients, and there may be a postoperative complication rate of at least 10% to 25%. To review the results and surgical implications of current localization techniques, 36 adult patients who were surgically treated for insulinomas at the Mayo Clinic, Rochester, Minn, from July 1982 through June 1987 were studied. The sensitivities of tumor localization using arteriography, computed tomography, and preoperative and intraoperative ultrasonography were 53%, 36%, 59%, and 90%, respectively. A subset of 29 patients underwent intraoperative ultrasonography, and all of these patients' insulinomas were identified with a combination of this technique and intraoperative palpation, with nonpalpable tumors being imaged in four patients. In 18 patients (62%), information obtained from the images appeared to influence the surgical management. While there is no substitute for exploration by an experienced surgeon, exploration appears to be enhanced by the addition of intraoperative ultrasonography, particularly during reoperation. PMID:2838008

  9. Intraoperative aortic dissection in pediatric heart surgery.

    PubMed

    Hibino, Narutoshi; Harada, Yorikazu; Hiramatsu, Takeshi; Yasukochi, Satoshi; Satomi, Gengi

    2006-06-01

    Intraoperative aortic dissection occurred in a 3-year-old-boy undergoing repair of an atrial septal defect. Transesophageal echocardiography was useful for the diagnosis, and conservative medical treatment under close observation was feasible in this case which involved a limited intimal tear. PMID:16714685

  10. The intraoperative Surgical Apgar Score predicts post-discharge complications after colon and rectal resection

    PubMed Central

    Regenbogen, Scott E.; Bordeianou, Liliana; Hutter, Matthew M.; Gawande, Atul A.

    2010-01-01

    Background We previously developed an intraoperative 10-point Surgical Apgar Score--based on blood loss, lowest heart rate, and lowest mean arterial pressure--to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate whether this intraoperative metric would predict post-discharge complications after colectomy. Methods We linked our institution's National Surgical Quality Improvement Program database with an Anesthesia Intraoperative Management System for all colorectal resections over four years. Using chi-square trend tests and logistic regression, we evaluated the Surgical Apgar Score's prediction for major postoperative complications before and after discharge. Results Among 795 colectomies, there were 230 (29%) major complications within 30 days; 45 (20%) after uncomplicated discharges. Surgical Apgar Scores predicted both inpatient complications and late post-discharge complications (both p<0.0001). Late complications occurred from 027 (median 11) days after discharge; the most common were surgical site infections (42%), sepsis (24%) and venous thromboembolism (16%). In pairwise comparisons against average-scoring patients (Surgical Apgar Scores 78), the relative risk of post-discharge complications trended lower, to 0.6 (95%CI 0.21.7) for those with the best Scores (910); and were significantly higher, at 2.6 (1.44.9) for Scores 56, and 4.5 (1.811.0) for Scores 04. Conclusions The intraoperative Surgical Apgar Score remained a useful metric for predicting post-colectomy complications arising after uncomplicated discharges. Even late complications may thus be related to intraoperative condition and events. Surgeons could use this intraoperative metric to target low-scoring patients for intensive post-discharge surveillance and mitigation of post-discharge complications after colectomy. PMID:20227100

  11. Intraoperative BiPAP in OSA Patients

    PubMed Central

    Singh, Bhavna P

    2015-01-01

    Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia. PMID:26023625

  12. Intraoperative BiPAP in OSA Patients.

    PubMed

    Singh, Bhavna P; Ns, Kodandaram

    2015-04-01

    Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia. PMID:26023625

  13. Achieving Adequate Margins in Ameloblastoma Resection: The Role for Intra-Operative Specimen Imaging. Clinical Report and Systematic Review

    PubMed Central

    Ramakrishnan, Anand; Mirkazemi, Mansoor; Baillieu, Charles; Ptasznik, Ronnie; Leong, James

    2012-01-01

    Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection. PMID:23094099

  14. The Art of Intraoperative Glioma Identification

    PubMed Central

    Zhang, Zoe Z.; Shields, Lisa B. E.; Sun, David A.; Zhang, Yi Ping; Hunt, Matthew A.; Shields, Christopher B.

    2015-01-01

    A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease. PMID:26284196

  15. [The intraoperative colonic irrigation in emergency surgery].

    PubMed

    Kiss, L

    2001-01-01

    Bowel preparations is frequently impossible in various ante colonic diseases, such as left-sided colonic obstruction. The goal of intraoperative colonic irrigation is to obtain, during surgery, a bowel preparation offering the possibility of primary resection with immediate anastomosis, when preoperative bowel preparation has not been feasible. Technical aspects of intra-operative colonic irrigation are described. Indications for this methods are presented: left-sided obstructing carcinomas, diverticulitis, more rarely inflammatory stenosis or functional obstruction. The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The post operative mortality rate was 13 per cent. The incidence of clinical anastomotic leakage was 6.65 per cent. PMID:12731192

  16. Intraoperative tracking of aortic valve plane

    PubMed Central

    Nguyen, Duc Long Hung; Garreau, Mireille; Auffret, Vincent; Le Breton, Herv; Verhoye, Jean-Philippe; Haigron, Pascal

    2013-01-01

    The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose a new method based on the Tracking-Learning-Detection approach, applied to the aortic valve calcifications in order to determine the position of the aortic valve plane in intra-operative TAVI images. This main contribution concerns the improvement of object detection by updating the recursive tracker in which all features are tracked jointly. The approach has been evaluated on four patient databases, providing an absolute mean displacement error less than 10 pixels ? 2mm). Its suitability for the TAVI procedure has been analyzed. PMID:24110703

  17. The Art of Intraoperative Glioma Identification.

    PubMed

    Zhang, Zoe Z; Shields, Lisa B E; Sun, David A; Zhang, Yi Ping; Hunt, Matthew A; Shields, Christopher B

    2015-01-01

    A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease. PMID:26284196

  18. Enhancing the safety of intraoperative RBC salvage.

    PubMed

    Bull, B S; Bull, M H

    1989-03-01

    Devices for intraoperative blood salvage remove plasma and, in theory, all of the cellular elements of blood except for rbcs. We have previously shown that complete white cell and platelet removal does not always occur and that the retained platelet-leukocyte deposit is potentially harmful (2). In this study we investigated the hydraulic conditions in the centrifuge bowl that allow activated platelets and leukocytes to adhere, the histology of the resulting cellular deposit, and the effects of reinfusing a saline extract of the deposit. Earlier work had suggested that the addition of calcium, of partially clotted blood, and of excessive saline should be avoided during intraoperative rbc salvage (2). The present observations explain, in part, why such measures would be expected to be beneficial. PMID:2926844

  19. Evaluation of intraoperative radioscopy on the coronal alignment of the tibial component in primary knee arthroplasty☆

    PubMed Central

    Cobra, Hugo; Hadid, Marcio Bruno; Jácome, Daniel Torres; de Sousa, Eduardo Branco; de Paula Mozella, Alan; e Albuquerque, Rodrigo Pires

    2015-01-01

    Objectives The present study had the objective of evaluating the effect of the use of intraoperative radioscopy in cases of primary knee arthroplasty, on the final alignment of the tibial component. Methods Patients who underwent total knee arthroplasty (TKA) between April 13, 2013, and April 20, 2013, were included in the study. These patients were evaluated retrospectively and two groups were identified: one in which intraoperative radioscopy was used to assess the positioning of the tibial component during the surgery and the other in which this resource was not used. Results The mean angle of alignment of the tibial component in relation to the tibial diaphysis was greater in the group without use of intraoperative radioscopy (90.82) than in the group with radioscopy (90.63), which was a statistically significant result (p < 0.05). Conclusion Use of intraoperative radioscopy during TKA produced a better mean angle of alignment between the tibial component and the tibial diaphysis, in comparison with nonuse. PMID:26535200

  20. Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide.

    PubMed

    Kahook, Malik Y; Camejo, Larissa; Noecker, Robert J

    2009-01-01

    Use of topical steroids is an important component of postoperative care after filtration surgery. Efficacy of postoperative medications is affected by patient adherence and physical limitations in the elderly population often prohibit proper dosing of ophthalmic drops. We describe a technique for the use of intraoperative retrobulbar triamcinolone acetonide in trabeculectomy surgery and report on postoperative outcomes. This technique appears safe and may be an attractive method of delivering a steroid depot at the time of trabeculectomy. PMID:19668541

  1. Fluorescence goggle for intraoperative breast cancer imaging

    NASA Astrophysics Data System (ADS)

    Liu, Yang; Bauer, Adam Q.; Akers, Walter; Sudlow, Gail; Liang, Kexian; Charanya, Tauseef; Mondal, Suman; Culver, Joseph P.; Achilefu, Samuel

    2012-03-01

    We have developed a fluorescence goggle device for intraoperative oncologic imaging. With our system design, the surgeon can directly visualize the fluorescence information from the eyepieces in real time without any additional monitor, which can improve one's coordination and surgical accuracy. In conjunction with targeting fluorescent dyes, the goggle device can successfully detect tumor margins and small nodules that are not obvious to naked eye. This can potentially decrease the incidence of incomplete resection.

  2. The effect of ephedrine on intraoperative hypothermia

    PubMed Central

    Jo, Youn Yi; Kim, Ji Young; Kim, Joon-Sik; Kwon, Youngjun

    2011-01-01

    Background Prevention of intraoperative hypothermia has become a standard of operative care. Since ephedrine has a thermogenic effect and it is frequently used to treat hypotension during anesthesia, this study was designed to determine the effect of ephedrine on intraoperative hypothermia of patients who are undergoing spine surgery. Methods Twenty-four patients were randomly divided to receive an ephedrine (the ephedrine group, n = 12) or normal saline (the control group, n = 12) infusion for 2 h. The esophageal temperature (the core temperature), the index finger temperature (the peripheral temperature) and the hemodynamic variables such as the mean blood pressure and heart rate were measured every 15 minutes after the intubation. Results At the end of the study period, the esophageal temperature and hemodynamic variables were significantly decreased in the control group, whereas those in the ephedrine group were stably maintained. The index finger temperature was significantly lower in the ephedrine group compared to that in the control group, suggesting the prevention of core-to-peripheral redistribution of the heat as the cause of temperature maintenance. Conclusions An intraoperative infusion of ephedrine minimized the decrease of the core temperature and it stably maintained the hemodynamic variables during spine surgery with the patient under general anesthesia. PMID:21602974

  3. Acoustic monitoring of intraoperative neuromuscular block.

    PubMed

    Dascalu, A; Geller, E; Moalem, Y; Manoah, M; Enav, S; Rudick, Z

    1999-09-01

    Standard methods for accurate intraoperative measurement of neuromuscular block are either expensive or inconvenient and are not used widely. We have evaluated a new method of monitoring neuromuscular block using a low-frequency microphone. The method is based on the phenomenon of low-frequency sound emission by contracting skeletal muscle. Acoustic monitoring (MIC) with an air-coupled microphone was used to evaluate intraoperative neuromuscular block in 25 anaesthetized patients. The MIC recorded the response of the adductor pollicis muscle to supramaximal electrical stimulation of the ulnar nerve with train-of-four stimuli. The ratios of the first response (TI) to control (TC) were used for evaluation. Data obtained from the MIC were compared with simultaneous recordings, from the same hand, of mechanomyography (FDT), electromyography (EMG) and accelerography (ACC). Throughout the operative procedure, TI/TC ratios of the acoustic method correlated with the three reference devices: FDT, 12 patients, 262 data sets, r = 0.86, bias (%MIC-%FDT) = mean -5.3 (SD 19.6)%; EMG, 18 patients, 490 data sets, r = 0.85, bias (%MIC-%EMG) = -0.39 (20.29)%; and ACC, 13 patients, 328 data sets, r = 0.91, bias (%MIC-%ACC) = -3.0 (15.6)%. We conclude that monitoring intraoperative neuromuscular block by a microphone which transduces low-frequency muscle sounds is clinically feasible. PMID:10655910

  4. Intraoperative anterior cruciate ligament graft contamination.

    PubMed

    Pasque, Charles B; Geib, Timothy M

    2007-03-01

    Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family. PMID:17349486

  5. Estimations of global warming potentials from computational chemistry calculations for CH(2)F(2) and other fluorinated methyl species verified by comparison to experiment.

    PubMed

    Blowers, Paul; Hollingshead, Kyle

    2009-05-21

    In this work, the global warming potential (GWP) of methylene fluoride (CH(2)F(2)), or HFC-32, is estimated through computational chemistry methods. We find our computational chemistry approach reproduces well all phenomena important for predicting global warming potentials. Geometries predicted using the B3LYP/6-311g** method were in good agreement with experiment, although some other computational methods performed slightly better. Frequencies needed for both partition function calculations in transition-state theory and infrared intensities needed for radiative forcing estimates agreed well with experiment compared to other computational methods. A modified CBS-RAD method used to obtain energies led to superior results to all other previous heat of reaction estimates and most barrier height calculations when the B3LYP/6-311g** optimized geometry was used as the base structure. Use of the small-curvature tunneling correction and a hindered rotor treatment where appropriate led to accurate reaction rate constants and radiative forcing estimates without requiring any experimental data. Atmospheric lifetimes from theory at 277 K were indistinguishable from experimental results, as were the final global warming potentials compared to experiment. This is the first time entirely computational methods have been applied to estimate a global warming potential for a chemical, and we have found the approach to be robust, inexpensive, and accurate compared to prior experimental results. This methodology was subsequently used to estimate GWPs for three additional species [methane (CH(4)); fluoromethane (CH(3)F), or HFC-41; and fluoroform (CHF(3)), or HFC-23], where estimations also compare favorably to experimental values. PMID:19402663

  6. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates

    PubMed Central

    Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.; Hurd, Wendy J.

    2014-01-01

    Background There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates. Hypotheses (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups. Study Design Cross-sectional study; Level of evidence, 3. Methods One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength. Results The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures. Conclusion Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries. PMID:21051421

  7. In vivo virtual intraoperative surgical photoacoustic microscopy

    SciTech Connect

    Han, Seunghoon Kim, Sehui Kim, Jeehyun E-mail: chulhong@postech.edu; Lee, Changho Jeon, Mansik; Kim, Chulhong E-mail: chulhong@postech.edu; Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, New York 14221

    2013-11-11

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

  8. Towards intra-operative computerized planning of prostate cryosurgery

    PubMed Central

    Tanaka, Daigo; Shimada, Kenji; Rossi, Michael R.; Rabin, Yoed

    2008-01-01

    Background As part of ongoing efforts to develop computerized planning tools for cryosurgery, the current study provides a comparison between two recently developed methods for planning, known as bubble packing and force-field analogy. Methods For the purpose of comparison, four 3D prostate models were reconstructed from ultrasound imaging. The quality of planning for each method was evaluated based on bioheat transfer simulations. Results Both methods are shown to be robust planning tools in 3D. Typical results show at least 75% of the target region volume having temperatures below a target temperature isotherm for planning. While the force-field analogy method yields superior planning results, it comes at the expense of an order of magnitude longer run time, with only moderate improvement. Conclusions Due to time constraints in a clinical setup, bubble packing alone may be considered adequate for computerized planning. Furthermore, only bubble packing is demonstrated to be adequate for intra-operative planning. Copyright 2007 John Wiley & Sons, Ltd. PMID:17441020

  9. Application experience of intraoperative neuromonitoring in thyroidectomy

    PubMed Central

    Zheng, Haitao; Jiang, Lixin; Wang, Xuewen; Hu, Jinchen; Ning, Jinrao; Wang, Dong; Li, Baoyuan; Zheng, Guibin; Xu, Jie

    2015-01-01

    Objective: The aim of this study is to summarize the experience of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery. Methods: There were 220 cases in this study, male 53, female 167, mean age 38.2 years old. 85 cases in the study had thyroid cancer, 19 cases had thyroid benign tumor, 90 cases had thyroid goiter, 3 cases had Hashimoto’s diseases, and 23 cases had hyperthyroidism. The tumor diameters were over than 5 cm in 113 cases. In the procedure, two recording needle electrodes were put into cricothyroid muscle; one stimulator electrodes was explored in tracheo-asophageal groove, if recurrent laryngeal nerves were right there or near, doctors could see the electromyogram and hear the toot honk. With careful dissection, recurrent laryngeal nerve could be found out till explored into the larynx site. Results: 207 cases (278 sizes) of 220 were finished, electromyogram was not drawn out in 13 cases; 9 cases were false-negative because of system and anesthesia questions; needle electrodes cannot be put in properly in 4 cases because of cricothyroid muscle cancer invasion. No permanent recurrent laryngeal nerve paralysis occurred, 2 cases with transient nerve paralysis recovered in one month. Conclusion: The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when exposing the recurrent laryngeal nerve in the whole operation, therefore, with less medical complications. PMID:26885214

  10. Brain mapping in tumors: intraoperative or extraoperative?

    PubMed

    Duffau, Hugues

    2013-12-01

    In nontumoral epilepsy surgery, the main goal for all preoperative investigation is to first determine the epileptogenic zone, and then to analyze its relation to eloquent cortex, in order to control seizures while avoiding adverse postoperative neurologic outcome. To this end, in addition to neuropsychological assessment, functional neuroimaging and scalp electroencephalography, extraoperative recording, and electrical mapping, especially using subdural strip- or grid-electrodes, has been reported extensively. Nonetheless, in tumoral epilepsy surgery, the rationale is different. Indeed, the first aim is rather to maximize the extent of tumor resection while minimizing postsurgical morbidity, in order to increase the median survival as well as to preserve quality of life. As a consequence, as frequently seen in infiltrating tumors such as gliomas, where these lesions not only grow but also migrate along white matter tracts, the resection should be performed according to functional boundaries both at cortical and subcortical levels. With this in mind, extraoperative mapping by strips/grids is often not sufficient in tumoral surgery, since in essence, it allows study of the cortex but cannot map subcortical pathways. Therefore, intraoperative electrostimulation mapping, especially in awake patients, is more appropriate in tumor surgery, because this technique allows real-time detection of areas crucial for cerebral functions--eloquent cortex and fibers--throughout the resection. In summary, rather than choosing one or the other of different mapping techniques, methodology should be adapted to each pathology, that is, extraoperative mapping in nontumoral epilepsy surgery and intraoperative mapping in tumoral surgery. PMID:24328878

  11. Quantitative, spectrally-resolved intraoperative fluorescence imaging

    NASA Astrophysics Data System (ADS)

    Valds, Pablo A.; Leblond, Frederic; Jacobs, Valerie L.; Wilson, Brian C.; Paulsen, Keith D.; Roberts, David W.

    2012-11-01

    Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the first time. Moreover, we present images from human surgery which detect residual tumor not evident with state-of-the-art vFI. The wide-field qFI technique has broad implications for intraoperative surgical guidance because it provides near real-time quantitative assessment of multiple fluorescent biomarkers across the operative field.

  12. Intraoperative identification of the human communicating nerve during thyroidectomy

    PubMed Central

    Hodnett, Benjamin L.; Schmitt, Nicole C.; Thirumala, Parthasarathy D.; Duvvuri, Umamaheswar

    2015-01-01

    The human communicating nerve (HCN) is a connection between the superior and recurrent laryngeal nerves that has been described in cadaveric studies. We report a case of an extralaryngeal variant of the HCN that was identified and stimulated intraoperatively during thyroidectomy. This appears to be the first case of intraoperative identification of this anatomic variant, of which the functional significance remains unclear. PMID:26666834

  13. Intraoperative identification of the human communicating nerve during thyroidectomy.

    PubMed

    Hodnett, Benjamin L; Schmitt, Nicole C; Thirumala, Parthasarathy D; Duvvuri, Umamaheswar

    2015-01-01

    The human communicating nerve (HCN) is a connection between the superior and recurrent laryngeal nerves that has been described in cadaveric studies. We report a case of an extralaryngeal variant of the HCN that was identified and stimulated intraoperatively during thyroidectomy. This appears to be the first case of intraoperative identification of this anatomic variant, of which the functional significance remains unclear. PMID:26666834

  14. Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleeding.

    PubMed

    Flickinger, E G; Stanforth, A C; Sinar, D R; MacDonald, K G; Lannin, D R; Gibson, J H

    1989-01-01

    Intraoperative video panendoscopy was performed in 14 patients with chronic, recurrent gastrointestinal bleeding. All of the study patients had undergone extensive and expensive diagnostic testing including multiple radiographic contrast studies of the gastrointestinal tract, upper and lower endoscopy, nuclear bleeding scans, and selective mesenteric angiography without definition of the bleeding source. Intraoperative video panendoscopy, employing a segmental advance and look technique, allowed visualization and transillumination of the entire gut and identified mucosal disease in 13 patients (93 percent). Angiodysplasia of the colon and small intestine was the most common pathologic finding. Intraoperative video panendoscopy significantly influenced the operation performed in 13 patients (93 percent). Postoperative complications were minimal, with none being directly attributable to intraoperative video panendoscopy. Bleeding was totally controlled in 10 patients (71 percent) during a mean follow-up period of 25 months. Intraoperative video panendoscopy is a valuable technique for assisting in the management of the patient with recurrent gastrointestinal bleeding. PMID:2491932

  15. Intraoperative patient skin prep agents: is there a difference?

    PubMed

    Zinn, Jennifer; Jenkins, Jeanne B; Swofford, Vangela; Harrelson, Beverly; McCarter, Sharon

    2010-12-01

    For health care institutions, intraoperative prep agents are a critical link in combating surgical site infections and the associated economic burden. The question remains, is there an intraoperative prep agent that is truly superior to the others? We conducted a literature review to examine available empirical evidence related to intraoperative prep agents used in our health system for open abdominal, general surgery procedures: povidone-iodine, chlorhexidine gluconate, parachoroxylenol, and iodine povacrylex in 74% isopropyl alcohol. Intraoperative surgical skin prep studies were limited in providing empirical evidence to support one superior prep agent. Each prep agent has a specific mechanism of action along with specific advantages and disadvantages. We concluded that no one perioperative skin prep agent is superior in all clinical situations. Factors to consider when choosing an appropriate intraoperative skin prep agent include contraindications, environmental risks, the patient's allergies and skin condition, the surgical site, the manufacturer recommendations for the prep agent, and surgeon preference. PMID:21130204

  16. Surgical Pathology and Intraoperative Consultation: An Audit

    PubMed Central

    GOLAM, Mostafa; QUEEN, Zarat

    2015-01-01

    Background: While intraoperative consultation has been used in Bangladesh for a long period of time, to date, there has been no published reporting on the performance of frozen sections. The current audit evaluates the performance of frozen sections in a well reputed medical center in Bangladesh, Anowara Medical Services. Objective: This retrospective study has been designed to measure the accuracy of frozen section diagnosis in a medical center in a third-world country, where many surgical procedures rely on intraoperative consultation. Methods: A series of 1379 intra- and peri-operative frozen section cases, from 2007 to 2014, was reviewed. Intraoperative tissue specimens received at Anowara Medical Services were processed for frozen sections. After examination of the frozen section that yielded the initial frozen section diagnoses, the frozen tissues were reprocessed for regular paraffin sectioning. These paraffin sections were examined by a second pathologist, and a final diagnosis was issued. The frozen section diagnosis and final diagnoses of all cases were retrospectively analysed to determine the accuracy of frozen section examination. Results: Overall, accurate diagnosis was made on frozen sections in 98.2% of the cases. The discrepant diagnoses were all clinically significant, i.e., there were discrepancies between benign and malignant diagnoses on frozen and paraffin sections. In 1% of the cases, diagnosis was deferred. Fifty percent of the deferred cases were benign. Two cases, received in formalin, were excluded. In both cases, the diagnosis was positive for malignancy. The number of false negative results (4 false negatives) was slightly lower than that of false positives (5 false positives). Specificity and sensitivity of 99.3% and 99.4% were achieved, respectively. In this study, the positive predictive value was 99.2% and the negative predictive value was 99.5%. Over the years, the number of discrepant diagnoses remained fairly constant. Conclusion: The present method has a satisfactory rate of accuracy of frozen section diagnosis, which is comparable to other remote and recent published series. The results of this study offer a testament to the reliability of frozen section diagnosis rendered by qualified pathologists in Bangladesh and may serve as evidence in building confidence among the surgeons who use this service for improved patient care. PMID:26715906

  17. Highlights of anesthetic considerations for intraoperative neuromonitoring.

    PubMed

    Deiner, Stacie

    2010-03-01

    Though relatively new, intraoperative neurophysiological monitoring (IONM) has become standard of care for many neurosurgical procedures. The use of IONM has substantially decreased the rate of paralysis after deformity surgery, and has been validated in cervical spine surgery, and thoracic and lumbar laminectomy (1) (2), (3). The main modalities are: somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMGs). Each test examines a functionally separate area of the spinal cord, which test is chosen depends on the location of the surgery and the patient's preexisting injuries and deficits (6). Inhaled anesthetics decrease the waveform amplitude and increase latency, intravenous anesthetics have the same effect but to a lesser degree. Best anesthetic regimen for surgery involving intraoperative monitoring is controversial. Both inhaled and intravenous agents depress signal attainment, however for equal MAC concentrations inhaled agents cause more depression(11). While studies have shown that halogenated agents and nitrous oxide do in fact depress MEP signals more than total intravenous anesthesia, less is known on the relationship between IONM and patient characteristics. Lo's study documenting MEP attainment with 0.5 MAC was done in an otherwise healthy scoliosis population (12), and no study to date has analyzed signal attainment in correlation with patient characteristics and anesthetic technique. While it is clear that anesthetic technique is extremely important, certain patient characteristics appear to be more common in difficult to monitor patients. The identification of these characteristics would suggest to the anesthesiologist the need for a more stringent technique (TIVA) and avert surgical delay or cancellation due to inability to obtain baseline or worse- loss of intraoperative waveform and need for a Stagnara wake-up test. Our group at Mt. Sinai has retrospectively studied patient characteristics, anesthetic technique and attainment of neuromonitoring signals. Hypertension and diabetes are independent predictors of monitoring failure, and these are preferentially sensitive to inhalational agents. Age and weight are also predictors, but less significant. In summary, neurophysiologic monitoring has evolved to be a consistent part of many procedures. The anesthesiologist should strive to understand the rationale behind monitoring and the basis of its utility. IONM has many implications for anesthetic technique and need for control of the physiologic milieu. With this knowledge the anesthesiologist can work together with the neuromonitoring team and surgeon to ensure patient safety during and after surgery. PMID:20472627

  18. Relationship of Postoperative Recatheterization and Intraoperative Bladder Distention Volume in Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

    PubMed Central

    Kim, Hyeon Jun; Lee, Han Yi; Song, Sang Hun

    2013-01-01

    Purpose The purpose of this study was to identify the risk factors for recatheterization after holmium laser enucleation of the prostate (HoLEP). Materials and Methods A total of 166 consecutive patients treated with HoLEP by a single surgeon from January 2010 to June 2011 were enrolled in this study. We collected data on preoperative and intraoperative parameters, including intraoperative bladder distention volume. The patients were divided into two groups. Group 1 included patients who voided successfully after removal of the catheter, and group 2 included patients who required recatheterization. Analysis and comparison of the perioperative parameters of both groups was performed for identification of risk factors for recatheterization. Results Recatheterization was required in 9 of 166 (5.4%) patients. No significant differences in age or preoperative parameters, including prostate-specific antigen, prostate volume, International Prostate Symptom Score, peak flow rate, postvoid residual urine, maximal bladder capacity, and Abrahams Griffiths number, were observed between the two groups. Of the intraoperative parameters, intraoperative bladder distention volume was significantly smaller in group 1 than in group 2 (700.65 mL vs. 897.78 mL, p<0.001). In the multivariate logistic regression analysis, after adjustment for other variables, intraoperative bladder distention volume was found to be a statistically significant risk factor for postoperative recatheterization (hazard ratio, 1.006; confidence interval, 1.002 to 1.010; p=0.002). Conclusions Nine of 166 (5.4%) patients failed to void after HoLEP and required catheterization. Intraoperative bladder distention volume was found to be a statistically significant risk factor for recatheterization in this patient group. PMID:23549294

  19. [Intraoperative neurophysiological monitoring improves outcome in neurosurgery].

    PubMed

    Sarnthein, J; Krayenbhl, N; Actor, B; Bozinov, O; Bernays, R

    2012-01-18

    Intraoperative Neurophysiological Mo-nitoring (IONM) identifies eloquent areas or nerves fibers during neurosurgical interventions and monitors their function. For several interventions IONM has become mandatory in neurosurgery. IONM increases patient safety during surgery as the risk of neurological deficits is reduced. Safer surgery reduces the time needed for the intervention and thereby reduces risk. IONM contributes to complete resection of tumors, which in turn prolongs patients' survival. Complicated surgical interventions associated with an elevated risk of neurological deficits have only become possible due to IONM. IONM comprises a variety of procedures that are selected for a particular intervention. With appropriate selection of the procedures IONM has been shown to improve neurological and functional outcome after neurosurgical interventions. PMID:22252591

  20. Anesthesia in the intraoperative MRI environment.

    PubMed

    Bergese, Sergio D; Puente, Erika G

    2009-04-01

    Intraoperative MRI (iMRI) can be applied in several surgical settings. The incorporation of MRI technology into the operating room requires special considerations. The size and design of the operating room, including the equipment introduced into this setting, must be MR safe and allow adequate anesthesia monitoring and care. There are general restrictions and perils that may present in an operating room setting because of the MRI technology involving the monitoring equipment, anesthesia machine, and infusion devices. Incorporating the MRI technology into the operating room presents a new challenge in a transdisciplinary environment. The use of the iMRI technology has provided revolutionary tools for the new generation of medical practice. PMID:19555877

  1. Intraoperative photodynamic therapy for larynx carcinomas

    NASA Astrophysics Data System (ADS)

    Loukatch, Erwin V.; Latyshevska, Galina; Fekeshgazi, Ishtvan V.

    1995-05-01

    We made an experimental and clinical researches to examine Intraoperative Photodynamic Therapy (IPT) as a method to prevent the recidives of tumors. In experimental researches on models with radio-inducated fibrosarcomas and Erlich carcinomas of mice the best method of IPT was worked out. The therapeutic effect was studied also on patients with laryngeal cancer. In researches on C3H mice the antirecidive effect of IPT established with local administration of methylene blue and Ar-laser. We found that IPT (He-Ne laser combined with methylene blue administration) was endured by patients with laryngeal cancers without problems. We got good results of treatment 42 patients with laryngeal cancers with middle localization during three years with using IPT method. This can show the perspectives of using this method in treatment of other ENT-oncological diseases.

  2. Anesthetic Considerations for Intraoperative Radiation Therapy

    PubMed Central

    Glynn, Kathryn M.; Riker, Adam I.

    2015-01-01

    Background Formerly, anesthetized patients who received intraoperative radiation therapy (IORT) had to be transported from the operating room (OR) to the location of the linear accelerator. With the advent of mobile accelerators, therapy is delivered directly to the patient in the OR, presenting specific challenges for the anesthesiologist. Methods We review the uses and benefits, operative and anesthetic challenges, and unique issues associated with IORT. Results Patient safety and precise delivery of the radiation dose are the primary goals of IORT. The anesthesiologist's role in ensuring the success of these two outcomes includes selecting the optimal anesthetic technique to prevent patient movement and permit sentinel node mapping, monitoring the patient's vital signs throughout the procedure, and ensuring that the sterile field is maintained in the OR. Conclusion Although keeping patients in the OR has simplified the process of providing IORT, the anesthesiologist must be aware of potential problems and plan accordingly.

  3. Optical technologies for intraoperative neurosurgical guidance.

    PubMed

    Valdés, Pablo A; Roberts, David W; Lu, Fa-Ke; PhD; Golby, Alexandra

    2016-03-01

    Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery. PMID:26926066

  4. Autologous Thrombin: Intraoperative Production From Whole Blood

    PubMed Central

    Kumar, Vijay; Chapman, John R.

    2008-01-01

    Abstract: Thrombin is routinely combined in surgical practice with a fibrinogen source to prepare fibrin sealant to promote hemostasis or with platelet concentrates to prepare platelet gels to enhance wound healing. The purpose of this study was to evaluate the robustness and reproducibility of a new sterile handheld disposable thrombin-processing device (TPD) to generate autologous human thrombin in the intraoperative setting, using whole blood as the starting source material. By using whole blood instead of plasma as the starting material, it is possible to eliminate the plasma separation step from whole blood and reduce the thrombin production time and increase its availability to the surgical team intraoperatively. Active thrombin was prepared by combining 4 mL of thrombin reagent (a mixture of calcium chloride and ethanol) to 11 mL of blood in a reaction chamber containing negatively charged particles. The whole blood, reagent and particle mixture was incubated for 25 minutes at either 18C or 24C (n = 25/group) to assess stability of the thrombin activity. The mean activity of the thrombin produced at 18C and 24C was 52 14 (n = 25) and 61 12.2 IU/mL (n = 25), respectively. The average volume of thrombin harvested from each aliquot of blood at 18C and 24C was 10 0.4 and 9 0.6 mL, respectively. The thrombin concentration generated was shown to rapidly (<5 seconds) coagulate fibrinogen concentrate and retained clotting activity for 1 hour at room temperature (1826C) and up to 4 hours when stored on ice. The results show that the TPD is able to consistently generate high thrombin activity from human whole blood. The device offers a robust and rapid approach for preparing active thrombin from whole blood. PMID:18705544

  5. Intraoperative radiation therapy in recurrent ovarian cancer

    SciTech Connect

    Yap, O.W. Stephanie . E-mail: stbeast@stanford.edu; Kapp, Daniel S.; Teng, Nelson N.H.; Husain, Amreen

    2005-11-15

    Purpose: To evaluate disease outcomes and complications in patients with recurrent ovarian cancer treated with cytoreductive surgery and intraoperative radiation therapy (IORT). Methods and Materials: A retrospective study of 24 consecutive patients with ovarian carcinoma who underwent secondary cytoreduction and intraoperative radiation therapy at our institution between 1994 and 2002 was conducted. After optimal cytoreductive surgery, IORT was delivered with orthovoltage X-rays (200 kVp) using individually sized and beveled cone applications. Outcomes measures were local control of disease, progression-free interval, overall survival, and treatment-related complications. Results: Of these 24 patients, 22 were available for follow-up analysis. Additional treatment at the time of and after IORT included whole abdominopelvic radiation, 9; pelvic or locoregional radiation, 5; chemotherapy, 6; and no adjuvant treatment, 2. IORT doses ranged from 9-14 Gy (median, 12 Gy). The anatomic sites treated were pelvis (sidewalls, vaginal cuff, presacral area, anterior pubis), para-aortic and paracaval lymph node beds, inguinal region, or porta hepatitis. At a median follow-up of 24 months, 5 patients remain free of disease, whereas 17 patients have recurred, of whom 4 are alive with disease and 13 died from disease. Five patients recurred within the radiation fields for a locoregional relapse rate of 32% and 12 patients recurred at distant sites with a median time to recurrence of 13.7 months. Five-year overall survival was 22% with a median survival of 26 months from time of IORT. Nine patients (41%) experienced Grade 3 toxicities from their treatments. Conclusion: In carefully selected patients with locally recurrent ovarian cancer, combined IORT and tumor reductive surgery is reasonably tolerated and may contribute to achieving local control and disease palliation.

  6. Intraoperative neurosonography revisited: effective neuronavigation in pediatric neurosurgery

    PubMed Central

    2015-01-01

    Intraoperative ultrasonography (IOUS) is a widely used noninvasive method to evaluate the morphology, vasculature, and pathologies of the brain. The advantages of IOUS include realtime depiction of neuroanatomy, accurate localization and characterization of a lesion, reduced surgical exploration and surgical time, and presumably decreased patient morbidity. IOUS is useful in the intraoperative monitoring of lesion resection as well as intraoperative localization and characterization of focal parenchymal lesions. This review aims to provide an overview of the clinical application of IOUS in pediatric intracranial neurosurgery. PMID:25672771

  7. Goal-directed therapy in intraoperative fluid and hemodynamic management

    PubMed Central

    Gutierrez, Maria Cristina; Moore, Peter G.; Liu, Hong

    2013-01-01

    Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk procedures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy. PMID:24086168

  8. Progressive transition from pre-planned to intraoperative optimizing seed implant: post implementation analysis

    PubMed Central

    Bodner, William; Yaparpalvi, Ravindra; Guha, Chandan; Tolia, Bhupendra M.; Mehta, Keyur J.; Mah, Dennis; Kalnicki, Shalom

    2012-01-01

    Purpose To perform a dosimetric comparison between a pre-planned technique and a pre-plan based intraoperative technique in prostate cancer patients treated with I-125 permanent seed implantation. Material and methods Thirty patients were treated with I-125 permanent seed implantation using TRUS guidance. The first 15 of these patients (Arm A) were treated with a pre-planned technique using ultrasound images acquired prior to seed implantation. To evaluate the reproducibility of the prostate volume, ultrasound images were also acquired during the procedure in the operating room (OR). A surface registration was applied to determine the 6D offset between different image sets in arm A. The remaining 15 patients (Arm B) were planned by putting the pre-plan on the intraoperative ultrasound image and then re-optimizing the seed locations with minimal changes to the pre-plan needle locations. Post implant dosimetric analyses included comparisons of V100(prostate), D90(prostate) and V100(rectum). Results In Arm A, the 6D offsets between the two image sets were ?x=?1.44.3; ?y=?1.72.6; ?z=?0.52.6; X=0.51.8 mm; Y=?1.3?3.5 mm; Z=?1.62.2 mm. These differences alone degraded V100 by 6.4% and D90 by 9.3% in the pre-plan, respectively. Comparing Arm A with Arm B, the pre-plan based intraoperative optimization of seed locations used in the plans for patients in Arm B improved the V100 and D90 in their post-implant studies by 4.0% and 5.7%, respectively. This was achieved without significantly increasing the rectal dose (V100(rectum)). Conclusions We have progressively moved prostate seed implantation from a pre-planned technique to a pre-plan based intraoperative technique. In addition to reserving the advantage of cost-effective seed ordering and efficient OR implantation, our intraoperative technique demonstrates increased accuracy and precision compared to the pre-planned technique. PMID:23346139

  9. WWTP design in warm climates - guideline comparison and parameter adaptation for a full-scale activated sludge plant using mass balancing.

    PubMed

    Walder, C; Lindtner, S; Proesl, A; Klegraf, F; Weissenbacher, N

    2013-01-01

    The ATV-A-131 guideline and the design approach published in 'Wastewater Engineering, Treatment and Reuse (WE)' are widely used for the design of activated sludge plants. They are both based on simplified steady-state assumptions tailored to the boundary conditions of temperate climates. Using design guidelines beyond the designated temperature range may lead to inappropriate results. The objectives of this paper are (1) to summarise temperature relevant differences between ATV-A-131 and WE; (2) to show the related design components; and (3) to demonstrate a procedure for design parameter adaptation for a full-scale activated sludge plant located in a warm climate region. To gain steady-state data required for wastewater treatment plant (WWTP) design according to ATV-A-131 and WE, full-scale plant data were acquired for a period of 6 months as a basis for analyses and adaptation. Mass balances were calculated for the verification of the measurements and for analysing excess sludge production. The two approaches showed relevant temperature related differences. WE default application resulted in lower deviation in the mass balance results for excess sludge production. However, with the adaptation of the heterotrophic decay rates for both approaches and the inert organic and mineral solids fraction additionally for ATV-A-131, a good fit to the observed excess sludge production could be achieved. PMID:23128643

  10. High-global warming potential F-gas emissions in California: comparison of ambient-based versus inventory-based emission estimates, and implications of refined estimates.

    PubMed

    Gallagher, Glenn; Zhan, Tao; Hsu, Ying-Kuang; Gupta, Pamela; Pederson, James; Croes, Bart; Blake, Donald R; Barletta, Barbara; Meinardi, Simone; Ashford, Paul; Vetter, Arnie; Saba, Sabine; Slim, Rayan; Palandre, Lionel; Clodic, Denis; Mathis, Pamela; Wagner, Mark; Forgie, Julia; Dwyer, Harry; Wolf, Katy

    2014-01-21

    To provide information for greenhouse gas reduction policies, the California Air Resources Board (CARB) inventories annual emissions of high-global-warming potential (GWP) fluorinated gases, the fastest growing sector of greenhouse gas (GHG) emissions globally. Baseline 2008 F-gas emissions estimates for selected chlorofluorocarbons (CFC-12), hydrochlorofluorocarbons (HCFC-22), and hydrofluorocarbons (HFC-134a) made with an inventory-based methodology were compared to emissions estimates made by ambient-based measurements. Significant discrepancies were found, with the inventory-based emissions methodology resulting in a systematic 42% under-estimation of CFC-12 emissions from older refrigeration equipment and older vehicles, and a systematic 114% overestimation of emissions for HFC-134a, a refrigerant substitute for phased-out CFCs. Initial, inventory-based estimates for all F-gas emissions had assumed that equipment is no longer in service once it reaches its average lifetime of use. Revised emission estimates using improved models for equipment age at end-of-life, inventories, and leak rates specific to California resulted in F-gas emissions estimates in closer agreement to ambient-based measurements. The discrepancies between inventory-based estimates and ambient-based measurements were reduced from -42% to -6% for CFC-12, and from +114% to +9% for HFC-134a. PMID:24328112

  11. Heat sensitive microbubbles for intraoperative assessment of cancer ablation margin

    NASA Astrophysics Data System (ADS)

    Huang, Jiwei; Xu, Jeff S.; Schmidt, Carl; Xu, Ronald X.

    2012-03-01

    We developed a heat-sensitive microbubble (HSM) agent for intraoperative assessment of thermal ablation margins in cancer ablation therapies. The HSM agent, comprising a core of liquid perfluorocarbon (PFC) compound and a shell of biodegradable poly lactic-coglycolic acid (PLGA), was fabricated using an emulsion evaporation method. In our previous study, significant increase of ultrasound contrast was observed after heat activation of HSMs. In this study, intraoperative ultrasonic assessment of thermal ablation margins by HSMs was demonstrated in vivo in a pig model. HSMs were delivered to the pig liver by portal vein injection. Liver ablation was done using a RF ablation probe. Intraoperative ultrasound imaging with HSMs clearly delineated the ablation margin. Fluorescence images of liver tissue samples confirmed the existence and activation of HSMs. This result demonstrated that the HSM agent can be potentially utilized as a multimodal contrast agent for intraoperative ultrasonic and fluorescence assessment of thermal ablation margins in cancer ablation therapies.

  12. Intraoperative interstitial implantation of Iridium 192 in the breast

    SciTech Connect

    Mansfield, C.M.; Jewell, W.R.

    1984-02-01

    Intraoperative interstitial implantation of iridium 192 during a lumpectomy for carcinoma of the breast has been well tolerated by the patient. This procedure has decreased the need for anesthesia and repeat hospitalization.

  13. Comparison of scarab grub populations and associated pathogens and parasitoids in warm- or cool-season grasses used on transitional zone golf courses.

    PubMed

    Redmond, Carl T; Williams, David W; Potter, Daniel A

    2012-08-01

    Seven different turfgrass species or mixes used on golf courses in the United States' transitional climatic zone were maintained as randomized and replicated plots in separate stands mowed at fairway (1.6 cm) or rough (6.4 cm) cutting heights and sampled in autumn to assess the density and species composition of scarab grubs; incidence of disease and parasitism thereof; and extent of turf damage from foraging insectivorous skunks, Mephitis mephitis. Influence of grass species on parasitism by spring or autumn-active tiphiid wasps was further assessed on implanted grubs in open enclosures. Masked chafers (Cyclocephala spp.) were three-fold more abundant than Japanese beetle, Popillia japonica Newman, grubs in plots of Zoysia and Cynodon sp. mowed at fairway height, and P. japonica were five-fold more abundant than masked chafer grubs in cool-season turf plots mowed at rough height. Phyllophaga spp. accounted for <1% of grubs in the samples. Milky disease bacteria (Paenibacillus sp.) were the predominant pathogens of Cyclocephala spp., followed by Serratia sp. bacteria and gregarines (Stictospora cf. villani). Cyclocephala grub densities, milky disease incidence (25%), and parasitism by the native tiphiid Tiphia pygidialis Alien (10-12%) were especially high in zoysiagrass. Japanese beetle grubs were infected by Paenibacillus, Serratia, Stictospora, and microsporidia (Ovavesicula sp.), but incidence of individual pathogens was relatively low (<6%) and similar among grasses within each stand. Few nematode-infected grubs were found. Skunk damage was mainly in the cool-season fairway-height grasses, probably reflecting difficulty in foraging in the much tougher stolons and rhizomes of the warm season turfgrasses. The degree of natural suppression of scarab grubs provided by endemic pathogens or parasitoids is unlikely to be compromised by the grass species used on a particular site. PMID:22928312

  14. High-dose-rate remote afterloaders for intraoperative radiation therapy.

    PubMed

    Gao, Song; Delclos, Marc E; Tomas, Lyvia C; Crane, Christopher H; Beddar, Sam

    2007-11-01

    Intraoperative radiation therapy (IORT) is a treatment option that directly irradiates a surgically exposed tumor or tumor bed while preventing radiation exposure of normal tissues. This article discusses the high-dose-rate intraoperative radiation therapy (HDR-IORT) technique by reviewing the roles of IORT team members, discussing needed equipment and supplies, describing quality assurance processes, explaining the HDR-IORT treatment delivery procedure, and reviewing the post-treatment phase. PMID:18050890

  15. Localization of an occult insulinoma by intraoperative ultrasonography.

    PubMed

    Norton, J A; Sigel, B; Baker, A R; Ettinghausen, S E; Shawker, T H; Krudy, A G; Doppman, J L; Taylor, S I; Gordon, P

    1985-03-01

    Intraoperative ultrasonography has not been used previously to locate an insulinoma that was not surgically palpable or that could not be seen by selective arteriography. In this report we described a patient with an insulinoma localized to the pancreatic head identified by transhepatic portal venous sampling but not by selective arteriography or palpation. At operation intraoperative ultrasonography demonstrated an 8 mm tumor in the pancreatic head and guided the successful enucleation. PMID:2983451

  16. [Intraoperative ultrasonography in the staging of pancreatic head neoplasms].

    PubMed

    Alberti, Antonino; Dattola, Pasquale; Littori, Francesca; Dattola, Arturo; Maccarone, Pietro; Basile, Maurizio

    2002-01-01

    Tumours of the head of the pancreas constitute the fourth most common cause of cancer deaths. These tumours are characterised by low survival rates (5% at 5 years) and low surgical resectability rates (20-25%). Liver metastases, lymph-node and vascular involvement, and peritoneal metastases are, in our opinion, exclusion criteria for curative surgical resection. The aim of the study was to evaluate the impact of intraoperative ultrasonography on the staging of such tumours. Over the period from 1990 to 2000 we introduced intraoperative ultrasonography in the staging of pancreatic cancer. We evaluated 51 patients who at preoperative staging had been regarded as candidates for surgical therapy consisting in a pancreaticoduodenectomy. All patients had been staged by preoperative abdominal ultrasound, ERCP, CT and MRI. Intraoperative ultrasound and colour-Doppler imaging (from 1997 on) revealed involvement of (i) the liver, (ii) the splenomesenteric vessels and (iii) the portal vein. Intraoperative ultrasonography yielded a diagnosis of occult liver metastases in 10 cases and signs of vascular involvement (absence of cleavage, partial and total thrombosis) in 12. One false-negative was registered. Intraoperative ultrasonography in our experience showed 98% sensitivity and specificity in the detection of vascular and lymph-node involvement. Its sensitivity in the detection of liver metastases was 100%. Intraoperative ultrasound is a procedure with a very high sensitivity in the operative staging of cancer of the head of the pancreas. PMID:11942011

  17. Thin-Profile Transducers for Intraoperative Hemostasis

    NASA Astrophysics Data System (ADS)

    Zderic, Vesna; Mera, Thomas; Vaezy, Shahram

    2005-03-01

    Our goal has been to develop thin-profile HIFU applicators for intraoperative hemostasis. The HIFU device consisted of a concave PZT element encased in a spoon-shaped aluminum housing with the diameter of 4 cm and thickness of 1 cm. The housing front surface had a thickness of 3/4 ultrasound wavelength in aluminum (0.92 mm) to provide acoustic matching. The device had a resonant frequency of 6.26 MHZ, and efficiency of 42%. The ultrasound field was observed using hydrophone field mapping and radiation force balance. The full-width half-maximum (FWHM) dimensions of the focal region were 0.6 mm and 2.2 mm in lateral and axial direction, respectively. The maximal intensity at the focus was 9,500 W/cm2 (in water). The device was tested using BSA-polyacrylamide gel phantom and rabbit kidney in vivo. HIFU application for 10 s produced lesions in the gel phantom (lesion width of 3 mm), and rabbit kidney in vivo (lesion width of 8 mm). A thin-profile HIFU applicator has advantages of high efficiency, simple design, and small dimensions.

  18. Intraoperative Electroretinograms before and after Core Vitrectomy

    PubMed Central

    Yagura, Kazuma; Shinoda, Kei; Matsumoto, Soiti; Terauchi, Gaku; Watanabe, Emiko; Matsumoto, Harue; Akiyama, Goichi; Mizota, Atsushi; Miyake, Yozo

    2016-01-01

    Purpose To evaluate retinal function by intraoperative electroretinograms (ERGs) before and after core vitrectomy. Design Retrospective consecutive case series. Method Full-field photopic ERGs were recorded prior to the beginning and just after core vitrectomy using a sterilized contact lens electrode in 20 eyes that underwent non-complicated vitreous surgery. A light-emitted diode was embedded into the contact lens, and a stimulus of 150 ms on and 350 ms off at 2 Hz was delivered. The amplitudes and latencies of the a-, b-, and d-waves, photopic negative response (PhNR), and oscillatory potentials (OPs) were analyzed. The intraocular temperature at the mid-vitreous was measured at the beginning and just after the surgery with a thermoprobe. Results The intraocular temperature was 33.2 ± 1.3°C before and 29.4 ± 1.7°C after the vitrectomy. The amplitudes of the PhNR and OPs were significantly smaller after surgery, and the latencies of all components were prolonged after the surgery. These changes were not significantly correlated with the changes of the temperature. Conclusion Retinal function is reduced just after core vitrectomy in conjunction with significant temperature reduction. The differences in the degree of alterations of each ERG component suggests different sensitivity of each type of retinal neuron. PMID:27010332

  19. Intraoperative knee anthropometrics: correlation with cartilage wear.

    PubMed

    Rooney, N; Fitzpatrick, D P; Beverland, D E

    2006-08-01

    Accurate knee morphology is of value in determining the correct sizing of prosthetic implants. Intraoperative measurement of key linear dimensional variables was carried out on 196 Caucasian knees (osteoarthritic patients: 68 male and 128 female). Of the 196 knees measured, 70 had extensive cartilage degeneration. Statistical analysis was carried out on this large sample size of data. Summary statistics and correlation coefficients between variables were determined and compared between subgroups. Male knees were on average larger than female knees. Higher correlation was found between variables for males than between variables for females. Overall, the patellar dimensions were seen to correlate least well with other anatomical variables. High correlation between femoral variables supports current femoral sizing procedure, although routine patellar resection practices are called into question. Average values for the 70 knees with extensive cartilage degeneration were significantly smaller (P < 0.01) than their counterparts for the other 126 knees. For a measurement not containing cartilage, such as femoral epicondylar width, this difference cannot be accounted for by the loss of cartilage owing to wear. This suggests that, for similar height and weight, a naturally narrower femoral epicondylar width may be associated with severe osteoarthritis. PMID:16961186

  20. Intraoperative pathology consultation: error, cause and impact

    PubMed Central

    Mahe, Etienne; Ara, Shamim; Bishara, Mona; Kurian, Annie; Tauqir, Syeda; Ursani, Nafisa; Vasudev, Pooja; Aziz, Tariq; Ross, Cathy; Lytwyn, Alice

    2013-01-01

    Background Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institutions quality assurance process. Methods We performed a quality assurance review of 1207 frozen section diagnoses from 812 surgical cases performed in the Hamilton Regional Laboratory Medicine Programme during a 6-month period in 2007. We reviewed the frozen section and permanent slides from all potentially discordant cases using a multiheaded microscope to arrive at a consensus pertaining to the type and reason for error. We reviewed the clinical record to determine whether there had been a potential adverse impact on immediate clinical management. Results Frozen sections were most commonly requested for head and neck, nervous system and female genital tract specimens. Twenty-eight frozen sections (3%) were deferred. We identified 24 discordant diagnoses involving 3% of cases and 2% of specimens. The organ systems showing the greatest frequency of discordance relative to the total number from that system were the nervous system, head and neck, and the lungs. Of the errors identified, most occurred owing to diagnostic misinterpretation, followed by problems related to tissue sampling. There was a potential adverse impact on immediate clinical management in 14 cases. Conclusion Our results add to the Canadian data on the correlation between frozen sections and permanent sections; we note comparability to the concordance rates reported in the literature. PMID:23706852

  1. Perspectives in Intraoperative Diagnostics of Human Gliomas

    PubMed Central

    Tyurikova, O.; Dembitskaya, Y.; Yashin, K.; Mishchenko, M.; Vedunova, M.; Medyanik, I.; Kazantsev, V.

    2015-01-01

    Amongst large a variety of oncological diseases, malignant gliomas represent one of the most severe types of tumors. They are also the most common type of the brain tumors and account for over half of the astrocytic tumors. According to different sources, the average life expectancy of patients with various glioblastomas varies between 10 and 12 months and that of patients with anaplastic astrocytic tumors between 20 and 24 months. Therefore, studies of the physiology of transformed glial cells are critical for the development of treatment methods. Modern medical approaches offer complex procedures, including the microsurgical tumor removal, radiotherapy, and chemotherapy, supplemented with photodynamic therapy and immunotherapy. The most radical of them is surgical resection, which allows removing the largest part of the tumor, reduces the intracranial hypertension, and minimizes the degree of neurological deficit. However, complete removal of the tumor remains impossible. The main limitations are insufficient visualization of glioma boundaries, due to its infiltrative growth, and the necessity to preserve healthy tissue. This review is devoted to the description of advantages and disadvantages of modern intraoperative diagnostics of human gliomas and highlights potential perspectives for development of their treatment. PMID:26543495

  2. Using intraoperative MRI to assess bleeding

    NASA Astrophysics Data System (ADS)

    Liu, Haiying; Hall, Walter A.; Martin, Alastair J.; Truwit, Charles L.

    2001-05-01

    Immediate detector of any surgically induced hemorrhage prior to the closure is important for minimizing the unnecessary post surgical complications. In the case of hemorrhage, the surgical site of interests often involves hemorrhagic blood in the presence of CSF as well as air pockets. It is known that the hemorrhagic blood or air has a different magnetic susceptibility from its surrounding tissue, and CSF has long T1 and T2. Based on these differences, a set of complimentary imaging techniques (T2, FLAIR, and GE) were optimized to reveal the existence of surgically induced acute hemorrhage. Among 330 neurosurgical cases, one relatively severe hemorrhage has been successfully found intra-operatively using the concept. During the case, a new hyperintense area close to the primary motor cortex was initially noticed on T2 weighted HASTE images. As soon as it was found to increase in size rapidly, the patient was treated immediately via craniotomy for aspiration of the intra-parenchymal blood. Owing to early detection and treatment, the patient was completely free of motor deficits. Besides, there were ten much less severe hemorrhages have been noticed using the method. The proper post-surgical care was planned to closely follow-up the patient for any sign of hemorrhage.

  3. Continuous Intraoperative Neuromonitoring in Thyroid Surgery.

    PubMed

    Angeletti, Flavia; Musholt, Petra B; Musholt, Thomas J

    2015-11-01

    Intermittent intraoperative neuromonitoring (I-IONM) has been introduced to thyroid surgery during the past two decades. The neuromonitoring devices (hardware and software) were significantly improved with the development of the second and third device generations. Needle electrodes, which were widely used 10 years ago, are almost completely substituted by less invasive, optimized endotracheal tube electrodes that ensure signal stability. In addition, recommendations of surgical societies for the standardized application of IONM have been established and incorporated into guidelines. However, due to the already very low frequency of (permanent) recurrent laryngeal nerve (RLN) paralysis following primary thyroid resections, a significant benefit of IONM compared to the "gold standard" of visual identification of the RLN alone has not been demonstrated so far. Moreover, the idea to enable surgeons to recognize impending nerve damage during (not after) dissection cannot be implemented with I-IONM techniques. The main benefit of I-IONM, therefore, remains the possible change of resection strategy in case of a "loss of signal (LOS)" after resection of one thyroid lobe in patients with planned bilateral resection. The recent introduction of continuous neuromonitoring (C-IONM) represents a significant step forward, potentially enabling the surgeon to react before irreversible damage to the RLN occurs. Preliminary data are supporting this methodological advantage. PMID:26680382

  4. Intraoperative determination and display of cortical function

    NASA Astrophysics Data System (ADS)

    Bass, W. Andrew; Galloway, Robert L., Jr.; Dawant, Benoit M.; Maciunas, Robert J.

    1997-05-01

    One of the most important issues in neurosurgical lesion resection is margin definition. And while there is still some effort required to exactly determine lesion boundaries from tomographic images, the lesions are at least perceptible on the scans. What is not visible is the location of function. Functional imaging such as PET and fMRI hold some promise for cortical function localization; however, intraoperative cortical mapping can provide exact localization of function without ambiguity. Since tomographic images can provide lesion margin definition and cortical mapping can provide functional information we have developed a system for combining the two in our Interactive, Image-Guided system. For cortical surface mapping we need a surface description. Brain contours are extracted from a MRI volume using a deformable model approach and rendered from multiple angular positions. As the surgeon moves a probe, its position is displayed on the view closes to the angular position of the probe. During functional mapping, positive response to stimulation result in a color overlay 'dot' added to the cortical surface display. Different colored dots are used to distinguish between motor function and language function. And a third color is used to display overlapping functionality. This information is used to guide the resection around functionally eloquent areas of the cortex.

  5. Intraoperative neurophysiological monitoring in spinal surgery.

    PubMed

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-09-16

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  6. Intraoperative neurophysiological monitoring in spinal surgery

    PubMed Central

    Park, Jong-Hwa; Hyun, Seung-Jae

    2015-01-01

    Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. PMID:26380823

  7. Intraoperative Neurophysiological Monitoring (IONM) for Cordotomy Procedures.

    PubMed

    Jahangiri, Faisal R

    2015-09-01

    This case illustrates the benefits of utilizing intraoperative neurophysiological monitoring (IONM) for preventing injury to sensory/motor pathways of the spinal cord during a cordotomy procedure to relieve pain. Cordotomy has been used effectively in the treatment of visceral pain but comes with a high risk of damaging motor and sensory pathways due to close proximity of lesion. The subject is a 47-year-old female with a pancoast tumor of the left lung, left brachialplexopathy, and severe neuropathic pain syndrome, refractory to medical therapy. A palliative cordotomy procedure was elected for pain control. Baseline bilateral posterior tibial and median nerve somatosensory evoked potentials (SSEP) were present except in the left upper extremity. Transcranial electric motor evoked potential (TCeMEP) baselines were present in all extremities except the left upper. Total intravenous anesthesia was used. The spine was exposed at C2-C3 and a right single anterolateral cordotomy was performed with an immediate drop in TCeMEPs (70-80% amplitude reduction) in the right upper and right lower extremities. The surgeon decided to stop the cordotomy at that point. Postoperatively, the patient had no sensory or motor deficit. In this patient, TCeMEPs were used effectively to guide the surgeon in preventing damage to the spinal cord that could lead to motor deficits. PMID:26630809

  8. Perspectives in Intraoperative Diagnostics of Human Gliomas.

    PubMed

    Tyurikova, O; Dembitskaya, Y; Yashin, K; Mishchenko, M; Vedunova, M; Medyanik, I; Kazantsev, V

    2015-01-01

    Amongst large a variety of oncological diseases, malignant gliomas represent one of the most severe types of tumors. They are also the most common type of the brain tumors and account for over half of the astrocytic tumors. According to different sources, the average life expectancy of patients with various glioblastomas varies between 10 and 12 months and that of patients with anaplastic astrocytic tumors between 20 and 24 months. Therefore, studies of the physiology of transformed glial cells are critical for the development of treatment methods. Modern medical approaches offer complex procedures, including the microsurgical tumor removal, radiotherapy, and chemotherapy, supplemented with photodynamic therapy and immunotherapy. The most radical of them is surgical resection, which allows removing the largest part of the tumor, reduces the intracranial hypertension, and minimizes the degree of neurological deficit. However, complete removal of the tumor remains impossible. The main limitations are insufficient visualization of glioma boundaries, due to its infiltrative growth, and the necessity to preserve healthy tissue. This review is devoted to the description of advantages and disadvantages of modern intraoperative diagnostics of human gliomas and highlights potential perspectives for development of their treatment. PMID:26543495

  9. Global Warming Trends.

    ERIC Educational Resources Information Center

    Jones, Philip D.; Wigley, Tom M. L.

    1990-01-01

    Results from the analysis of land and marine records from the past century are presented. It is indicated that the planet earth has warmed about one-half of a degree celsius. The uncertainty of these measurements and future warming trends are discussed. (CW)

  10. EPA GLOBAL WARMING WEBSITE

    EPA Science Inventory

    The U.S. EPA Global Warming Site strives to present or direct viewers to the most timely social, scientific, and logistic information available on the global warming issue. The site offers links to related sites as well as its own selection of material, which is expected to grow ...

  11. The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid-warm oxygen), and pethidine on the severity of shivering in general anesthesia patients in the recovery room

    PubMed Central

    Nasiri, Ahmad; Akbari, Ayob; Sharifzade, GholamReza; Derakhshan, Pooya

    2015-01-01

    Background: Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia. Materials and Methods: Eighty-seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine). Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38C), patients in combined warming group received pre-warmed Ringer serum (38C) accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16) with the significance level being P < 0.05. Results: The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5) min, 6 (1.5) min, and 2.8 (0.7) min, respectively, which was statistically significant (P < 0.05). The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05). Conclusions: Combined warming can be effective in controlling postoperative shivering and body temperature increase. PMID:26793258

  12. Our intraoperative boost radiotherapy experience and applications

    PubMed Central

    Günay, Semra; Alan, Ömür; Yalçın, Orhan; Türkmen, Aygen; Dizdar, Nihal

    2016-01-01

    Objective: To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer. Material and Methods: Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery. Results: Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2–3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph node biopsy was performed and advancement flaps were prepared according to the size and inclination of the conus following evaluation of tumor size and surgical margins by pathology. Distance to the thoracic wall was measured, and a radiation oncologist and radiation physicist calculated the required dose. Anesthesia was regulated with slower ventilation frequency, without causing hypoxia. The skin and incision edges were protected, the field was radiated (with 6 MeV electron beam of 10 Gy) and the incision was closed. In our cases, there were no major postoperative surgical or early radiotherapy related complications. Conclusion: The completion of another stage of local therapy with IObRT during surgery positively effects sequencing of other treatments like chemotherapy, hormonotherapy and radiotherapy, if required. IObRT increases disease free and overall survival, as well as quality of life in breast cancer patients.

  13. Intraoperative cell salvage in revision hip surgery

    PubMed Central

    Herd, J.M.; Joseph, J.J.; McGarvey, M.; Tsimbouri, P.; Bennett, A.; Meek, R.M.D.; Morrison, A.

    2014-01-01

    Allogenic blood is a finite resource, with associated risks. Previous studies show intraoperative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, there are concerns regarding efficacy and cost-effectiveness of ICS. This study was carried out to review ICS use in revision hip arthroplasty. All patients who underwent ICS and re-infusion between 2008 and 2010 in the Southern General Hospital (SGH) were audited. The fall in haemoglobin (Hb), volume of blood re-infused and postoperative allogenic transfusion rates were recorded. This group was compared to a similar SGH cohort who underwent surgery by the same surgeons between 2006 and 2008, and a pre-2005 control group where no ICS was used. The proportion of patients receiving a postoperative allogenic transfusion fell by 55% in the 2008–2010 ICS cohort compared with the control, and by 40% compared with the previous ICS group. In both instances, there was a statistically significant (p < 0.001) reduction in mean units transfused per patient; in the 2008–2010 ICS cohort, a mean of 0.8 units was used per patient, while 1.4 were used in the 2006–2008 cohort. 3.5 units were used in the control group. There was no statistically significant difference in age or preoperative Hb between the groups, or in length of hospital stay. In this study, ICS has been shown to be effective in reducing rates and volume of postoperative allogenic transfusion in patients undergoing revision hip surgery at the SGH. However, further work is needed to establish the effect of changing anaesthetic technique on postoperative allogenic transfusion rates. PMID:25568779

  14. Intraoperative cell salvage in revision hip surgery.

    PubMed

    Herd, J M; Joseph, J J; McGarvey, M; Tsimbouri, P; Bennett, A; Meek, R M D; Morrison, A

    2014-03-01

    Allogenic blood is a finite resource, with associated risks. Previous studies show intraoperative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, there are concerns regarding efficacy and cost-effectiveness of ICS. This study was carried out to review ICS use in revision hip arthroplasty. All patients who underwent ICS and re-infusion between 2008 and 2010 in the Southern General Hospital (SGH) were audited. The fall in haemoglobin (Hb), volume of blood re-infused and postoperative allogenic transfusion rates were recorded. This group was compared to a similar SGH cohort who underwent surgery by the same surgeons between 2006 and 2008, and a pre-2005 control group where no ICS was used. The proportion of patients receiving a postoperative allogenic transfusion fell by 55% in the 2008-2010 ICS cohort compared with the control, and by 40% compared with the previous ICS group. In both instances, there was a statistically significant (p<0.001) reduction in mean units transfused per patient; in the 2008-2010 ICS cohort, a mean of 0.8 units was used per patient, while 1.4 were used in the 2006-2008 cohort. 3.5 units were used in the control group. There was no statistically significant difference in age or preoperative Hb between the groups, or in length of hospital stay. In this study, ICS has been shown to be effective in reducing rates and volume of postoperative allogenic transfusion in patients undergoing revision hip surgery at the SGH. However, further work is needed to establish the effect of changing anaesthetic technique on postoperative allogenic transfusion rates. PMID:25568779

  15. Intraoperative Patient Selection for Tubeless Percutaneous Nephrolithotomy

    PubMed Central

    Lee, Joo Yong; Kim, Kyu Hyun; Kim, Man Deuk; Chung, Doo Yong; Cho, Kang Su

    2014-01-01

    This study was conducted to report our experience of intraoperative patient selection for tubeless percutaneous nephrolithotomy (PCNL) based on a tentative decision-making algorithm. Thirty-four consecutive patients who were scheduled to undergo tubeless PCNL were included and medical records were obtained from a prospectively maintained database for these patients. After completion of PCNL, the nephrostomy site was observed with a safety guidewire in place. If there was no significant bleeding through the tract, tubeless PCNL was performed, and in cases with significant bleeding or other complications, nephrostomy catheter insertion was performed as usual. In 29 cases (85.3%), tubeless PCNL was performed according to our decision-making protocol. Mean stone size was 7.33 9.35 cm2. Mean hospital stay was 2.61 1.01 days. The difference between preoperative and postoperative hemoglobin was 0.68 1.22 g/dL (p > 0.05). Visual analog pain scale scores immediately post-operation, on postoperative day one and on the day of discharge were 4.62 1.80, 3.25 1.68 (postoperative day one vs. operative day; p = 0.001), and 1.87 0.83 (the day of discharge vs. operative day; p = 0.001), respectively. The success rate with insignificant remnant stones was 85.2% and complete stone-free rate was 76.5%. In conclusion, tubeless PCNL was performed successfully with low complication rate and reduced pain score through our decision-making algorithm. PMID:25216439

  16. Automated intraoperative calibration for prostate cancer brachytherapy

    SciTech Connect

    Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor

    2011-11-15

    Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 {+-} 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 {+-} 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 {+-} 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 {+-} 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

  17. A light blanket for intraoperative photodynamic therapy

    PubMed Central

    Hu, Yida; Wang, Ken; Zhu, Timothy C.

    2015-01-01

    A novel light source - light blanket composed of a series of parallel cylindrical diffusing fibers (CDF) is designed to substitute the hand-held point source in the PDT treatment of the malignant pleural or intraperitoneal diseases. It achieves more uniform light delivery and less operation time in operating room. The preliminary experiment was performed for a 9cmx9cm light blanket composed of 8 9-cm CDFs. The linear diffusers were placed in parallel finger-like pockets. The blanket is filled with 0.2 % intralipid scattering medium to improve the uniformity of light distribution. 0.3-mm aluminum foil is used to shield and reflect the light transmission. The full width of the profile of light distribution at half maximum along the perpendicular direction is 7.9cm and 8.1cm with no intralipid and with intralipid. The peak value of the light fluence rate profiles per input power is 11.7mW/cm2/W and 8.6mW/cm2/W respectively. The distribution of light field is scanned using the isotropic detector and the motorized platform. The average fluence rate per input power is 8.6 mW/cm2/W and the standard deviation is 1.6 mW/cm2/W for the scan in air, 7.4 mW/cm2/W and 1.1 mW/cm2/W for the scan with the intralipid layer. The average fluence rate per input power and the standard deviation are 20.0 mW/cm2/W and 2.6 mW/cm2/W respectively in the tissue mimic phantom test. The light blanket design produces a reasonably uniform field for effective light coverage and is flexible to confirm to anatomic structures in intraoperative PDT. It also has great potential value for superficial PDT treatment in clinical application. PMID:25983369

  18. Intraoperative probe-directed immunodetection using a monoclonal antibody

    SciTech Connect

    O'Dwyer, P.J.; Mojzisik, C.M.; Hinkle, G.H.; Rousseau, M.; Olsen, J.; Tuttle, S.E.; Barth, R.F.; Thurston, M.O.; McCabe, D.P.; Farrar, W.B.

    1986-12-01

    To assess monoclonal antibody (MAb) 17-1A and its F(ab')2 fragment in intraoperative radioimmunodetection and to evaluate further the clinical usefulness of a hand-held gamma-detecting probe (GDP), we injected radiolabeled monoclonal antibody 17-1A three to six days preoperatively or its F(ab')2 fragment two to three days preoperatively into 18 patients with colorectal cancer. Intraoperative GDP counts with tumor-tissue ratios of 1.5:1 or greater were obtained from 15 (75%) of 20 tumor sites, with ratios averaging 2.3:1 for fragments and 3.4:1 for whole antibody. The GDP counts contributed to intraoperative decision making in three patients, either by localization of tumor not identified by inspection or palpation or by mapping margins of resection with histologic confirmation of a local/regional recurrence. These preliminary data demonstrate that probe-directed, intraoperative radioimmunodetection can assist the surgeon in detecting subclinical tumor deposits and thus better evaluate the extent of primary or recurrent colorectal cancers intraoperatively.

  19. Multifocal Insulinoma in Pancreas and Effect of Intraoperative Ultrasonography

    PubMed Central

    Borazan, Ersin; Aytekin, Alper; Yilmaz, Latif; Elci, Muhsin; Karaca, Mehmet Salih; Kervancioglu, Selim; Balik, Ahmet Abdulhalik

    2015-01-01

    Insulinoma is the most frequently seen functional pancreatic neuroendocrine tumor. The incidence of multifocal insulinoma is lower than 10%. Its treatment is direct or laparoscopic excision. The present case was examined with the findings of hypoglycemia and hypercalcemia, and as there was high insulin and C-peptide levels the initial diagnosis was insulinoma. The case was investigated in terms of MEN 1. During preoperative screening for localization, there was one focus in the head of the pancreas in the abdominal tomography and two foci in endoscopic ultrasonography. No other focus was detected through intraoperative visual or manual palpation. However, five foci were detected during operation by intraoperative ultrasonography. The relation of masses with the main pancreatic canal was evaluated and they were excised by enucleation method. There was no recurrence during the postoperative 18-month follow-up of the patient. As a result, during treatment for insulinoma, it should be kept in mind that there might be multifocal foci. In all insulinomas, the whole pancreas should be evaluated with intraoperative ultrasonography because none of the current preoperative diagnostic methods are as sensitive as manual palpation of pancreas and intraoperative ultrasonography. The intraoperative detection of synchronous five foci in pancreas is quite a rare condition. PMID:26295000

  20. The intraoperative gamma probe: basic principles and choices available.

    PubMed

    Zanzonico, P; Heller, S

    2000-01-01

    By taking advantage of the proximity to radioactive sentinel nodes and occult tumors achievable in an operative setting, intraoperative probes are becoming increasingly important in the surgical management of cancer. This article begins with a discussion of the statistical limitations of radiation detection and measurement and of the key performance parameters (sensitivity, energy resolution, and spatial resolution) that characterize detectors. The basic design and operating principle of radiation detectors used in intraoperative probes, scintillation and semiconductor detectors, are then reviewed. Scintillation detector-based intraoperative probes, generally using a NaI(T1) or a CsI(T1) crystal connected to a photomultiplier tube by a fiberoptic cable, have the advantages of reliability, relatively low cost, and high sensitivity, especially for medium- to high-energy photons. Disadvantages include poor energy resolution and scatter rejection, and bulkiness. Semiconductor (CdZn, CdZnTe, HgI2)-based probes are compact and have excellent energy resolution and scatter rejection, but with complex energy spectra reflecting charge-carrier trapping. Their main disadvantage is lower sensitivity. The performance parameters of various commercially available intraoperative probes are then compared. The article concludes with a discussion of the practical considerations in selecting and using intraoperative probes, including ergonomic and other design features, as well as performance parameters. PMID:10656242

  1. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin.

    PubMed Central

    Lau, W Y; Fan, S T; Wong, S H; Wong, K P; Poon, G P; Chu, K W; Yip, W C; Wong, K K

    1987-01-01

    In the past six years, 37 patients with gastrointestinal bleeding of obscure origin had their bleeding sites localised preoperatively or intraoperatively. Preoperative investigations followed a regime consisting of endoscopy, barium meal and follow through, small bowel enema, 99mTc pertechnetate scan, 99mTc-labelled red blood cell scan and selective coeliac and mesenteric angiography. Bleeding lesions were localised preoperatively in 36 patients. In one patient, diagnostic laparotomy had to be carried out immediately before any investigation because the bleeding was severe. At operation, angiosarcoma of ileum was found. Unless preoperative investigations showed the lesions to be in anatomically fixed organs like the duodenum or colon, the lesions had still to be found at operation. Palpation and transillumination detected the lesion intraoperatively in 21 patients while only some lesions were found in three patients with multiple lesions. Sigmoidoscopy through enterotomies was required in one patient. Intraoperative enteroscopy was done for small lesions not found grossly at operation in nine patients, to detect additional lesions in three patients or to rule out suspicious lesion shown on preoperative tests in one patient. In another patient with diffuse lymphoma of small bowel with bleeding from only a small segment of jejunum, injection of methylene blue intraoperatively through a previously placed angiographic catheter stained the bleeding segment of jejunum blue. This segment was identified easily and resected. These preoperative and intraoperative localisation procedures were simple and effective and we recommend them to be used more freely. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3498667

  2. Global warming elucidated

    SciTech Connect

    Shen, S.

    1995-03-01

    The meaning of global warming and its relevance to everyday life is explained. Simple thermodynamics is used to predict an oscillatory nature of the change in climate due to global warming. Global warming causes extreme events and bad weather in the near term. In the long term it may cause the earth to transition to another equilibrium state through many oscillation in climatic patterns. The magnitudes of these oscillations could easily exceed the difference between the end points. The author further explains why many no longer fully understands the nature and magnitudes of common phenomena such as storms and wind speeds because of these oscillations, and the absorptive properties of clouds. The author links the increase in duration of the El Nino to global warming, and further predicts public health risks as the earth transitions to another equilibrium state in its young history.

  3. Warm and Cool Dinosaurs.

    ERIC Educational Resources Information Center

    Mannlein, Sally

    2001-01-01

    Presents an art activity in which first grade students draw dinosaurs in order to learn about the concept of warm and cool colors. Explains how the activity also helped the students learn about the concept of distance when drawing. (CMK)

  4. Reconciling Warming Trends

    NASA Technical Reports Server (NTRS)

    Schmidt, Gavin A.; Shindell, Drew T.; Tsigaridis, Konstantinos

    2014-01-01

    Climate models projected stronger warming over the past 15 years than has been seen in observations. Conspiring factors of errors in volcanic and solar inputs, representations of aerosols, and El NiNo evolution, may explain most of the discrepancy.

  5. Integrated assessment of global warming

    SciTech Connect

    Ott, K.O.

    1996-12-31

    The anomalies of sea surface temperatures, which show a warming trend since the 1850s through the decade 1960/70 of {Delta}SST {approximately} 0.3 C, are complemented by changes of the ground surface temperature ({Delta}GST). The global surface temperature change, based on these data, allows an integrated assessment of the associated increase in black-body irradiance and a comparison with the enhanced greenhouse-gas back-scattering. Information on the GST history is obtained from unfolding analyses of underground temperature distributions measured in 90 boreholes in Alaskan permafrost and Canadian bedrock. These analyses show GST increases ({Delta}GST) since the 19th century through 1960/70 of 3 C on average, with standard deviations of +1.8 C and {minus}0.9 C on the high and low end respectively. The onset of the warming trend, which is uncertain in the GST data, is timed more accurately by detailed length records of large valley glaciers in the US and the Alps. Evaluation of the heat capacities and heat transfer indicates that the temperature response to an increase in radiative forcing must be much larger on land than on the sea. Conversely, the observed large ratio of {Delta}GST and {Delta}SST can only be explained by increased radiative forcing. From 1960/70 through the warmest decade on record, 1980/90, global {Delta}SST and {Delta}SAT have further increased to 0.6 C and 0.8 C respectively, But, the most recent GST data are not accurate enough to extend the comparison through 1990. Calculation of the increase of radiative forcing from back-scattering of greenhouse gases for 1850 to 1970 yields 1.3 W/cm{sup 2}. The increase in black-body irradiance from 3.6 C warming on land and 0.3 C on sea provides the required balance. The warming on land of 3.6 C is larger than the average value of 3.0 C, but well within the observed range.

  6. [Intracoronary air embolism detected during intraoperative transesophageal echocardiography].

    PubMed

    Cabrera Schulmeyer, M C; Santelices Cuevas, E; Vega Seplveda, R; Allamand, F; De la Maza, J C

    2005-01-01

    A 39-year-old hypertensive man with severe aortic stenosis underwent aortic valve replacement monitored by intraoperative transesophageal echocardiography. Upon weaning the patient off extracorporeal circulation, hemodynamics became severely compromised, with hypotension, tachycardia, and elevated precordial electrocardiographic tracings. The echocardiographic images were instrumental during the episode to demonstrate that the anterior wall presented hypokinesis consistent with ischemia in the region but that there were also images of hyperrefringence highly suggestive of intracoronary air embolism. Intraoperative transesophageal echocardiography allowed us to diagnose the real cause of the ischemic event and rule out an atheromatous plaque as the source. Perfusion pressure was increased to treat the air embolism. The echocardiographic image demonstrated success, specifically restoration of left ventricular regional contractility. This experience revealed the usefulness of transesophageal echocardiography in intraoperative monitoring to diagnose ischemia, assess the cause, and guide treatment. PMID:16038178

  7. The Use of Optical Coherence Tomography in Intraoperative Ophthalmic Imaging

    PubMed Central

    Hahn, Paul; Migacz, Justin; O’Connell, Rachelle; Maldonado, Ramiro S.; Izatt, Joseph A.; Toth, Cynthia A.

    2012-01-01

    Optical coherence tomography (OCT) has transformed diagnostic ophthalmic imaging but until recently has been limited to the clinic setting. The development of spectral-domain OCT (SD-OCT), with its improved speed and resolution, along with the development of a handheld OCT scanner, enabled portable imaging of patients unable to sit in a conventional tabletop scanner. This handheld SD-OCT unit has proven useful in examinations under anesthesia and, more recently, in intraoperative imaging of preoperative and postoperative manipulations. Recently, several groups have pioneered the development of novel OCT modalities, such as microscope-mounted OCT systems. Although still immature, the development of these systems is directed toward real-time imaging of surgical maneuvers in the intraoperative setting. This article reviews intraoperative imaging of the posterior and anterior segment using the handheld SD-OCT and recent advances toward real-time microscope-mounted intrasurgical imaging. PMID:21790116

  8. Climate change between the Medieval Warm Period and the Little Ice Age: Model-data comparison between CMIP5/PMIP3 last millennium simulations and available temperature proxy records

    NASA Astrophysics Data System (ADS)

    Charpentier Ljungqvist, Fredrik; Zhang, Qiong; Sundqvist, Hanna S.; Brattstrm, Gudrun; Moberg, Anders

    2014-05-01

    We present a model-data comparison between the CMIP5/PMIP3 last millennium simulations and available individual temperature proxy records from across the globe. Our focus is to investigate the agreement in amplitude of the simulated and the reconstructed temperature difference between the Medieval Warm Period (MWP, here defined as AD 950-1250) and the Little Ice Age (LIA, here defined as AD 1400-1700). An emphasis is placed on analysing to what extent the high latitude and continental amplification of the temperature signal is the same in the model simulations as in the proxies. We further discuss to what extent the models have captured the spatial signatures that is shown in the proxy data. We have collected 125 calibrated proxy records - representing either annual mean, winter or summer temperature - extending back to at least AD 950. The proxies include data from a wide range of archives: ice-cores, marine and terrestrial sediments, tree-rings, speleothems and historical records. Only proxies with at least two observations per century were included. We calculated the amplitude of change between the MWP and the LIA in the individual proxy records using the temperature calibrations by the original authors. The last millennium simulations from 8 different models in CMIP5 database are used to compare with the proxy records. This model-data comparison reveals that the ensemble mean and median of the models mostly underestimate the amplitude of temperature difference between the MWP and the LIA as estimated from the proxy records at those locations where proxy records exist. The relative lack of proxy data from the tropics and the Southern Hemisphere, however, precludes a fully comprehensive model-data comparison. We also note large differences between the model simulations both in amplitude of the temperature change and in their spatial patterns. The use of an ensemble mean or median of the model simulations emphasizes the averaged signature within the model ensemble. We observe an average tendency for the models to overestimate the magnitude of the Arctic amplification as compared to the proxies. On the other hand, the models underestimate the coastal-continental temperature gradient compared to the proxies.

  9. Intraoperative neurophysiology in deep brain surgery for psychogenic dystonia

    PubMed Central

    Ramos, Vesper Fe Marie L; Pillai, Ajay S; Lungu, Codrin; Ostrem, Jill; Starr, Philip; Hallett, Mark

    2015-01-01

    Psychogenic dystonia is a challenging entity to diagnose and treat because little is known about its pathophysiology. We describe two cases of psychogenic dystonia who underwent deep brain stimulation when thought to have organic dystonia. The intraoperative microelectrode recordings in globus pallidus internus were retrospectively compared with those of five patients with known DYT1 dystonia using spontaneous discharge parameters of rate and bursting, as well as movement-related discharges. Our data suggest that simple intraoperative neurophysiology measures in single subjects do not differentiate psychogenic dystonia from DYT1 dystonia. PMID:26125045

  10. Intraoperative wide bore nasogastric tube knotting: A rare incidence

    PubMed Central

    Lamba, Sangeeta; Sethi, Surendra K.; Khare, Arvind; Saini, Sudheendra

    2016-01-01

    Nasogastric tubes are commonly used in anesthetic practice for gastric decompression in surgical patients intraoperatively. The indications for its use are associated with a number of potential complications. Knotting of small-bore nasogastric tubes is usually common both during insertion and removal as compared to wide bore nasogastric tubes. Knotting of wide bore nasogastric tube is a rare complication and if occurs usually seen in long standing cases. We hereby report a case of incidental knotting of wide bore nasogastric tube that occurred intraoperatively.

  11. Intraoperative neurophysiology in deep brain surgery for psychogenic dystonia.

    PubMed

    Ramos, Vesper Fe Marie L; Pillai, Ajay S; Lungu, Codrin; Ostrem, Jill; Starr, Philip; Hallett, Mark

    2015-06-01

    Psychogenic dystonia is a challenging entity to diagnose and treat because little is known about its pathophysiology. We describe two cases of psychogenic dystonia who underwent deep brain stimulation when thought to have organic dystonia. The intraoperative microelectrode recordings in globus pallidus internus were retrospectively compared with those of five patients with known DYT1 dystonia using spontaneous discharge parameters of rate and bursting, as well as movement-related discharges. Our data suggest that simple intraoperative neurophysiology measures in single subjects do not differentiate psychogenic dystonia from DYT1 dystonia. PMID:26125045

  12. Intraoperative limb length measurement in total hip arthroplasty.

    PubMed

    Naito, M; Ogata, K; Asayama, I

    1999-01-01

    In order to evaluate the efficacy of intraoperative measurement of limb length inequality (LLI), we performed a prospective study on 64 patients who underwent unilateral total hip arthroplasty. The patients were divided into 2 groups. In Group I, the LLI was evaluated by the Shuck test, and in Group II by intraoperative measurement using a Steinman pin and an adjustable caliper. Preoperative LLIs assessed on radiographs averaged 1.18 cm in Group I and 0.37 cm in Group II. PMID:10192014

  13. Intraoperative ultrasound to facilitate removal of a submucosal foreign body.

    PubMed

    Smith, Matthew E; Riffat, Faruque; Berman, Laurence H; Jani, Piyush

    2014-01-01

    A 61-year-old man with a history of fish bone ingestion and poorly localized symptoms was seen. His clinical examination was unremarkable, but CT demonstrated a foreign body deeply embedded within his tongue. Intraoperative ultrasound (US) guidance facilitated identification of a bone, allowing a needle to be placed as a guide to dissection. Repeat US scanning through the incision permitted precisely targeted surgery. CT and US are the most effective imaging techniques for localizing fish bones. Intraoperative US can be used to accurately locate a submucosal fish bone in mobile tissue such as the tongue, and focused, image-guided dissection can reduce surgical tissue trauma. PMID:25145586

  14. CNS intraoperative consultation: a survival guide for non-neuropathologists.

    PubMed

    Kresak, Jesse Lee; Rivera-Zengotita, Marie; Foss, Robin M; Yachnis, Anthony T

    2014-01-01

    Intraoperative consultations for central nervous system disease may be challenging due to limitations of sample size, lack of familiarity with neurosurgical procedures, or poor access to neuroimaging studies. Despite these challenges, the surgical pathologist is charged with determining if the tissue sample is representative of the pathologic process while ensuring that enough diagnostic tissue has been retained for routine histology, immunohistochemistry, fluorescence in situ hybridization, molecular testing, and in some cases, tissue banking. Here, we present basic methods and a practical approach for CNS intraoperative consultation including critical pre-analytic considerations that promote optimal tissue management. PMID:25015160

  15. Global warming on trial

    SciTech Connect

    Broeker, W.S.

    1992-04-01

    Jim Hansen, a climatologist at NASA's Goddard Space Institute, is convinced that the earth's temperature is rising and places the blame on the buildup of greenhouse gases in the atmosphere. Unconvinced, John Sununu, former White House chief of staff, doubts that the warming will be great enough to produce serious threat and fears that measures to reduce the emissions would throw a wrench into the gears that drive the Unites States' troubled economy. During his three years at the White House, Sununu's view prevailed, and although his role in the debate has diminished, others continue to cast doubt on the reality of global warming. A new lobbying group called the Climate Council has been created to do just this. Burning fossil fuels is not the only problem; a fifth of emissions of carbon dioxide now come from clearing and burning forests. Scientists are also tracking a host of other greenhouse gases that emanate from a variety of human activities; the warming effect of methane, chlorofluorocarbons and nitrous oxide combined equals that of carbon dioxide. Although the current warming from these gases may be difficult to detect against the background noise of natural climate variation, most climatologists are certain that as the gases continue to accumulate, increases in the earth's temperature will become evident even to skeptics. If the reality of global warming were put on trial, each side would have trouble making its case. Jim Hansen's side could not prove beyond a reasonable doubt that carbon dioxide and other greenhouse gases have warmed the planet. But neither could John Sununu's side prove beyond a reasonable doubt that the warming expected from greenhouse gases has not occurred. To see why each side would have difficulty proving its case, this article reviews the arguments that might be presented in such a hearing.

  16. Long range global warming

    SciTech Connect

    Rolle, K.C.; Pulkrabek, W.W.; Fiedler, R.A.

    1995-12-31

    This paper explores one of the causes of global warming that is often overlooked, the direct heating of the environment by engineering systems. Most research and studies of global warming concentrate on the modification that is occurring to atmospheric air as a result of pollution gases being added by various systems; i.e., refrigerants, nitrogen oxides, ozone, hydrocarbons, halon, and others. This modification affects the thermal radiation balance between earth, sun and space, resulting in a decrease of radiation outflow and a slow rise in the earth`s steady state temperature. For this reason the solution to the problem is perceived as one of cleaning up the processes and effluents that are discharged into the environment. In this paper arguments are presented that suggest, that there is a far more serious cause for global warming that will manifest itself in the next two or three centuries; direct heating from the exponential growth of energy usage by humankind. Because this is a minor contributor to the global warming problem at present, it is overlooked or ignored. Energy use from the combustion of fuels and from the output of nuclear reactions eventually is manifest as warming of the surroundings. Thus, as energy is used at an ever increasing rate the consequent global warming also increases at an ever increasing rate. Eventually this rate will become equal to a few percent of solar radiation. When this happens the earth`s temperature will have risen by several degrees with catastrophic results. The trends in world energy use are reviewed and some mathematical models are presented to suggest future scenarios. These models can be used to predict when the global warming problem will become undeniably apparent, when it will become critical, and when it will become catastrophic.

  17. ENSO and greenhouse warming

    NASA Astrophysics Data System (ADS)

    Cai, Wenju; Santoso, Agus; Wang, Guojian; Yeh, Sang-Wook; An, Soon-Il; Cobb, Kim M.; Collins, Mat; Guilyardi, Eric; Jin, Fei-Fei; Kug, Jong-Seong; Lengaigne, Matthieu; McPhaden, Michael J.; Takahashi, Ken; Timmermann, Axel; Vecchi, Gabriel; Watanabe, Masahiro; Wu, Lixin

    2015-09-01

    The El Nio/Southern Oscillation (ENSO) is the dominant climate phenomenon affecting extreme weather conditions worldwide. Its response to greenhouse warming has challenged scientists for decades, despite model agreement on projected changes in mean state. Recent studies have provided new insights into the elusive links between changes in ENSO and in the mean state of the Pacific climate. The projected slow-down in Walker circulation is expected to weaken equatorial Pacific Ocean currents, boosting the occurrences of eastward-propagating warm surface anomalies that characterize observed extreme El Nio events. Accelerated equatorial Pacific warming, particularly in the east, is expected to induce extreme rainfall in the eastern equatorial Pacific and extreme equatorward swings of the Pacific convergence zones, both of which are features of extreme El Nio. The frequency of extreme La Nia is also expected to increase in response to more extreme El Nios, an accelerated maritime continent warming and surface-intensified ocean warming. ENSO-related catastrophic weather events are thus likely to occur more frequently with unabated greenhouse-gas emissions. But model biases and recent observed strengthening of the Walker circulation highlight the need for further testing as new models, observations and insights become available.

  18. Surgery for intramedullary spinal cord tumors: the role of intraoperative (neurophysiological) monitoring

    PubMed Central

    Bricolo, Albino; Faccioli, Franco; Lanteri, Paola; Gerosa, Massimo

    2007-01-01

    In spite of advancements in neuro-imaging and microsurgical techniques, surgery for intramedullary spinal cord tumors (ISCT) remains a challenging task. The rationale for using intraoperative neurophysiological monitoring (IOM) is in keeping with the goal of maximizing tumor resection and minimizing neurological morbidity. For many years, before the advent of motor evoked potentials (MEPs), only somatosensory evoked potentials (SEPs) were monitored. However, SEPs are not aimed to reflect the functional integrity of motor pathways and, nowadays, the combined used of SEPs and MEPs in ISCT surgery is almost mandatory because of the possibility to selectively injury either the somatosensory or the motor pathways. This paper is aimed to review our perspective in the field of IOM during ISCT surgery and to discuss it in the light of other intraoperative neurophysiologic strategies that have recently appeared in the literature with regards to ISCT surgery. Besides standard cortical SEP monitoring after peripheral stimulation, both muscle (mMEPs) and epidural MEPs (D-wave) are monitored after transcranial electrical stimulation (TES). Given the dorsal approach to the spinal cord, SEPs must be monitored continuously during the incision of the dorsal midline. When the surgeon starts to work on the cleavage plane between tumor and spinal cord, attention must be paid to MEPs. During tumor removal, we alternatively monitor D-wave and mMEPs, sustaining the stimulation during the most critical steps of the procedure. D-waves, obtained through a single pulse TES technique, allow a semi-quantitative assessment of the functional integrity of the cortico-spinal tracts and represent the strongest predictor of motor outcome. Whenever evoked potentials deteriorate, temporarily stop surgery, warm saline irrigation and improved blood perfusion have proved useful for promoting recovery, Most of intraoperative neurophysiological derangements are reversible and therefore IOM is able to prevent more than merely predict neurological injury. In our opinion combining mMEPs and D-wave monitoring, when available, is the gold standard for ISCT surgery because it supports a more aggressive surgery in the attempt to achieve a complete tumor removal. If quantitative (threshold or waveform dependent) mMEPs criteria only are used to stop surgery, this likely impacts unfavorably on the rate of tumor removal. PMID:17653776

  19. Model predicts global warming

    NASA Astrophysics Data System (ADS)

    Wainger, Lisa A.

    Global greenhouse warming will be clearly identifiable by the 1990s, according to eight scientists who have been studying climate changes using computer models. Researchers at NASA's Goddard Space Flight Center, Goddard Institute for Space Studies, New York, and the Massachusetts Institute of Technology, Cambridge, say that by the 2010s, most of the globe will be experiencing substantial warming. The level of warming will depend on amounts of trace gases, or greenhouse gases, in the atmosphere.Predictions for the next 70 years are based on computer simulations of Earth's climate. In three runs of the model, James Hansen and his colleagues looked at the effects of changing amounts of atmospheric gases with time.

  20. Fusion of intraoperative force sensoring, surface reconstruction and biomechanical modeling

    NASA Astrophysics Data System (ADS)

    Rhl, S.; Bodenstedt, S.; Kderle, C.; Suwelack, S.; Kenngott, H.; Mller-Stich, B. P.; Dillmann, R.; Speidel, S.

    2012-02-01

    Minimally invasive surgery is medically complex and can heavily benefit from computer assistance. One way to help the surgeon is to integrate preoperative planning data into the surgical workflow. This information can be represented as a customized preoperative model of the surgical site. To use it intraoperatively, it has to be updated during the intervention due to the constantly changing environment. Hence, intraoperative sensor data has to be acquired and registered with the preoperative model. Haptic information which could complement the visual sensor data is still not established. In addition, biomechanical modeling of the surgical site can help in reflecting the changes which cannot be captured by intraoperative sensors. We present a setting where a force sensor is integrated into a laparoscopic instrument. In a test scenario using a silicone liver phantom, we register the measured forces with a reconstructed surface model from stereo endoscopic images and a finite element model. The endoscope, the instrument and the liver phantom are tracked with a Polaris optical tracking system. By fusing this information, we can transfer the deformation onto the finite element model. The purpose of this setting is to demonstrate the principles needed and the methods developed for intraoperative sensor data fusion. One emphasis lies on the calibration of the force sensor with the instrument and first experiments with soft tissue. We also present our solution and first results concerning the integration of the force sensor as well as accuracy to the fusion of force measurements, surface reconstruction and biomechanical modeling.

  1. High-accuracy registration of intraoperative CT imaging

    NASA Astrophysics Data System (ADS)

    Oentoro, A.; Ellis, R. E.

    2010-02-01

    Image-guided interventions using intraoperative 3D imaging can be less cumbersome than systems dependent on preoperative images, especially by needing neither potentially invasive image-to-patient registration nor a lengthy process of segmenting and generating a 3D surface model. In this study, a method for computer-assisted surgery using direct navigation on intraoperative imaging is presented. In this system the registration step of a navigated procedure was divided into two stages: preoperative calibration of images to a ceiling-mounted optical tracking system, and intraoperative tracking during acquisition of the 3D medical image volume. The preoperative stage used a custom-made multi-modal calibrator that could be optically tracked and also contained fiducial spheres for radiological detection; a robust registration algorithm was used to compensate for the very high false-detection rate that was due to the high physical density of the optical light-emitting diodes. Intraoperatively, a tracking device was attached to plastic bone models that were also instrumented with radio-opaque spheres; A calibrated pointer was used to contact the latter spheres as a validation of the registration. Experiments showed that the fiducial registration error of the preoperative calibration stage was approximately 0.1 mm. The target registration error in the validation stage was approximately 1.2 mm. This study suggests that direct registration, coupled with procedure-specific graphical rendering, is potentially a highly accurate means of performing image-guided interventions in a fast, simple manner.

  2. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

    PubMed

    Bible, Jesse E; Rihn, Jeffrey A; Lim, Moe R; Brodke, Darrel S; Lee, Joon Y

    2015-12-01

    The incidence of intraoperative complications in cervical spine surgery is low. However, when they do occur, such complications have the potential for causing considerable morbidity and mortality. Spine surgeons should be familiar with methods of minimizing such complications. Furthermore, if they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity. PMID:26519429

  3. Capturing intraoperative deformations: research experience at Brigham and Women's Hospital.

    PubMed

    Warfield, Simon K; Haker, Steven J; Talos, Ion-Florin; Kemper, Corey A; Weisenfeld, Neil; Mewes, Andrea U J; Goldberg-Zimring, Daniel; Zou, Kelly H; Westin, Carl-Fredrik; Wells, William M; Tempany, Clare M C; Golby, Alexandra; Black, Peter M; Jolesz, Ferenc A; Kikinis, Ron

    2005-04-01

    During neurosurgical procedures the objective of the neurosurgeon is to achieve the resection of as much diseased tissue as possible while achieving the preservation of healthy brain tissue. The restricted capacity of the conventional operating room to enable the surgeon to visualize critical healthy brain structures and tumor margin has lead, over the past decade, to the development of sophisticated intraoperative imaging techniques to enhance visualization. However, both rigid motion due to patient placement and nonrigid deformations occurring as a consequence of the surgical intervention disrupt the correspondence between preoperative data used to plan surgery and the intraoperative configuration of the patient's brain. Similar challenges are faced in other interventional therapies, such as in cryoablation of the liver, or biopsy of the prostate. We have developed algorithms to model the motion of key anatomical structures and system implementations that enable us to estimate the deformation of the critical anatomy from sequences of volumetric images and to prepare updated fused visualizations of preoperative and intraoperative images at a rate compatible with surgical decision making. This paper reviews the experience at Brigham and Women's Hospital through the process of developing and applying novel algorithms for capturing intraoperative deformations in support of image guided therapy. PMID:15721230

  4. Volumetric Intraoperative Brain Deformation Compensation: Model Development and Phantom Validation

    PubMed Central

    DeLorenzo, Christine; Papademetris, Xenophon; Staib, Lawrence H.; Vives, Kenneth P.; Spencer, Dennis D.; Duncan, James S.

    2012-01-01

    During neurosurgery, nonrigid brain deformation may affect the reliability of tissue localization based on preoperative images. To provide accurate surgical guidance in these cases, preoperative images must be updated to reflect the intraoperative brain. This can be accomplished by warping these preoperative images using a biomechanical model. Due to the possible complexity of this deformation, intraoperative information is often required to guide the model solution. In this paper, a linear elastic model of the brain is developed to infer volumetric brain deformation associated with measured intraoperative cortical surface displacement. The developed model relies on known material properties of brain tissue, and does not require further knowledge about intraoperative conditions. To provide an initial estimation of volumetric model accuracy, as well as determine the models sensitivity to the specified material parameters and surface displacements, a realistic brain phantom was developed. Phantom results indicate that the linear elastic model significantly reduced localization error due to brain shift, from >16 mm to under 5 mm, on average. In addition, though in vivo quantitative validation is necessary, preliminary application of this approach to images acquired during neocortical epilepsy cases confirms the feasibility of applying the developed model to in vivo data. PMID:22562728

  5. Physics-based shape matching for intraoperative image guidance

    SciTech Connect

    Suwelack, Stefan Röhl, Sebastian; Bodenstedt, Sebastian; Reichard, Daniel; Dillmann, Rüdiger; Speidel, Stefanie; Santos, Thiago dos; Maier-Hein, Lena; Wagner, Martin; Wünscher, Josephine; Kenngott, Hannes; Müller, Beat P.

    2014-11-01

    Purpose: Soft-tissue deformations can severely degrade the validity of preoperative planning data during computer assisted interventions. Intraoperative imaging such as stereo endoscopic, time-of-flight or, laser range scanner data can be used to compensate these movements. In this context, the intraoperative surface has to be matched to the preoperative model. The shape matching is especially challenging in the intraoperative setting due to noisy sensor data, only partially visible surfaces, ambiguous shape descriptors, and real-time requirements. Methods: A novel physics-based shape matching (PBSM) approach to register intraoperatively acquired surface meshes to preoperative planning data is proposed. The key idea of the method is to describe the nonrigid registration process as an electrostatic–elastic problem, where an elastic body (preoperative model) that is electrically charged slides into an oppositely charged rigid shape (intraoperative surface). It is shown that the corresponding energy functional can be efficiently solved using the finite element (FE) method. It is also demonstrated how PBSM can be combined with rigid registration schemes for robust nonrigid registration of arbitrarily aligned surfaces. Furthermore, it is shown how the approach can be combined with landmark based methods and outline its application to image guidance in laparoscopic interventions. Results: A profound analysis of the PBSM scheme based on in silico and phantom data is presented. Simulation studies on several liver models show that the approach is robust to the initial rigid registration and to parameter variations. The studies also reveal that the method achieves submillimeter registration accuracy (mean error between 0.32 and 0.46 mm). An unoptimized, single core implementation of the approach achieves near real-time performance (2 TPS, 7–19 s total registration time). It outperforms established methods in terms of speed and accuracy. Furthermore, it is shown that the method is able to accurately match partial surfaces. Finally, a phantom experiment demonstrates how the method can be combined with stereo endoscopic imaging to provide nonrigid registration during laparoscopic interventions. Conclusions: The PBSM approach for surface matching is fast, robust, and accurate. As the technique is based on a preoperative volumetric FE model, it naturally recovers the position of volumetric structures (e.g., tumors and vessels). It cannot only be used to recover soft-tissue deformations from intraoperative surface models but can also be combined with landmark data from volumetric imaging. In addition to applications in laparoscopic surgery, the method might prove useful in other areas that require soft-tissue registration from sparse intraoperative sensor data (e.g., radiation therapy)

  6. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    PubMed Central

    Lee, Su-Keon; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

    2016-01-01

    Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients. PMID:26929801

  7. Transcutaneous vs. intraoperative quantitative ultrasound for staging bovine hepatic steatosis.

    PubMed

    Weijers, Gert; Starke, Alexander; Thijssen, Johan M; Haudum, Alois; Wohlsein, Peter; Rehage, Juergen; de Korte, Chris L

    2012-08-01

    The aim of this study was to test the hypothesis that quantitative analysis of transcutaneous (Transc) ultrasound (US) images can predict the liver fat content with similar accuracy and precision as using intraoperative (Intraop) US. The second goal was to investigate if a tissue mimicking phantom (TMP) might be used as reference for automatic gain compensation (AGC) vs. depth instead of using the data of a set of cows without hepatic alterations. A study was performed in post partum dairy cows (N = 151), as an animal model of human nonalcoholic fatty liver disease (NAFLD), to test these hypotheses. Five Transc and five Intraop US liver images were acquired in each animal and a liver biopsy was taken. In liver tissue samples, triacylglycerol (TAG) content was measured by biochemical analysis and hepatic alterations, other than hepatic steatosis, were excluded by clinical examination. Several preprocessing steps were performed before the ultrasound tissue characteristics (UTC) parameters of B-mode images were derived. Stepwise multiple linear regression analysis was performed on a training set (N = 76) and the results were used on the test group (N = 75) to predict the TAG content in the liver. In all cases, the residual attenuation coefficient (ResAtt) was the only selected parameter. Receiver operating characteristics (ROC) analysis was applied to assess the performance and area under the curve (AUC) of predicting TAG and to compare the sensitivity and specificity of the methods used. High ROC values for AUC (95%), sensitivity (87%) and specificity (83%) for both Intraop and Transc applications with control group as well as with phantom-based AGC were obtained. Consequently, it can be concluded that Transc results are equivalent to Intraop results. Furthermore, equivalent ROC values, when using TMP AGC, indicates the potential use of TMP-based corrections instead of normal group-based corrections. The high predictive values indicate that noninvasive quantitative US has a great potential for staging and screening on hepatic steatosis in cows. PMID:22749338

  8. Does ultrasongraphy predict intraoperative findings at cholecystectomy? An institutional review

    PubMed Central

    Stogryn, Shannon; Metcalfe, Jennifer; Vergis, Ashley; Hardy, Krista

    2016-01-01

    Background Ultrasonography (US) is the mainstay of biliary tract imaging, but few recent studies have tested its ability to diagnose acute cholecystitis (AC). Our objective was to determine how well a US diagnosis of AC correlates with the intraoperative diagnosis. We hypothesize that US underestimates this diagnosis, potentially leading to unexpected findings in the operating room (OR). Methods This retrospective review included all patients admitted to the acute care surgical service of a tertiary hospital in 2011 with suspected biliary pathology who underwent US and subsequent cholecystectomy. We determined the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US using the intraoperative diagnosis as the gold standard. Further analysis identified which US findings were most predictive of an intraoperative diagnosis of AC. We used a recursive partitioning method with random forests to identify unique combinations of US findings that, together, are most predictive of AC. Results In total, 254 patients underwent US for biliary symptoms; 152 had AC diagnosed, and 143 (94%) of them underwent emergency surgery (median time to OR 23.03 hr). Ultrasonography predicted intraoperative findings with a sensitivity of 73.2%, specificity of 85.5% and PPV of 93.7%. The NPV (52.0%) was quite low. The US indicators most predictive of AC were a thick wall, a positive sonographic Murphy sign and cholelithiasis. Recursive partitioning demonstrated that a positive sonographic Murphy sign is highly predictive of intraoperative AC. Conclusion Ultrasonography is highly sensitive and specific for diagnosing AC. The poor NPV confirms our hypothesis that US can underestimate AC. PMID:26574703

  9. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients

    PubMed Central

    2014-01-01

    Background The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone. Methods Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041. Results In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative. Conclusions Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury. PMID:24942225

  10. Warm and Cool Cityscapes

    ERIC Educational Resources Information Center

    Jubelirer, Shelly

    2012-01-01

    Painting cityscapes is a great way to teach first-grade students about warm and cool colors. Before the painting begins, the author and her class have an in-depth discussion about big cities and what types of buildings or structures that might be seen in them. They talk about large apartment and condo buildings, skyscrapers, art museums,

  11. Warming Up to Communication.

    ERIC Educational Resources Information Center

    Garner, Lucia Caycedo; Rusch, Debbie

    Daily warm-up exercises are advocated as a means of bridging the gap between previously unrelated activities outside the classroom and immersion into the second language, relaxing the class, and establishing a mood for communication. Variety, careful preparation, assuring that the students understand the activity, feeling free to discontinue an

  12. Warm Springs Creek, Idaho

    USGS Multimedia Gallery

    Warm Springs Creek is a tributary of the Big Wood River in south-central Idaho. It is one of eight sites at which the USGS is conducting an ecological assessment during the summer of 2014. Study results will be published in 2015....

  13. Intraoperative /sup 99m/Tc bone imaging in the treatment of benign osteoblastic tumors

    SciTech Connect

    Sty, J.; Simons, G.

    1982-05-01

    Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success.

  14. Prevention of hypothermia by cutaneous warming with new electric blankets during abdominal surgery.

    PubMed

    Camus, Y; Delva, E; Bossard, A E; Chandon, M; Lienhart, A

    1997-12-01

    We have evaluated the efficacy of new electric warming blankets, which meet the requirements of the international standard for perioperative electrical and thermal safety, in preventing intraoperative hypothermia. We studied 18 patients undergoing abdominal surgery, allocated to one of two groups: in the control group, there was no prevention of intraoperative hypothermia (n = 8) and in the electric blanket group, two electric blankets covered the legs and upper body (n = 10). Anaesthesia duration was similar in the two groups (mean 201 (SEM 11) min), as was ambient temperature (20.5 (0.1) degrees C). Core temperature decreased during operation by 1.5 (0.1) degrees C in the control group, but only by 0.3 (0.2) degree C in the electric blanket group (P < 0.01). Five patients shivered in the control group compared with one in the electric blanket group (P < 0.05). We conclude that cutaneous warming with electric blankets was an effective means of preventing intraoperative hypothermia during prolonged abdominal surgery. PMID:9496215

  15. Plant community responses to experimental warming across the tundra biome.

    PubMed

    Walker, Marilyn D; Wahren, C Henrik; Hollister, Robert D; Henry, Greg H R; Ahlquist, Lorraine E; Alatalo, Juha M; Bret-Harte, M Syndonia; Calef, Monika P; Callaghan, Terry V; Carroll, Amy B; Epstein, Howard E; Jnsdttir, Ingibjrg S; Klein, Julia A; Magnsson, Borgthr; Molau, Ulf; Oberbauer, Steven F; Rewa, Steven P; Robinson, Clare H; Shaver, Gaius R; Suding, Katharine N; Thompson, Catharine C; Tolvanen, Anne; Totland, rjan; Turner, P Lee; Tweedie, Craig E; Webber, Patrick J; Wookey, Philip A

    2006-01-31

    Recent observations of changes in some tundra ecosystems appear to be responses to a warming climate. Several experimental studies have shown that tundra plants and ecosystems can respond strongly to environmental change, including warming; however, most studies were limited to a single location and were of short duration and based on a variety of experimental designs. In addition, comparisons among studies are difficult because a variety of techniques have been used to achieve experimental warming and different measurements have been used to assess responses. We used metaanalysis on plant community measurements from standardized warming experiments at 11 locations across the tundra biome involved in the International Tundra Experiment. The passive warming treatment increased plant-level air temperature by 1-3 degrees C, which is in the range of predicted and observed warming for tundra regions. Responses were rapid and detected in whole plant communities after only two growing seasons. Overall, warming increased height and cover of deciduous shrubs and graminoids, decreased cover of mosses and lichens, and decreased species diversity and evenness. These results predict that warming will cause a decline in biodiversity across a wide variety of tundra, at least in the short term. They also provide rigorous experimental evidence that recently observed increases in shrub cover in many tundra regions are in response to climate warming. These changes have important implications for processes and interactions within tundra ecosystems and between tundra and the atmosphere. PMID:16428292

  16. Intraoperative Cortical Surface Characterization Using Laser Range Scanning: Preliminary Results

    PubMed Central

    Sinha, Tuhin K.; Miga, Michael I.; Cash, David M.; Weil, Robert J.

    2013-01-01

    OBJECTIVE To present a novel methodology that uses a laser range scanner (LRS) capable of generating textured (intensity-encoded) surface descriptions of the brain surface for use with image-to-patient registration and improved cortical feature recognition during intraoperative neurosurgical navigation. METHODS An LRS device was used to acquire cortical surface descriptions of eight patients undergoing neurosurgery for a variety of clinical presentations. Textured surface descriptions were generated from these intraoperative acquisitions for each patient. Corresponding textured surfaces were also generated from each patients preoperative magnetic resonance tomograms. Each textured surface pair (LRS and magnetic resonance tomogram) was registered using only cortical surface information. Novel visualization of the combined surfaces allowed for registration assessment based on quantitative cortical feature alignment. RESULTS Successful textured LRS surface acquisition and generation was performed on all eight patients. The data acquired by the LRS accurately presented the intraoperative surface of the cortex and the associated features within the surgical field-of-view. Registration results are presented as overlays of the intraoperative data with respect to the preoperative data and quantified by comparing mean distances between cortical features on the magnetic resonance tomogram and LRS surfaces after registration. The overlays demonstrated that accurate registration can be provided between the preoperative and intraoperative data and emphasized a potential enhancement to cortical feature recognition within the operating room environment. Using the best registration result from each clinical case, the mean feature alignment error is 1.7 0.8 mm over all cases. CONCLUSION This study demonstrates clinical deployment of an LRS capable of generating textured surfaces of the surgical field of view. Data from the LRS was registered accurately to the corresponding preoperative data. Visual inspection of the registration results was provided by overlays that put the intraoperative data within the perspective of the whole brains surface. These visuals can be used to more readily assess the fidelity of image-to-patient registration, as well as to enhance recognition of cortical features for assistance in comparing the neurotopography between magnetic resonance image volume and physical patient. In addition, the feature-rich data presented here provides considerable motivation for using LRS scanning to measure deformation during surgery. PMID:17041506

  17. Intraoperative Neuromonitoring for Superior Semicircular Canal Dehiscence and Hearing Outcomes

    PubMed Central

    Wenzel, Angela; Ward, Bryan K.; Ritzl, Eva K.; Gutierrez-Hernandez, Sergio; Della Santina, Charles C.; Minor, Lloyd B.; Carey, John P.

    2016-01-01

    Background Recent findings in patients with superior semicircular canal dehiscence (SCD) have shown an elevated ratio of summating potential (SP) to action potential (AP), as measured by electrocochleography (ECochG). Changes in this ratio can be seen during surgical intervention. The objective of this study was to evaluate the utility of intraoperative ECochG and auditory brainstem response (ABR) as predictive tools for postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for SCD syndrome (SCDS). Methods This was a review of 34 cases (33 patients) in which reproducible intraoperative ECochG recordings were obtained during surgery. Diagnosis of SCDS was based on history, physical examination, vestibular function testing, and computed tomography imaging. Simultaneous intraoperative ECochG and ABR were performed. Pure-tone audiometry was performed preoperatively and at least 1 month postoperatively, and air-bone gap (ABG) was calculated. Changes in SP/AP ratio, SP amplitude, and ABR wave I latency were compared with changes in pure-tone average and ABG before and after surgery. Results Median SP/AP ratio of affected ears was 0.62 (interquartile range [IQR], 0.45–0.74) and decreased immediately after surgical plugging of the affected canal to 0.42 (IQR, 0.29–0.52; p < 0.01). Contralateral SP/AP ratio before plugging was 0.33 (IQR, 0.25–0.42) and remained unchanged at the conclusion of surgery (0.30; IQR, 0.25–0.35; p = 0.32). Intraoperative changes in ABR wave I latency and SP amplitude did not predict changes in pure-tone average or ABG after surgery (p > 0.05). Conclusion This study confirmed the presence of an elevated SP/AP ratio in ears with SCDS. The SP/AP ratio commonly decreases during plugging. However, an intraoperative decrease in SP/AP does not appear to be sensitive to either the beneficial decrease in ABGs or the mild high-frequency sensory loss that can occur in patients undergoing surgical plugging of the superior semicircular canal. Future work will determine the value of intraoperative ECochG in predicting changes in vestibular function. PMID:25333320

  18. Climate science: Pacemakers of warming

    NASA Astrophysics Data System (ADS)

    Brnnimann, Stefan

    2015-02-01

    In the first decades of the twentieth century, the Earth warmed rapidly. A coral-based climate proxy record of westerly winds over the equatorial Pacific suggests that wind strength and warming rate were linked, as they are today.

  19. Intraoperative blood loss in orthotopic liver transplantation: The predictive factors

    PubMed Central

    Pandey, Chandra Kant; Singh, Anshuman; Kajal, Kamal; Dhankhar, Mandeep; Tandon, Manish; Pandey, Vijay Kant; Karna, Sunaina Tejpal

    2015-01-01

    Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding. Excessive blood loss and transfusion during orthotopic liver transplant are correlated with diminished graft survival and increased septic episodes and prolonged ICU stay. With improvements in surgical skills, anesthetic technique, graft preservation, use of intraoperative cell savers and overall perioperative management, orthotopic liver transplant is now associated with decreased intra operative blood losses. The purpose of this review is to discuss the risk factors predictive of increased intra operative bleeding in patients undergoing orthotopic liver transplant. PMID:26131330

  20. Transsphenoidal pituitary resection with intraoperative MR guidance: preliminary results

    NASA Astrophysics Data System (ADS)

    Pergolizzi, Richard S., Jr.; Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Black, Peter M.; Martin, Claudia; Jolesz, Ferenc A.

    1999-05-01

    The use of intraoperative MR image guidance has the potential to improve the precision, extent and safety of transsphenoidal pituitary resections. At Brigham and Women's Hospital, an open-bore configuration 0.5T MR system (SIGNA SP, GE Medical Systems, Milwaukee, WI) has been used to provide image guidance for nine transsphenoidal pituitary adenoma resections. The intraoperative MR system allowed the radiologist to direct the surgeon toward the sella turcica successfully while avoiding the cavernous sinus, optic chiasm and other sensitive structures. Imaging performed during the surgery monitored the extent of resection and allowed for removal of tumor beyond the surgeon's view in five cases. Dynamic MR imaging was used to distinguish residual tumor from normal gland and postoperative changes permitting more precise tumor localization. A heme-sensitive long TE gradient echo sequence was used to evaluate for the presence of hemorrhagic debris. All patients tolerated the procedure well without significant complications.

  1. Segmentation-Based Registration of Organs in Intraoperative Video Sequences

    SciTech Connect

    Goddard Jr, James Samuel; Gee, Timothy Felix; Wang, Hengliang; Gorbach, Alexander M

    2006-01-01

    Intraoperative optical imaging of exposed organs in visible, near-infrared, and infrared (IR) wavelengths in the body has the potential to be use-ful for real-time assessment of organ viability and image guidance during surgical intervention. However, the motion of the internal organs presents significant challenges for fast analysis of recorded 2D video sequences. The movement observed during surgery, due to respiration, cardiac motion, blood flow, and mechanical shift accompanying the surgical intervention, causes organ reflection in the image sequence, making optical measurements for further analysis challenging. Correcting alignment is difficult in that the motion is not uniform over the image. This paper describes a Canny edge-based method for segmentation of the specific organ or region under study, along with a moment-based registration method for the segmented region. Experimental results are provided for a set of intraoperative IR image sequences.

  2. Intraoperative Functional Mapping and Monitoring during Glioma Surgery

    PubMed Central

    SAITO, Taiichi; MURAGAKI, Yoshihiro; MARUYAMA, Takashi; TAMURA, Manabu; NITTA, Masayuki; OKADA, Yoshikazu

    2015-01-01

    Glioma surgery represents a significant advance with respect to improving resection rates using new surgical techniques, including intraoperative functional mapping, monitoring, and imaging. Functional mapping under awake craniotomy can be used to detect individual eloquent tissues of speech and/or motor functions in order to prevent unexpected deficits and promote extensive resection. In addition, monitoring the patients neurological findings during resection is also very useful for maximizing the removal rate and minimizing deficits by alarming that the touched area is close to eloquent regions and fibers. Assessing several types of evoked potentials, including motor evoked potentials (MEPs), sensory evoked potentials (SEPs) and visual evoked potentials (VEPs), is also helpful for performing surgical monitoring in patients under general anesthesia (GA). We herein review the utility of intraoperative mapping and monitoring the assessment of neurological findings, with a particular focus on speech and the motor function, in patients undergoing glioma surgery. PMID:25744346

  3. Intraoperative tumor lysis syndrome in a child with Wilms' tumor

    PubMed Central

    Dhar, Mridul; Prakash, Shashi; Pandey, Vaibhav; Pai, Vishal Krishna

    2016-01-01

    Tumor lysis syndrome in an onco-metabolic emergency resulting from massive lysis of rapidly proliferating malignant cells seen commonly in patients with hematological malignancies such as acute lymphocytic leukemia and Burkitt's lymphoma and is quite rare in solid tumors. Spontaneous development of tumor lysis has been described among other trigger factors such as corticosteroid therapy, anesthesia, tumor manipulation during surgery and pyrexia. We describe such a case in a 5-year-old boy posted for excision and staging of a massive Wilms' tumor who developed a hyperkalemic cardiac arrest during the procedure and its subsequent intraoperative and postoperative management. Intraoperative cardiac arrest is a stressful situation for both the anesthesiologist and the surgeon, more so when it involves a child. The aim of this report is to make the anesthesiologist aware of the possibility and occurrence of such a phenomenon in children and be adequately prepared for such an emergency.

  4. Toward Intraoperative Image-Guided Transoral Robotic Surgery

    PubMed Central

    Liu, Wen P.; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M.; Siewerdsen, Jeffrey H.; Richmon, Jeremy; Taylor, Russell H.

    2014-01-01

    This paper presents the development and evaluation of video augmentation on the stereoscopic da Vinci S system with intraoperative image guidance for base of tongue tumor resection in transoral robotic surgery (TORS). Proposed workflow for image-guided TORS begins by identifying and segmenting critical oropharyngeal structures (e.g., the tumor and adjacent arteries and nerves) from preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging. These preoperative planned data can be deformably registered to the intraoperative endoscopic view using mobile C-arm cone-beam computed tomography (CBCT) [1, 2]. Augmentation of TORS endoscopic video defining surgical targets and critical structures has the potential to improve navigation, spatial orientation, and confidence in tumor resection. Experiments in animal specimens achieved statistically significant improvement in target localization error when comparing the proposed image guidance system to simulated current practice. PMID:25525474

  5. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  6. Does the Surgical Apgar Score Measure Intraoperative Performance?

    PubMed Central

    Regenbogen, Scott E.; Lancaster, R. Todd; Lipsitz, Stuart R.; Greenberg, Caprice C.; Hutter, Matthew M.; Gawande, Atul A.

    2008-01-01

    Objective To evaluate whether Surgical Apgar Scores measure the relationship between intraoperative care and surgical outcomes. Summary Background Data With preoperative risk-adjustment now well-developed, the role of intraoperative performance in surgical outcomes may be considered. We previously derived and validated a ten-point Surgical Apgar Scorebased on intraoperative blood loss, heart rate, and blood pressurethat effectively predicts major postoperative complications within 30 days of general and vascular surgery. This study evaluates whether the predictive value of this score comes solely from patients preoperative risk, or also measures care in the operating room. Methods Among a systematic sample of 4,119 general and vascular surgery patients at a major academic hospital, we constructed a detailed risk-prediction model including 27 patient-comorbidity and procedure-complexity variables, and computed patients propensity to suffer a major postoperative complication. We evaluated the prognostic value of patients Surgical Apgar Scores before and after adjustment for this preoperative risk. Results After risk-adjustment, the Surgical Apgar Score remained strongly correlated with postoperative outcomes (p<0.0001). Odds of major complications among average-scoring patients (scores 78) were equivalent to preoperative predictions (likelihood ratio (LR) 1.05, 95%CI 0.781.41), significantly decreased for those who achieved the best scores of 910 (LR 0.52, 95%CI 0.350.78), and were significantly poorer for those with low scoresLRs 1.60 (1.122.28) for scores 56, and 2.80 (1.505.21) for scores 04. Conclusions Even after accounting for fixed preoperative riskdue to patients acute condition, comorbidities and/or operative complexitythe Surgical Apgar Score appears to detect differences in intraoperative management that reduce odds of major complications by half, or increase them by nearly three-fold. PMID:18650644

  7. Macular Surgery Using Intraoperative Spectral Domain Optical Coherence Tomography

    PubMed Central

    Riazi-Esfahani, Mohammad; Khademi, Mohammad Reza; Mazloumi, Mehdi; Khodabandeh, Alireza; Riazi-Esfahani, Hamid

    2015-01-01

    Purpose: To report the use of intraoperative spectral domain optical coherence tomography (SD-OCT) for detecting anatomical changes during macular surgery. Methods: In a consecutive case series, 32 eyes of 32 patients undergoing concurrent pars plana vitrectomy and intraoperative SD-OCT for macular hole (MH), epiretinal membrane (ERM) and vitreomacular traction (VMT) were enrolled. Intraoperative changes in retinal thickness and dimensions of the macular hole were measured in patients with ERM and VMT following surgical manipulation using a hand-held SD-OCT device (iVue, Optovue Inc., Fremont, CA, USA). Results: SD-OCT images of sixteen eyes with macular hole were subjected to quantitative and qualitative analysis. All MH dimensions remained stable during consecutive stages of surgery except for MH apex diameter, which showed a significant decrease after internal limiting membrane (ILM) peeling (P=0.025). Quantitative analysis of ten patients with ERM showed a significant decrease in retinal thickness after membrane removal (P=0.018) which did not remain significant until the end of the procedure (P=0.8). In three cases, subretinal fluid was formed after ILM peeling. Quantitative analysis of five patients with VMT showed a decrease in retinal thickness during consecutive steps of the surgery, although these changes were not significant. In two cases, subretinal fluid was formed after ILM peeling. Conclusion: Intraoperative SD-OCT is a useful imaging technique which provides vitreoretinal surgeons with rapid awareness of changes in macular anatomy during surgery and may therefore result in better anatomical and visual outcomes.

  8. Misleading FLAIR imaging pattern after glioma surgery with intraoperative MRI.

    PubMed

    Lescher, Stephanie; Jurcoane, Alina; Schniewindt, Sonja; Senft, Christian; Hattingen, Elke

    2016-01-01

    Intraoperative MRI (iMRI) allows a more detailed appreciation of the extent of resection than does conventional neurosurgery and results in longer overall survival in patients with malignant glioma. However, it is unknown whether the intraoperative application of contrast agent influences the early postsurgical MRI. The preceding iMRI could alter the signals of MR sequences in the early postsurgical MRI, especially in sequences influenced by T1 contrast. Hereby, we investigate such iMRI-induced influences on the fluid-attenuated inversion recovery (FLAIR) sequence. We retrospectively analyzed postsurgical T2w, T1w, and FLAIR images by visual inspection and by signal measurements in 46 patients with malignant gliomas after tumor resection. Of these, n?=?25 patients were operated with conventional microsurgery, and n?=?21 patients were operated with contrast-enhanced iMRI-guided microsurgery. We measured signal intensity in the resection cavity, in the cerebrospinal fluid (CSF) of the ventricles, and in the normal brain tissue contralateral to the tumor-bearing hemisphere on axial FLAIR images and T1-weighted and T2-weighted images. In 18 patients, the FLAIR sequence revealed hyperintense signal changes of the CSF in the subarachnoid or ventricular spaces. Seventeen of these 18 patients had received intraoperative MRI. In both FLAIR and T1-weighted images, the signal of the CSF in the ventricles was significantly higher in patients with iMRI than in patients without iMRI. The intraoperative application of contrast agent that is used for iMRI significantly influences postsurgical MRI within the first 72h. We found hyperintense signal changes of the CSF in the FLAIR sequence in the subarachnoid and intraventricular spaces mimicking subarachnoid hemorrhage. The findings may result in a misdiagnosis of subarachnoid hemorrhage (SAH) in these patients. PMID:26201972

  9. Recurrent intraoperative silent ST depression responding to phenylephrine

    PubMed Central

    Singh, PM; Shah, Dipal; Trikha, Anjan

    2012-01-01

    Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae. PMID:23225936

  10. A tool for intraoperative visualization of registration results

    NASA Astrophysics Data System (ADS)

    King, Franklin; Lasso, Andras; Pinter, Csaba; Fichtinger, Gabor

    2014-03-01

    PURPOSE: Validation of image registration algorithms is frequently accomplished by the visual inspection of the resulting linear or deformable transformation due to the lack of ground truth information. Visualization of transformations produced by image registration algorithms during image-guided interventions allows for a clinician to evaluate the accuracy of the result transformation. Software packages that perform the visualization of transformations exist, but are not part of a clinically usable software application. We present a tool that visualizes both linear and deformable transformations and is integrated in an open-source software application framework suited for intraoperative use and general evaluation of registration algorithms. METHODS: A choice of six different modes are available for visualization of a transform. Glyph visualization mode uses oriented and scaled glyphs, such as arrows, to represent the displacement field in 3D whereas glyph slice visualization mode creates arrows that can be seen as a 2D vector field. Grid visualization mode creates deformed grids shown in 3D whereas grid slice visualization mode creates a series of 2D grids. Block visualization mode creates a deformed bounding box of the warped volume. Finally, contour visualization mode creates isosurfaces and isolines that visualize the magnitude of displacement across a volume. The application 3D Slicer was chosen as the platform for the transform visualizer tool. 3D Slicer is a comprehensive open-source application framework developed for medical image computing and used for intra-operative registration. RESULTS: The transform visualizer tool fulfilled the requirements for quick evaluation of intraoperative image registrations. Visualizations were generated in 3D Slicer with little computation time on realistic datasets. It is freely available as an extension for 3D Slicer. CONCLUSION: A tool for the visualization of displacement fields was created and integrated into 3D Slicer, facilitating the validation of image registration algorithms within a comprehensive application framework suited for intraoperative use.

  11. Modern preoperative and intraoperative management of hereditary angioedema.

    PubMed

    Szema, Anthony M; Paz, George; Merriam, Louis; Stellaccio, Francis; Jen, James

    2009-01-01

    Hereditary angioedema (HAE), deficiency of C1 esterase inhibitor, poses a risk of airway compromise during trauma, including surgery, due to activation of the complement cascade. Classical surgical management includes emergent/slash tracheostomy and cricothyrotomy, associated with high complication rates. We provide here an evidence-based review of available medical literature to construct guidelines for managing patients with HAE pre- and intra-operatively. We also describe our experience with a patient for whom we cared using these guidelines. Our objective was to explain new preventive measures to prevent airway compromise in HAE and their level of evidence for averting potential therapeutic misadventure. We analyzed PUBMED literature regarding airway management and etiology of angioedema and its prevention, followed by application of guidelines based on these data in a patient with HAE undergoing inguinal hernia repair. An analysis of contemporary literature yielded key points: (1) using a Cook Exchange catheter to facilitate re-intubation, (2) measuring cuff leak pressure to verify whether airway pressure had increased during surgery, (3) visualizing the airway directly using a fiberoptic laryngoscope connected to a digital flat-screen monitor for real-time assessment, (4) following conventional dictum to double stanozolol dosages 2 weeks before admission, (5) administering fresh frozen plasma pre- and intraoperatively, and (6) preparing recombinant C1 esterase inhibitor for instantaneous intraoperative use; and using FDA-approved human-derived C1-esterase inhibitor prophylactically. Biotechnology in the form of novel but currently available and in-practice medical devices, as well as new therapeutic agents, have expanded the armamentarium for safely managing patients with HAE pre- and intraoperatively. PMID:19368763

  12. Intraoperative MRI in pediatric neurosurgeryan update

    PubMed Central

    2014-01-01

    Since the advent of intraoperative magnetic resonance imaging (ioMRI) at the Brigham and Womens Hospital in 1994, ioMRI has spread widely and in many different forms. This article traces the developmental history of ioMRI and reviews the relevant literature regarding its effectiveness in pediatric neurosurgery. While of considerable expense, current trends in healthcare essentially mandate the use of ioMRI in a growing number of cases.

  13. Pediatric intraoperative floppy iris syndrome associated with persistent pupillary membrane.

    PubMed

    Motley, W Walker; Melson, Andrew T

    2011-04-01

    Intraoperative floppy iris syndrome (IFIS) occurring during cataract surgery in adults has been widely reported in association with tamsulosin and other ?-1(a) adrenergic antagonists; however, only one case of pediatric IFIS has been previously reported and was associated with congenital cataract. We report a case of a 1-month old girl with IFIS associated with bilateral persistent pupillary membranes without cataracts and the use of preoperative topical phenylephrine and pilocarpine for IFIS prophylaxis. PMID:21463957

  14. Necrotizing Fasciitis: A Life-threatening Complication of Intraoperative Electromyography

    PubMed Central

    Shoakazemi, Alireza; Tubbs, R. Shane; Wingerson, Mary; Ajayi, Olaide; Zwillman, Michael E; Gottlieb, Jourdan; Hanscom, David

    2016-01-01

    Intraoperative neurophysiological monitoring is a commonly used practice during spine surgery. Complications of electromyography (EMG) needle electrode placement are very uncommon. We present a patient who was infected with necrotizing fasciitis in her left thigh due to an EMG needle electrode during a two-stage complex spine procedure. This case demonstrates that providers should continue to meticulously adhere to protocol when inserting and removing EMG needles, but also be cognizant during postoperative observation of the possibility of infection caused by EMG needles.

  15. Intraoperative augmented reality for minimally invasive liver interventions

    NASA Astrophysics Data System (ADS)

    Scheuering, Michael; Schenk, Andrea; Schneider, Armin; Preim, Bernhard; Greiner, Guenther

    2003-05-01

    Minimally invasive liver interventions demand a lot of experience due to the limited access to the field of operation. In particular, the correct placement of the trocar and the navigation within the patient's body are hampered. In this work, we present an intraoperative augmented reality system (IARS) that directly projects preoperatively planned information and structures extracted from CT data, onto the real laparoscopic video images. Our system consists of a preoperative planning tool for liver surgery and an intraoperative real time visualization component. The planning software takes into account the individual anatomy of the intrahepatic vessels and determines the vascular territories. Methods for fast segmentation of the liver parenchyma, of the intrahepatic vessels and of liver lesions are provided. In addition, very efficient algorithms for skeletonization and vascular analysis allowing the approximation of patient-individual liver vascular territories are included. The intraoperative visualization is based on a standard graphics adapter for hardware accelerated high performance direct volume rendering. The preoperative CT data is rigidly registered to the patient position by the use of fiducials that are attached to the patient's body, and anatomical landmarks in combination with an electro-magnetic navigation system. Our system was evaluated in vivo during a minimally invasive intervention simulation in a swine under anesthesia.

  16. Intraoperative wake-up test in neonatal neurosurgery.

    PubMed

    Govindarajan, Ramasamy; Babalola, Oluwaseun; Gad-El-Kareem, Magdy; Kodali, Nagendra S; Aronson, Judith; Abadir, Adel

    2006-04-01

    Intraoperative wake-up test (WPT) still remains the gold standard to monitor anterior spinal cord function during spinal surgery. However, the test requires patient cooperation and hence difficult to perform in very young children or mentally challenged. In this report, we describe a WPT in a newborn during surgical repair of a large myelomeningocele. We relied on mivacurium for intubation and the relaxant effect was allowed to wear-off to permit the use of intraoperative nerve stimulator. We used desflurane and propofol infusion for rapid titration of the anesthetic depth and BIS monitor to 'gauge' the 'wakefulness' of the child during the WPT. We employed lidocaine infusion to improve tolerance to the tracheal tube and to bestow beneficial effect on intracranial pressure during surgery and the WPT. The results of the WPT were judged to be satisfactory after confirming flexion and extension of the lower extremities at the hip and knee level, correlating it with the BIS values, and comparing it with the preoperative status. Frequently associated prematurity, higher possibility of remaining intubated in the immediate postoperative period and any new onset neurologic deficit not becoming apparent until after extubation makes intraoperative neuromonitoring relevant in this age group. Our methodology of management has permitted us to perform a delicate test safely and will allow us to repeat the WPT if needed during neonatal neurosurgery. PMID:16618301

  17. Intraoperative echocardiographic detection of regurgitant jets after valve replacement

    NASA Technical Reports Server (NTRS)

    Morehead, A. J.; Firstenberg, M. S.; Shiota, T.; Qin, J.; Armstrong, G.; Cosgrove, D. M. 3rd; Thomas, J. D.

    2000-01-01

    BACKGROUND: Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. METHODS: Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. RESULTS: Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. CONCLUSIONS: Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.

  18. Noninvasive intraoperative angiography for reconstruction of head and neck defects.

    PubMed

    Daram, Shiva P; Sacks, Justin M; Kupferman, Michael E

    2015-01-01

    Reconstruction of head and neck defects after cancer resection involves the use of local, pedicled musculocutaneous, and free flaps. Flap failure is often caused by vascular insufficiency, and it is associated with the presence of cardiovascular or peripheral vascular disease, a history of smoking, and previous radiation and/or surgery. Failure rates may be reduced by the use of indocyanine green near-infrared fluorescence laser angiography, which detects perfusion deficits intraoperatively. Although this technology has been validated in other fields, there is limited experience in the head and neck region. We present 3 cases in which different head and neck flaps were used along with this technology in patients at high risk for flap failure. All flaps were successfully implanted without perioperative or long-term complications. The increasing complexity, age, and comorbidities of the head and neck cancer population pose significant reconstructive challenges. This report demonstrates the feasibility of employing intraoperative angiography for local, pedicled, and free flaps. This noninvasive tool optimizes intraoperative planning and assesses viability, potentially lowering failure rates in high-risk patients. Identification of patients who most benefit from this technology warrants further investigation. PMID:26535829

  19. [Clinical research of intraoperative floppy iris syndrome during operation].

    PubMed

    Sun, Bing; Sun, Si-qin; Wen, Yue-chun; Liao, Rong-feng

    2008-12-01

    Intraoperative floppy iris syndrome (IFIS) has been recently identified as a new small pupil syndrome during phacoemulsification. This syndrome is characterized by three intraoperative features: a flaccid iris stroma that undulates and bellows in response to intraocular fluid currents; a propensity for the floppy iris stroma to prolapse toward the tip of phacoemulsification and side-port incisions despite proper wound construction; and progressive intraoperative pupil constriction despite standard preventive preoperative pharmacologic measures designed to prevent this. It is now mostly considered that IFIS is associated with the use of tamsolusin, a highly selective alpha-1A receptor antagonist for the treatment of benign prostatic hypertrophy. It is recommended that a careful history of the use of alpha-1 blocking agents be taken before cataract surgery to anticipate the occurrence of IFIS. A combination of strategies could decrease the complications of IFIS. These procedures include preoperative use of atropine, intracameral injection of dilute phenylephrine or epinephrine, the use of super-cohesive ophthalmic viscosurgical devices, lower phacoemulsification vacuum and aspiration settings and various iris hooks or pupil dilators. PMID:19187677

  20. A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

    PubMed Central

    Jin, Seung-Hyun; Kim, Jeong Eun; Choi, Young Doo

    2014-01-01

    Objective To propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study. Methods The proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included. Results We found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery. Conclusion Our results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring. PMID:25628803

  1. Noise suppressed, multifocus image fusion for enhanced intraoperative navigation

    PubMed Central

    Feruglio, Paolo Fumene; Vinegoni, Claudio; Fexon, Lyuba; Thurber, Greg; Sbarbati, Andrea; Weissleder, Ralph

    2013-01-01

    Current intraoperative imaging systems are typically not able to provide sharp images over entire large areas or entire organs. Distinct structures such as tissue margins or groups of malignant cells are therefore often difficult to detect, especially under low signal-to-noise-ratio conditions. In this report, we introduce a noise suppressed multifocus image fusion algorithm, that provides detailed reconstructions even when images are acquired under sub-optimal conditions, such is the case for real time fluorescence intraoperative surgery. The algorithm makes use of the Anscombe transform combined with a multi-level stationary wavelet transform with individual threshold-based shrinkage. While the imaging system is integrated with a respiratory monitor triggering system, it can be easily adapted to any commercial imaging system. The developed algorithm is made available as a plugin for Osirix. Intraoperative detection of small malignant fluorescent cells using the proposed noise suppressed multifocus image fusion system. Red/Yellow circles indicate small groups of malignant cells. PMID:22887724

  2. Global Warming And Meltwater

    NASA Astrophysics Data System (ADS)

    Bratu, S.

    2012-04-01

    In order to find new approaches and new ideas for my students to appreciate the importance of science in their daily life, I proposed a theme for them to debate. They had to search for global warming information and illustrations in the media, and discuss the articles they found in the classroom. This task inspired them to search for new information about this important and timely theme in science. I informed my students that all the best information about global warming and meltwater they found would be used in a poster that would help us to update the knowledge base of the Physics laboratory. I guided them to choose the most eloquent images and significant information. Searching and working to create this poster, the students arrived to better appreciate the importance of science in their daily life and to critically evaluate scientific information transmitted via the media. In the poster we created, one can find images, photos and diagrams and some interesting information: Global warming refers to the rising average temperature of the Earth's atmosphere and oceans and its projected evolution. In the last 100 years, the Earth's average surface temperature increased by about 0.8 °C with about two thirds of the increase occurring over just the last three decades. Warming of the climate system is unequivocal, and scientists are more than 90% certain most of it is caused by increasing concentrations of greenhouse gases produced by human activities such as deforestation and burning fossil fuel. They indicate that during the 21st century the global surface temperature is likely to rise a further 1.1 to 2.9 °C for the lowest emissions scenario and 2.4 to 6.4 °C for the highest predictions. An increase in global temperature will cause sea levels to rise and will change the amount and pattern of precipitation, and potentially result in expansion of subtropical deserts. Warming is expected to be strongest in the Arctic and would be associated with continuing decrease of glaciers, permafrost and sea ice. Other likely effects of the warming include more frequent occurrences of extreme weather events including heat waves, droughts and heavy rainfall events, species extinctions due to shifting temperature regimes, and changes in agricultural yields. Meltwater is the water released by the melting of snow or ice, including glacial ice and ice shelves in the oceans. Meltwater is often found in the ablation zone of glaciers, where the rate of snow cover is reduced. In a report published in June 2007, the United Nations Environment Program estimated that global warming could lead to 40% of the world's population being affected by the loss of glaciers, snow and the associated meltwater in Asia. This is one of many activities of the physics laboratory that the students of our high school are involved in.

  3. Global warming - A reduced threat

    SciTech Connect

    Michaels, P.J.; Stooksbury, D.E. )

    1992-10-01

    Issues associated with global warming are analyzed focusing on global and hemispheric temperature histories and trace gas concentrations; artificial warming from urban heat islands; high-latitude and diurnal temperatures; recent climate models; direct effects on vegetation of an increase in carbon dioxide; and compensatory cooling from other industrial products. Data obtained indicate that anthropogenerated sulfate emissions are mitigating some of the warming, and that increased cloudiness as a result of these emissions will further enhance night, rather than day, warming. It is noted that the sulfate emissions are not sufficient to explain all of the night warming. The sensitivity of climate to anthropogenerated aerosols, and the general lack of previously predicted warming, could drastically alter the debate on global warming in favor of less expensive policies. 61 refs.

  4. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

    PubMed Central

    Turalba, Angela V; Pasquale, Louis R

    2014-01-01

    Objective To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Design Retrospective comparative case series. Participants Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA. Methods A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery. Main outcome measures Primary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Results Five out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.24.6 in TA cases versus [vs] 14.75.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.81.3 in TA cases vs 1.61.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group. Conclusions Subtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery. PMID:25050061

  5. Global warning, global warming

    SciTech Connect

    Benarde, M.A. )

    1992-01-01

    This book provides insights into the formidable array of issues which, in a warmer world, could impinge upon every facet of readers lives. It examines climatic change and long-term implications of global warming for the ecosystem. Topics include the ozone layer and how it works; the greenhouse effect; the dangers of imbalance and its effects on human and animal life; disruptions to the basic ecology of the planet; and the real scientific evidence for and against aberrant climatic shifts. The author also examines workable social and political programs and changes that must be instituted to avoid ecological disaster.

  6. Natural warm inflation

    SciTech Connect

    Visinelli, Luca

    2011-09-01

    We derive the requirements that a generic axion-like field has to satisfy in order to play the role of the inflaton field in the warm inflation scenario. Compared to the parameter space in ordinary Natural Inflation models, we find that the parameter space in our model is enlarged. In particular, we avoid the problem of having an axion decay constant f that relates to the Planck scale, which is instead present in the ordinary Natural Inflation models; in fact, our model can easily accommodate values of the axion decay constant that lie well below the Planck scale.

  7. Prospective evaluation of the utility of intraoperative confocal laser endomicroscopy in patients with brain neoplasms using fluorescein sodium: experience with 74 cases.

    PubMed

    Martirosyan, Nikolay L; Eschbacher, Jennifer M; Kalani, M Yashar S; Turner, Jay D; Belykh, Evgenii; Spetzler, Robert F; Nakaji, Peter; Preul, Mark C

    2016-03-01

    OBJECTIVE This study evaluated the utility, specificity, and sensitivity of intraoperative confocal laser endomicroscopy (CLE) to provide diagnostic information during resection of human brain tumors. METHODS CLE imaging was used in the resection of intracranial neoplasms in 74 consecutive patients (31 male; mean age 47.5 years; sequential 10-month study period). Intraoperative in vivo and ex vivo CLE was performed after intravenous injection of fluorescein sodium (FNa). Tissue samples from CLE imaging-matched areas were acquired for comparison with routine histological analysis (frozen and permanent sections). CLE images were classified as diagnostic or nondiagnostic. The specificities and sensitivities of CLE and frozen sections for gliomas and meningiomas were calculated using permanent histological sections as the standard. RESULTS CLE images were obtained for each patient. The mean duration of intraoperative CLE system use was 15.7 minutes (range 3-73 minutes). A total of 20,734 CLE images were correlated with 267 biopsy specimens (mean number of images/biopsy location, in vivo 84, ex vivo 70). CLE images were diagnostic for 45.98% in vivo and 52.97% ex vivo specimens. After initiation of CLE, an average of 14 in vivo images and 7 ex vivo images were acquired before identification of a first diagnostic image. CLE specificity and sensitivity were, respectively, 94% and 91% for gliomas and 93% and 97% for meningiomas. CONCLUSIONS CLE with FNa provided intraoperative histological information during brain tumor removal. Specificities and sensitivities of CLE for gliomas and meningiomas were comparable to those for frozen sections. These data suggest that CLE could allow the interactive identification of tumor areas, substantially improving intraoperative decisions during the resection of brain tumors. PMID:26926051

  8. Intraoperative Assessment and Quantification of Coronary Artery Graft Patency Performed on or off Cardiopulmonary Bypass

    PubMed Central

    Rauch, Eric D.; Leach, Christopher; Barnes, Terry; Driscoll, Kurt; Strutz, Kurt; Holt, David W.

    2007-01-01

    Abstract: Within the last 10 years, the incorporation of off-pump coronary artery bypass grafting (OPCAB) into many surgical practices has grown. OPCAB requires the surgeon to operate on a beating heart, and it is generally accepted that OPCAB procedures are more technically demanding. Concerns of possible incomplete revascularizations and decreased graft patency have been noted in the literature. The objective of this study was to evaluate and compare on-pump and off-pump intraoperative coronary artery bypass graft (CABG) flow parameters. Intraoperative flow studies conducted with the Butterfly (Medi-Stim Norge AS, Oslo, Norway) flow meter were analyzed retrospectively on 74 patients. Comparisons were completed between patient groups having had their revascularizations performed on or off cardiopulmonary bypass. Our study revealed significant differences in the mean flow rate through saphenous vein grafts (SVG) to the obtuse marginal artery (OM; p = .014), to the diagonal artery (Diag; p = .003), to the right coronary artery (RCA; p = .001), and to the posterior descending artery (PDA; p = .001). Total blood product use showed significantly increased use of both platelets (PLTs) and cryoprecipitate (Cryo) in the on-pump group (p = .027 and .012, respectively). No differences were found for transfusions of red blood cells (RBCs) or fresh frozen plasma (FFP). Additional findings showed a significantly decreased median length of stay (LOS) for the off-pump group. The on-pump patients had a median hospital stay of 7 days (range, 424 days), whereas the off-pump patients had a median stay of 6 days (range, 322 days; p = .049). Although we were able to show some significance in the mean flow data supporting increased graft flow with the on-pump technique, we were not able to show an overall increase in all recorded flow characteristics to support one method over another. PMID:17672187

  9. Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy

    PubMed Central

    Farber, Alik; Tan, Tze-Woei; Rybin, Denis; Kalish, Jeffrey A.; Hamburg, Naomi M.; Doros, Gheorghe; Goodney, Philip P.; Cronenwett, Jack L.

    2013-01-01

    Objective Although dextran has been theorized to diminish the risk of stroke associated with carotid endarterectomy (CEA), variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility. Methods We studied all primary CEAs performed by 89 surgeons within the Vascular Study Group of New England database (20032010). Patients were stratified by intraoperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI), and congestive heart failure (CHF). Group and propensity score matching was performed for risk-adjusted comparisons, and multivariable logistic and gamma regressions were used to examine associations between dextran use and outcomes. Results There were 6641 CEAs performed, with dextran used in 334 procedures (5%). Dextran-treated and untreated patients were similar in age (70 years) and symptomatic status (25%). Clinical differences between the cohorts were eliminated by statistical adjustment. In crude, group-matched, and propensity-matched analyses, the stroke/death rate was similar for the two cohorts (1.2%). Dextran-treated patients were more likely to suffer postoperative MI (crude: 2.4% vs 1.0%; P = .03; group-matched: 2.4% vs 0.6%; P = .01; propensity-matched: 2.4% vs 0.5%; P = .003) and CHF (2.1% vs 0.6%; P = .01; 2.1% vs 0.5%; P = .01; 2.1% vs 0.2%; P < .001). In multivariable analysis of the crude sample, dextran was associated with a higher risk of postoperative MI (odds ratio, 3.52; 95% confidence interval, 1.627.64) and CHF (odds ratio, 5.71; 95% confidence interval, 2.3513.89). Conclusions Dextran use was not associated with lower perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for routine use of intraoperative dextran during CEA. PMID:23337295

  10. Intraoperative ultrasound patterns predict recurrences after surgical treatments for hepatocellular carcinoma?

    PubMed Central

    Santambrogio, R.; Costa, M.; Strada, D.; Barabino, M.; Conti, M.; Bertolini, E.; Zuin, M.; Opocher, E.

    2010-01-01

    Introduction Hepatocellular carcinoma (HCC) is associated with a high incidence of postoperative recurrence, despite high rates of complete necrosis with radiofrequency ablation (RFA) and curative hepatic resections (HR). The aim of this study was to identify intraoperative ultrasound patterns observed during HR or RFA that predicting intrahepatic HCC recurrence. Materials and methods From January 1997 through August 2008, we treated 377 patients with HCC (158 with HR and 219 with surgical RFA). All patients underwent intraoperative ultrasound (IOUS) examination. Primary HCCs was classified according to diameter, HCC pattern (nodular or infiltrative), echogenicity (hyper- or hypo-), echotexture (homogeneous or inhomogeneous), capsular invasion, mosaic pattern, nodule-in-nodule appearance, and infiltration of portal vessels. Number of HCC nodules was also considered. Comparisons between the groups of possible factors for intrahepatic recurrence of treated tumors were performed using the KaplanMeier method and compared using the log-rank test. Results Patients were followed for 9127 months (median: 18.6 months), and intrahepatic recurrence was observed in 198 (52.5%). In 138 patients (36.5%), recurrences were located in different segments with respect to the primary tumor. In 60 HCC tumors (16%), local recurrences were found in the same segment as the primary tumor. At univariate analysis, primary HCC echogenicity and mosaic pattern were the only factors not significant associated with intrahepatic recurrences. Conclusion IOUS is an accurate staging tool for use during surgical resection or RFA. This study shows that IOUS patterns can also be used to estimate the risk of post-treatment HCC recurrence. In patients at high risk for this outcome, closer follow-up and use of adjuvant therapies could be useful. PMID:23396628

  11. Is Global Warming Accelerating?

    NASA Astrophysics Data System (ADS)

    Shukla, J.; Delsole, T. M.; Tippett, M. K.

    2009-12-01

    A global pattern that fluctuates naturally on decadal time scales is identified in climate simulations and observations. This newly discovered component, called the Global Multidecadal Oscillation (GMO), is related to the Atlantic Meridional Oscillation and shown to account for a substantial fraction of decadal fluctuations in the observed global average sea surface temperature. IPCC-class climate models generally underestimate the variance of the GMO, and hence underestimate the decadal fluctuations due to this component of natural variability. Decomposing observed sea surface temperature into a component due to anthropogenic and natural radiative forcing plus the GMO, reveals that most multidecadal fluctuations in the observed global average sea surface temperature can be accounted for by these two components alone. The fact that the GMO varies naturally on multidecadal time scales implies that it can be predicted with some skill on decadal time scales, which provides a scientific rationale for decadal predictions. Furthermore, the GMO is shown to account for about half of the warming in the last 25 years and hence a substantial fraction of the recent acceleration in the rate of increase in global average sea surface temperature. Nevertheless, in terms of the global average “well-observed” sea surface temperature, the GMO can account for only about 0.1° C in transient, decadal-scale fluctuations, not the century-long 1° C warming that has been observed during the twentieth century.

  12. Case report: Recurrent glossopharyngeal neuralgia after previous glossopharyngeal rhizotomy: Microvascular decompression with intra-operative neurophysiology.

    PubMed

    Price, Sally-Ann S; Davies, Owain; Walsh, Peter; Patel, Nikunj

    2015-12-01

    We present a case of recurrent vago-glossopharyngeal neuralgia after previous surgery, treated successfully with microvascular decompression using intra-operative neurophysiology monitoring. PMID:25958960

  13. Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

    PubMed Central

    Mittlmeier, Thomas; Gierer, Philip; Harms, Christoph; Gradl, Georg

    2009-01-01

    Internal fixation is the established dorsal standard procedure for the treatment of thoracolumbar fractures. The main problem of the procedure is the false positioning of the pedicle screws. The exact determination of pedicle screws has up to now only been possible through postoperative computed tomography. This study was intended to clarify the diagnostic value of intraoperative 3D scans after pedicle screw implantation in thoracolumbar spine surgery. The direct intraoperative consequences of the 3D scans are reported and the results of the 3D scans are compared with the postoperative computed tomography images. Intraoperative 3D scans were prospectively carried out from June 2006 to October 2008 on 95 patients with fractures of the thoracolumbar spine that have been treated with internal fixation. Screws positions were categorised intraoperatively, screws in relevant malposition were repositioned immediately. A computed tomography of the involved spinal section was carried out postoperatively for all patients. The positions of the pedicle screws were determined and compared in the axial reconstructions of both procedures. Four hundred and fourteen pedicles with enclosed screws were evaluated by the 3D scans. The time needed for carrying out the 3D scan amounts to an average of 8.2min. Eleven screws (2.7%) in ten patients were primarily intraoperatively repositioned on the basis of the 3D scan evaluation. Two of 95 patients had to have false positions of the screws revised secondarily following evaluation of the computed tomographies. The secondary postoperative revision rate of the patients amounts to 2.1%. In relation to the number of screws, this is a revision rate of 0.5%. The postoperative computed tomographies showed 323 pedicles without cortical penetration by the screws (78.0%). Ninety-one screws penetrated the pedicle wall (22%). It was possible to postoperatively compare the position classifications of 406 pedicle screws. The CT showed 378 correct screw positions, while 28 screws were positioned falsely. On the basis of the 3D scans, 376 of 378 correct positions were correctly assessed. Twenty-one of 28 false positions could be correctly classified. The sensitivity of all 3D scans reached 91.3% and the specificity 98.2%. The position of 97.8% of the pedicle screws was correctly recognised by the intraoperative 3D scan. Nine screws were classified falsely (2.2%). The comparison of the classification results showed significantly higher error findings by the 3D scan in the spinal section T110 (P=0.014). The image quality of the 3D scan correlates significantly with the width of the scanned pedicle, with the body mass index, the scanned spinal section and the extent of the fixation assembly. 3D scans showed a high accuracy in predicting pedicle screw position. Primary false placement of screws and primary neurovascular damage cannot be avoided. But intraoperative evaluation of the 3D scans resulted in a primary revision rate of 2.7% of the pedicle screws and we could lower the secondary revision rate to 0.5%. PMID:19513764

  14. Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures.

    PubMed

    Beck, Markus; Mittlmeier, Thomas; Gierer, Philip; Harms, Christoph; Gradl, Georg

    2009-10-01

    Internal fixation is the established dorsal standard procedure for the treatment of thoracolumbar fractures. The main problem of the procedure is the false positioning of the pedicle screws. The exact determination of pedicle screws has up to now only been possible through postoperative computed tomography. This study was intended to clarify the diagnostic value of intraoperative 3D scans after pedicle screw implantation in thoracolumbar spine surgery. The direct intraoperative consequences of the 3D scans are reported and the results of the 3D scans are compared with the postoperative computed tomography images. Intraoperative 3D scans were prospectively carried out from June 2006 to October 2008 on 95 patients with fractures of the thoracolumbar spine that have been treated with internal fixation. Screws positions were categorised intraoperatively, screws in relevant malposition were repositioned immediately. A computed tomography of the involved spinal section was carried out postoperatively for all patients. The positions of the pedicle screws were determined and compared in the axial reconstructions of both procedures. Four hundred and fourteen pedicles with enclosed screws were evaluated by the 3D scans. The time needed for carrying out the 3D scan amounts to an average of 8.2 min. Eleven screws (2.7%) in ten patients were primarily intraoperatively repositioned on the basis of the 3D scan evaluation. Two of 95 patients had to have false positions of the screws revised secondarily following evaluation of the computed tomographies. The secondary postoperative revision rate of the patients amounts to 2.1%. In relation to the number of screws, this is a revision rate of 0.5%. The postoperative computed tomographies showed 323 pedicles without cortical penetration by the screws (78.0%). Ninety-one screws penetrated the pedicle wall (22%). It was possible to postoperatively compare the position classifications of 406 pedicle screws. The CT showed 378 correct screw positions, while 28 screws were positioned falsely. On the basis of the 3D scans, 376 of 378 correct positions were correctly assessed. Twenty-one of 28 false positions could be correctly classified. The sensitivity of all 3D scans reached 91.3% and the specificity 98.2%. The position of 97.8% of the pedicle screws was correctly recognised by the intraoperative 3D scan. Nine screws were classified falsely (2.2%). The comparison of the classification results showed significantly higher error findings by the 3D scan in the spinal section T1-10 (P = 0.014). The image quality of the 3D scan correlates significantly with the width of the scanned pedicle, with the body mass index, the scanned spinal section and the extent of the fixation assembly. 3D scans showed a high accuracy in predicting pedicle screw position. Primary false placement of screws and primary neurovascular damage cannot be avoided. But intraoperative evaluation of the 3D scans resulted in a primary revision rate of 2.7% of the pedicle screws and we could lower the secondary revision rate to 0.5%. PMID:19513764

  15. RHIC warm-bore systems

    SciTech Connect

    Welch, K.M.

    1994-07-01

    Pressure profiles, in time, are calculated as a consequence of anticipated outgassing of various beam components (e.g., rf cavities, etc.) and warm-bore beam pipes. Gold beam lifetimes and transverse beam emittance growth are given for calculated average pressures. Examples of undesirable warm-bore conditions are presented such as contaminated experimental beam pipes and warm-bore magnets (i.e., DX). These examples may prove instructive. The methods used in making these calculations are presented in Section 2. They are applicable to all linear systems. The calculations given apply to the RHIC accelerator and more specifically to warm-bore regions of the machine.

  16. Intraoperative spinal ultrasonography in two dogs with spinal disease.

    PubMed

    Tanaka, Hiroshi; Nakayama, Masanari; Takase, Katsuaki

    2006-01-01

    Ultrasonography was performed during spinal surgery on two dogs that were suspected of having intramedullary lesions by myelography and magnetic resonance imaging. Ultrasonographically, the pathologic conditions of the spinal canal or cord were adequately imaged during surgery in both dogs. On the basis of ultrasonographic findings, a biopsy was obtained in Patient 1 and removal of the lesion was accomplished in Patient 2. Histopathologic diagnosis was myelomalacia in Patient 1 and spinal nephroblastoma in Patient 2. Intraoperative ultrasonography was demonstrated to be suitable for detecting intradural conditions, and, thus, is valuable for increasing the accuracy of biopsies or completeness of resections of intramedullary lesions. PMID:16429994

  17. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy. PMID:26939896

  18. Intraoperative pterygo-palatine interstitial /sup 125/I seed implants

    SciTech Connect

    Goffinet, D.R.; Martinez, A.; Pooler, D.; Fee, W.; Levine, P.A.

    1983-01-01

    Intra-operative /sup 125/I seed implants of the pterygo-palantine fossa and/or base skull region were performed in 15 patients at Stanford between 1976 and 1980. Local control was obtained in the implanted volume in 6 of the 10 previously untreated patients and in 4 of 5 of those who were treated with combined resection and seed implantation after local recurrences. The technique of base skull implantation, the low incidence of complications from this procedure and the dosimetric methods are discussed.

  19. Intraoperative photodynamic therapy in laryngeal part of pharynx cancers

    NASA Astrophysics Data System (ADS)

    Loukatch, Erwin V.; Trojan, Vasily; Loukatch, Vjacheslav

    1996-12-01

    In clinic intraoperative photodynamic therapy (IPT) was done in patients with primal squamous cells cancer of the laryngeal part of the pharynx. The He-Ne laser and methylene blue as a photosensibilizator were used. Cobalt therapy in the postoperative period was done in dose 45 Gr. Patients of control groups (1-th group) with only laser and (2-th group) only methylene blue were controlled during three years with the main group. The statistics show certain differences of recidives in the main group compared to the control groups. These facts are allowing us to recommend the use of IPT as an additional method in ENT-oncology diseases treatment.

  20. Intraoperative Optical Imaging and Tissue Interrogation During Urologic Surgery

    PubMed Central

    Hsu, Mark; Gupta, Mohit; Su, Li-Ming; Liao, Joseph C.

    2014-01-01

    Purpose of review To review optical imaging technologies in urologic surgery aimed to facilitate intraoperative imaging and tissue interrogation. Recent findings Emerging new optical imaging technologies can be integrated in the operating room environment during minimally invasive and open surgery. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. Summary Optical imaging technologies that have reached the clinical arena in urologic surgery are reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy. PMID:24240512

  1. Computer planning and intraoperative navigation in cranio-maxillofacial surgery.

    PubMed

    Bell, R Bryan

    2010-02-01

    Preoperative computer design and stereolithographic modeling combined with intraoperative navigation provide a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, the author's early experience confirms that of other surgeons with more than a decade of experience: computer-assisted surgery is indicated for complex posttraumatic or postablative reconstruction of the orbits, cranium, maxilla, and mandible; total temporomandibular joint replacement; orthognathic surgery; and complex dental/craniofacial implantology. Further study is needed to provide outcomes data and cost-benefit analyses for each of these indications. PMID:20159483

  2. Global Warming on Triton

    NASA Technical Reports Server (NTRS)

    Elliot, J. L.; Hammel, H. B.; Wasserman, L. H.; Franz, O. G.; McDonald, S. W.; Person, M. J.; Olkin, C. B.; Dunham, E. J.; Spencer, J. R.; Stansberry, J. A.; Buie, M. W.; Pasachoff, J. M.; Babcock, B. A.; McConnochie, T. H.

    1998-01-01

    Triton, Neptune's largest moon, has been predicted to undergo significant seasonal changes that would reveal themselves as changes in its mean frost temperature. But whether this temperature should at the present time be increasing, decreasing or constant depends on a number of parameters (such as the thermal properties of the surface, and frost migration patterns) that are unknown. Here we report observations of a recent stellar occultation by Triton which, when combined with earlier results, show that Triton has undergone a period of global warming since 1989. Our most conservative estimates of the rate of temperature and surface-pressure increase during this period imply that the atmosphere is doubling in bulk every 10 years, significantly faster than predicted by any published frost model for Triton. Our result suggests that permanent polar caps on Triton play a c dominant role in regulating seasonal atmospheric changes. Similar processes should also be active on Pluto.

  3. Warm waters, bleached corals

    SciTech Connect

    Roberts, L.

    1990-10-12

    Two researchers, Tom Goreau of the Discovery Laboratory in Jamaica and Raymond Hayes of Howard University, claim that they have evidence that nearly clinches the temperature connection to the bleached corals in the Caribbean and that the coral bleaching is an indication of Greenhouse warming. The incidents of scattered bleaching of corals, which have been reported for decades, are increasing in both intensity and frequency. The researchers based their theory on increased temperature of the seas measured by satellites. However, some other scientists feel that the satellites measure the temperature of only the top few millimeters of the water and that since corals lie on reefs perhaps 60 to 100 feet below the ocean surface, the elevated temperatures are not significant.

  4. Global warming challenge

    SciTech Connect

    Hengeveld, H. )

    1994-11-01

    Global warming will necessitate significant adjustments in Canadian society and its economy. In 1979, the Canadian federal government created its Canadian Climate Program (CCP) in collaboration with other agencies, institutions, and individuals. It sought to coordinate national efforts to understand global and regional climate, and to promote better use of the emerging knowledge. Much of the CCP-coordinated research into sources and sinks of greenhouse gases interfaces with other national and international programs. Other researchers have become involved in the Northern Wetlands Study, a cooperative United States-Canada initiative to understand the role of huge northern bogs and muskegs in the carbon cycle. Because of the need to understand how the whole, linked climate system works, climate modeling emerged as a key focus of current research. 35 refs., 4 figs.

  5. Interacting warm dark matter

    SciTech Connect

    Cruz, Norman; Palma, Guillermo; Zambrano, David; Avelino, Arturo E-mail: guillermo.palma@usach.cl E-mail: avelino@fisica.ugto.mx

    2013-05-01

    We explore a cosmological model composed by a dark matter fluid interacting with a dark energy fluid. The interaction term has the non-linear ??{sub m}{sup ?}?{sub e}{sup ?} form, where ?{sub m} and ?{sub e} are the energy densities of the dark matter and dark energy, respectively. The parameters ? and ? are in principle not constrained to take any particular values, and were estimated from observations. We perform an analytical study of the evolution equations, finding the fixed points and their stability properties in order to characterize suitable physical regions in the phase space of the dark matter and dark energy densities. The constants (?,?,?) as well as w{sub m} and w{sub e} of the EoS of dark matter and dark energy respectively, were estimated using the cosmological observations of the type Ia supernovae and the Hubble expansion rate H(z) data sets. We find that the best estimated values for the free parameters of the model correspond to a warm dark matter interacting with a phantom dark energy component, with a well goodness-of-fit to data. However, using the Bayesian Information Criterion (BIC) we find that this model is overcame by a warm dark matter phantom dark energy model without interaction, as well as by the ?CDM model. We find also a large dispersion on the best estimated values of the (?,?,?) parameters, so even if we are not able to set strong constraints on their values, given the goodness-of-fit to data of the model, we find that a large variety of theirs values are well compatible with the observational data used.

  6. Interacting warm dark matter

    NASA Astrophysics Data System (ADS)

    Cruz, Norman; Palma, Guillermo; Zambrano, David; Avelino, Arturo

    2013-05-01

    We explore a cosmological model composed by a dark matter fluid interacting with a dark energy fluid. The interaction term has the non-linear ??m??e? form, where ?m and ?e are the energy densities of the dark matter and dark energy, respectively. The parameters ? and ? are in principle not constrained to take any particular values, and were estimated from observations. We perform an analytical study of the evolution equations, finding the fixed points and their stability properties in order to characterize suitable physical regions in the phase space of the dark matter and dark energy densities. The constants (?,?,?) as well as wm and we of the EoS of dark matter and dark energy respectively, were estimated using the cosmological observations of the type Ia supernovae and the Hubble expansion rate H(z) data sets. We find that the best estimated values for the free parameters of the model correspond to a warm dark matter interacting with a phantom dark energy component, with a well goodness-of-fit to data. However, using the Bayesian Information Criterion (BIC) we find that this model is overcame by a warm dark matter - phantom dark energy model without interaction, as well as by the ?CDM model. We find also a large dispersion on the best estimated values of the (?,?,?) parameters, so even if we are not able to set strong constraints on their values, given the goodness-of-fit to data of the model, we find that a large variety of theirs values are well compatible with the observational data used.

  7. "Now you see it...now you don't." Carmoisine vital dye facilitates complete removal of cutaneous neoplasia by intraoperative visual enhancement.

    PubMed

    Murphy, K D J; Hall, P N

    2003-09-01

    Patients presenting for excision of squamous cell carcinomata, including Bowen's disease, in sun-damaged skin often present with poorly defined, morphoeic or multifocal neoplasms, the extent of which can be difficult to identify intraoperatively. Use of vital staining has been commonly used to aid identification and appropriate excision of squamous lesions of the oral cavity and upper aerodigestive tract but has not been readily adopted for cutaneous lesions. We report a case of a morphoeic squamous cell neoplasm of the web space and fingers to illustrate the merits of vital staining cutaneous squamous neoplasms with the simple dye Carmoisine E122. This assists with intraoperative tumour identification and facilitates adequate oncological resection and appropriately planned reconstruction. By comparison with other methods such as Mohs, it is a simple, cheap, and rapid aid that may be used by surgeons of all grades to improve identification of the extent of the neoplasm, without special equipment. PMID:12946382

  8. Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy.

    PubMed

    Guerra, Pedro; Udías, José M; Herranz, Elena; Santos-Miranda, Juan Antonio; Herraiz, Joaquín L; Valdivieso, Manlio F; Rodríguez, Raúl; Calama, Juan A; Pascau, Javier; Calvo, Felipe A; Illana, Carlos; Ledesma-Carbayo, María J; Santos, Andrés

    2014-12-01

    This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning system and providing good accuracy in the dosage simulation. PMID:25365625

  9. Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy

    NASA Astrophysics Data System (ADS)

    Guerra, Pedro; Udías, José M.; Herranz, Elena; Santos-Miranda, Juan Antonio; Herraiz, Joaquín L.; Valdivieso, Manlio F.; Rodríguez, Raúl; Calama, Juan A.; Pascau, Javier; Calvo, Felipe A.; Illana, Carlos; Ledesma-Carbayo, María J.; Santos, Andrés

    2014-12-01

    This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning system and providing good accuracy in the dosage simulation.

  10. Complications of intraoperative radiofrequency ablation of liver metastases

    PubMed Central

    Razafindratsira, Tsiriniaina; Isambert, Milne; Evrard, Serge

    2011-01-01

    Background Intraoperative radiofrequency ablation (IRFA) of liver metastases can be used to treat patients with complex tumours that are unsuitable for parenchymal resection alone. This systematic review assesses the frequency, patterns and severity of complications associated with this procedure. Methods We carried out a bibliographic search on MEDLINE focused on IRFA for liver metastases, excluding hepatocarcinomas, and on intraoperative use, excluding percutaneous application. Results Thirty papers published between 1999 and 2007 were analysed. They covered a total of 2822 patients and 1755 IRFA procedures. The indications and techniques for IRFA differ from those for percutaneous treatment, as do associated results and complications. Specific complications associated with IRFA, such as liver abscesses, biliary stenoses and vascular thromboses, are directly correlated with the indications and associated procedures. Published results should be interpreted with caution as IRFA can be used alone or combined with parenchymal resection. Conclusions Specific complications related to IRFA are rare, especially for lesions of <35 mm in size located far from a main biliary duct, when additional septic procedures are not used. A lesion-by-lesion approach based on the benefit : risk ratio should therefore be used in the process of making surgical decisions. Combining resection with IRFA leads to higher morbidity, especially in difficult patients with numerous bilateral lesions, but may be necessary to achieve R0 (microscopically negative margins) outcomes. PMID:21159099

  11. Intraoperative passive knee kinematics during total knee arthroplasty surgery.

    PubMed

    Young, Kathryn L; Dunbar, Michael J; Richardson, Glen; Astephen Wilson, Janie L

    2015-11-01

    Surgical navigation systems for total knee arthroplasty (TKA) surgery are capable of capturing passive three-dimensional (3D) angular joint movement patterns intraoperatively. Improved understanding of patient-specific knee kinematic changes between pre and post-implant states and their relationship with post-operative function may be important in optimizing TKA outcomes. However, a comprehensive characterization of the variability among patients has yet to be investigated. The objective of this study was to characterize the variability within frontal plane joint movement patterns intraoperatively during a passive knee flexion exercise. Three hundred and forty patients with severe knee osteoarthritis (OA) received a primary TKA using a navigation system. Passive kinematics were captured prior to (pre-implant), and after prosthesis insertion (post-implant). Principal component analysis (PCA) was used to capture characteristic patterns of knee angle kinematics among patients, to identify potential patient subgroups based on these patterns, and to examine the subgroup-specific changes in these patterns between pre- and post-implant states. The first four extracted patterns explained 99.9% of the diversity within the frontal plane angle patterns among the patients. Post-implant, the magnitude of the frontal plane angle shifted toward a neutral mechanical axis in all phenotypes, yet subtle pattern (shape of curvature) features of the pre-implant state persisted. PMID:25990930

  12. Lightweight distributed computing for intraoperative real-time image guidance

    NASA Astrophysics Data System (ADS)

    Suwelack, Stefan; Katic, Darko; Wagner, Simon; Spengler, Patrick; Bodenstedt, Sebastian; Rhl, Sebastian; Dillmann, Rdiger; Speidel, Stefanie

    2012-02-01

    In order to provide real-time intraoperative guidance, computer assisted surgery (CAS) systems often rely on computationally expensive algorithms. The real-time constraint is especially challenging if several components such as intraoperative image processing, soft tissue registration or context aware visualization are combined in a single system. In this paper, we present a lightweight approach to distribute the workload over several workstations based on the OpenIGTLink protocol. We use XML-based message passing for remote procedure calls and native types for transferring data such as images, meshes or point coordinates. Two different, but typical scenarios are considered in order to evaluate the performance of the new system. First, we analyze a real-time soft tissue registration algorithm based on a finite element (FE) model. Here, we use the proposed approach to distribute the computational workload between a primary workstation that handles sensor data processing and visualization and a dedicated workstation that runs the real-time FE algorithm. We show that the additional overhead that is introduced by the technique is small compared to the total execution time. Furthermore, the approach is used to speed up a context aware augmented reality based navigation system for dental implant surgery. In this scenario, the additional delay for running the computationally expensive reasoning server on a separate workstation is less than a millisecond. The results show that the presented approach is a promising strategy to speed up real-time CAS systems.

  13. ECG artifacts during intraoperative high-field MRI scanning.

    PubMed

    Birkholz, Torsten; Schmid, Markus; Nimsky, Christopher; Schttler, Jrgen; Schmitz, Bernd

    2004-10-01

    High-field magnetic resonance imaging (MRI) (1.5 T) has recently been introduced into the neurosurgical operating room for intraoperative resection control and functional neuronavigational guidance. However, long-lasting neurosurgical procedures in an operating room equipped with a high-field MRI scanner raise new challenges to the anesthesiologist. In particular, monitoring of vital signs during anesthesia requires equipment compatible with working in close vicinity to the strong magnetic field. However, even MRI-compatible electrocardiographic (ECG) monitoring interferes with electromagnetic fields, so several ECG artifacts can be observed in static and pulsed magnetic fields. As shown in this study, pulsed high-frequency fields induce characteristic field frequency-based artifacts in the ECG that can imitate malignant arrhythmia or provoke ST-segment abnormalities. The knowledge of possible and characteristic ECG artifacts during high-field MRI is therefore essential to prevent misinterpretation. Moreover, interference-free parameters such as pulse oximetry or invasive blood pressure curves are highly relevant during intraoperative MRI scans. PMID:15557829

  14. Intraoperative Evaluation of Breast Tumor Margins with Optical Coherence Tomography

    PubMed Central

    Nguyen, Freddy T.; Zysk, Adam M.; Chaney, Eric J.; Kotynek, Jan G.; Oliphant, Uretz J.; Bellafiore, Frank J.; Rowland, Kendrith M.; Johnson, Patricia A.; Boppart, Stephen A.

    2009-01-01

    As breast cancer screening rates increase, smaller and more numerous lesions are being identified earlier, leading to more breast-conserving surgical procedures. Achieving a clean surgical margin represents a technical challenge with important clinical implications. Optical coherence tomography (OCT) is introduced as an intraoperative high-resolution imaging technique that assesses surgical breast tumor margins by providing real-time microscopic images up to 2 mm beneath the tissue surface. In a study of 37 patients split between training and study groups, OCT images covering 1 cm2 regions were acquired from surgical margins of lumpectomy specimens, registered with ink, and correlated with corresponding histological sections. A 17 patient training set used to establish standard imaging protocols and OCT evaluation criteria demonstrated that areas of higher scattering tissue with a heterogeneous pattern were indicative of tumor cells and tumor tissue, in contrast to lower scattering adipocytes found in normal breast tissue. The remaining 20 patients were enrolled into the feasibility study. Of these lumpectomy specimens, 11 were identified with a positive or close surgical margin and 9 were identified with a negative margin under OCT. Based on histological findings, 9 true positives, 9 true negatives, 2 false positives, and 0 false negatives were found, yielding a sensitivity of 100% and specificity of 82%. These results demonstrate the potential of OCT as a real-time method for intraoperative margin assessment in breast conserving surgeries. PMID:19910294

  15. Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

    PubMed Central

    Gwak, Heui-Chul; Kim, Jung-Han; Roh, Sang-Myung

    2015-01-01

    Background To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. Methods We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. Results In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. Conclusions Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants. PMID:26640632

  16. Toward Microendoscopic Electrical Impedance Tomography for Intraoperative Surgical Margin Assessment

    PubMed Central

    Halter, Ryan J.; Kim, Young-Joong

    2015-01-01

    No clinical protocols are routinely used to intraoperatively assess surgical margin status during prostate surgery. Instead, margins are evaluated through pathological assessment of the prostate following radical prostatectomy, when it is too late to provide additional surgical intervention. An intraoperative device potentially capable of assessing surgical margin status based on the electrical property contrast between benign and malignant prostate tissue has been developed. Specifically, a microendoscopic electrical impedance tomography (EIT) probe has been constructed to sense and image, at near millimeter resolution, the conductivity contrast within heterogeneous biological tissues with the goal of providing surgeons with real-time assessment of margin pathologies. This device consists of a ring of eight 0.6-mm diameter electrodes embedded in a 5-mm diameter probe tip to enable access through a 12-mm laparoscopic port. Experiments were performed to evaluate the volume of tissue sensed by the probe. The probe was also tested with inclusions in gelatin, as well as on a sample of porcine tissue with clearly defined regions of adipose and muscle. The probe's area of sensitivity consists of a circular area of 9.1 mm2 and the maximum depth of sensitivity is approximately 1.5 mm. The probe is able to distinguish between high contrast muscle and adipose tissue on a sub-mm scale (~500 ?m). These preliminary results suggest that EIT is possible in a probe designed to fit within a 12-mm laparoscopic access port. PMID:24951675

  17. Intraoperative metastases detection by laser-induced fluorescence spectroscopy

    NASA Astrophysics Data System (ADS)

    Vari, Sandor G.; Papazoglou, Theodore G.; van der Veen, Maurits J.; Fishbein, Michael C.; Young, J. D.; Chandra, Mudjianto; Papaioannou, Thanassis; Beeder, Clain; Shi, Wei-Qiang; Grundfest, Warren S.

    1991-06-01

    The authors studied the ability of Laser Induced Fluorescence Spectroscopy (LIFS) for the intraoperative identification of metastases using a photosensitizing agent Photofrin IIr to enhance spectroscopic detection. A He-Cd laser source (442 nm) was used to produce low-power illumination of tissue via a hand-held 400 micrometers fiberoptic probe. Through the same fiber, reflected and emitted light was returned to an optical multi-channel analyzer (OMA III) for analysis. Spectroscopic signals were displayed on a screen for immediate examination. Lobund Wistar rats, inoculated with Pollard rat adenocarcinoma cells, were used as an animal model. Photofrin IIr was administered intraperitoneal 24 or 48 hours prior to surgical exploration in doses varying from 0.75-7.5 mg/kg. Metastases detection was performed during abdominal exploration directed to ipsilateral and contralateral inguinal, iliac, para-aortic and renal lymph nodes. Nineteen tissue samples, identified as abnormal by LIFS, were removed for histologic analysis; 11 of these samples were larger than 5mm and histologic examination revealed malignancy in all cases. While LIFS signals showed malignancy in 8 tissue samples with dimensions less than 5mm, histology confirmed this in only 3. However, serial histologic sections were not performed. From the initial results, it was concluded that LIFS detection of malignant tissue is feasible and enhanced by the addition of Photofrin IIr. LIFS may be a promising technique for the intraoperative detection of primary malignant and metastatic tissue.

  18. Pancreatic resection combined with intraoperative radiation therapy for pancreatic cancer.

    PubMed Central

    Farrell, T J; Barbot, D J; Rosato, F E

    1997-01-01

    OBJECTIVE: The objective of the study was to analyze a single center's experience in the treatment of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT). SUMMARY BACKGROUND DATA: Pancreatic cancer is the most lethal form of gastrointestinal malignancy. Historically, it carries a 20% 1-year survival and a 5-year survival of 3% to 5%. Since 1987, patients at Thomas Jefferson University Hospital have been offered IORT in an attempt to improve their survival. METHODS: The authors reviewed all patients treated at Thomas Jefferson University Hospital with pancreatic adenocarcinoma from 1987 to 1994. From this population, 14 patients were identified who received IORT in conjunction with curative surgery. Duration of hospital stay, perioperative complications, duration of postoperative ileus, and survival were assessed by retrospective review. RESULTS: Of the 14 patients, 6 were male and 8 were female. Patient median age was 61. Six patients had stage I disease, 2 had stage II, 6 had stage III. Two patients had total pancreatectomy, 2 had distal pancreatectomy, and the remaining had pancreaticoduodenectomy (Whipple resection). Median survival was 16 months with a 15.5% 5-year survival. Postoperative complications, duration of hospital stay, and duration of postoperative ileus were not adversely affected by the addition of IORT when compared to in-house control subjects. CONCLUSIONS: Intraoperative radiation therapy is a useful adjunct to surgical resection as treatment of pancreatic cancer. The authors' data suggested it can prolong median survival and long-term survival without adding significant morbidity. PMID:9242339

  19. Stereoscopic Integrated Imaging Goggles for Multimodal Intraoperative Image Guidance

    PubMed Central

    Mela, Christopher A.; Patterson, Carrie; Thompson, William K.; Papay, Francis; Liu, Yang

    2015-01-01

    We have developed novel stereoscopic wearable multimodal intraoperative imaging and display systems entitled Integrated Imaging Goggles for guiding surgeries. The prototype systems offer real time stereoscopic fluorescence imaging and color reflectance imaging capacity, along with in vivo handheld microscopy and ultrasound imaging. With the Integrated Imaging Goggle, both wide-field fluorescence imaging and in vivo microscopy are provided. The real time ultrasound images can also be presented in the goggle display. Furthermore, real time goggle-to-goggle stereoscopic video sharing is demonstrated, which can greatly facilitate telemedicine. In this paper, the prototype systems are described, characterized and tested in surgeries in biological tissues ex vivo. We have found that the system can detect fluorescent targets with as low as 60 nM indocyanine green and can resolve structures down to 0.25 mm with large FOV stereoscopic imaging. The system has successfully guided simulated cancer surgeries in chicken. The Integrated Imaging Goggle is novel in 4 aspects: it is (a) the first wearable stereoscopic wide-field intraoperative fluorescence imaging and display system, (b) the first wearable system offering both large FOV and microscopic imaging simultaneously, (c) the first wearable system that offers both ultrasound imaging and fluorescence imaging capacities, and (d) the first demonstration of goggle-to-goggle communication to share stereoscopic views for medical guidance. PMID:26529249

  20. Global warming and prairie wetlands

    SciTech Connect

    Poiani, K.A. ); Johnson, W.C. )

    1991-10-01

    In this article, the authors discuss current understanding and projections of global warming; review wetland vegetation dynamics to establish the strong relationship among climate, wetland hydrology, vegetation patterns and waterfowl habitat; discuss the potential effects of a greenhouse warming on these relationships; and illustrate the potential effects of climate change on wetland habitat by using a simulation model.

  1. Impact of intraoperative parathyroid hormone levels on surgical results in patients with renal hyperparathyroidism.

    PubMed

    Weber, Theresia; Zeier, Martin; Hinz, Ulf; Schilling, Tobias; Bchler, Markus W

    2005-09-01

    The aim of our study was to evaluate the impact of intraoperative parathyroid hormone (PTH) measurement on surgical results in patients with renal hyperparathyroidism (HPT). From December 1999 to February 2004, a series of 95 consecutive patients underwent total parathyroidectomy and intraoperative PTH measurement for renal HPT. Intraoperative PTH was measured before and 15 minutes after parathyroidectomy with the Immulite DPC assay for intact PTH. The median PTH levels before surgery were 133.0 pmol/L, which declined to 5.9 pmol/L at the end of the operation. At follow-up, 91 of 95 (96%) patients presented with normal calcium levels. Persistent renal HPT was seen in three patients, and recurrent HPT was diagnosed in another. In 99% of the patients the intraoperative PTH levels declined more than 50% and in 73% the PTH decay was more than 90%. In 64% of the patients PTH levels dropped into the normal range (< 7.6 pmol/L). Altogether, 97% of the patients with an intraoperative PTH decrease of more than 90% presented with normal PTH levels postoperatively (p = 0.0237), as did all of the patients whose intraoperative PTH dropped into the normal range (p = 0.0432). Intraoperative PTH measurement with a decrease in intraoperative PTH of at least 90% is highly predictive of successful parathyroidectomy and normalization of postoperative calcium and PTH levels. PMID:16132402

  2. Autophagic activation in vitrified-warmed mouse oocytes.

    PubMed

    Bang, Soyoung; Shin, Hyejin; Song, Haengseok; Suh, Chang Suk; Lim, Hyunjung Jade

    2014-07-01

    Vitrification involves the use of cryoprotectants (CPAs) and liquid nitrogen (LN2), which may cause osmotic damage and cryoinjury to oocytes. Autophagy is widely recognized as a survival or response mechanism elicited by various environmental and cellular stressors. However, the induction of autophagy in vitrified-warmed oocytes has not been examined. In this work, we investigated whether the vitrification-warming process induces autophagy in mouse oocytes. Metaphase II (MII) oocytes that were vitrified and stored in LN2 for at least 2 weeks were used in the study. In RT-PCR analyses, we observed that several Atg genes such as Atg5, Atg7, Atg12, LC3a (Map1lc3a), LC3b (Map1lc3b), and Beclin1 were expressed in MII mouse oocytes. Slight reduction in mRNA levels of Atg7 and Atg12 in vitrified-warmed oocytes was noted, and expression of these genes was not significantly influenced. Confocal live imaging analysis using oocytes from GFP-LC3 transgenic mice revealed that vitrified-warmed oocytes had a significantly higher number of GFP-LC3 puncta in comparison to fresh oocytes. The expression of BECLIN1 protein was also increased in vitrified-warmed oocytes. Treatment with 3-methyladenine, an inhibitor of autophagy, did not significantly affect the rates of oocyte survival, IVF, and embryonic development after warming and IVF. The results suggest that the observed autophagic activation in vitrified-warmed oocytes is a natural adaptive response to cold stress. Collectively, we show for the first time that vitrified-warmed mouse oocytes exhibit autophagic activation during warming and that this response is not induced by CPA-containing solutions. The induction of autophagy by cold temperature is first reported herein. PMID:24760879

  3. Intraoperative near-infrared fluorescence imaging of a paraganglioma using methylene blue: A case report

    PubMed Central

    Tummers, Quirijn R.J.G.; Boonstra, Martin C.; Frangioni, John V.; van de Velde, Cornelis J.H.; Vahrmeijer, Alexander L.; Bonsing, Bert A.

    2014-01-01

    Introduction Intraoperative identification of tumors can be challenging. Near-infrared (NIR) fluorescence imaging is an innovative technique that can assist in intraoperative identification of tumors, which may otherwise be undetectable. Presentation of case A 19-year-old patient with symptoms, normetanephrine levels and radiological findings suspicious for a paraganglioma, a rare tumor arising from extra-adrenal chromaffin cells within the sympathetic nervous system, is presented. Intraoperative NIR fluorescence imaging using intravenous administration of methylene blue (MB) assisted in intraoperative detection of the tumor, and even identified a smaller second lesion, which was not identified during surgery by visual inspection. Discussion Although the exact mechanism of MB accumulation in neuroendocrine tumors is unclear, it is described in both preclinical and clinical studies. Conclusion In this report, we describe the first case of intraoperative NIR fluorescence imaging of a paraganglioma using MB, which identified an otherwise undetectable lesion. PMID:25541370

  4. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries

    PubMed Central

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young

    2015-01-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding. PMID:26623419

  5. Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes

    PubMed Central

    Pandarinath, Shrinivas Rudrapatna; Choudhary, Babulal; Chouhan, Harvinder Singh; Rudramani, Shivashankar; Dubey, Deepak

    2014-01-01

    Introduction: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. Materials and Methods: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN)? and delayed graft function were also recorded. Results: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. Conclusions: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity. PMID:25097308

  6. Defining Sudden Stratospheric Warmings

    NASA Astrophysics Data System (ADS)

    Butler, Amy; Seidel, Dian; Hardiman, Steven; Butchart, Neal; Birner, Thomas; Match, Aaron

    2015-04-01

    The general form of the definition for Sudden Stratospheric Warmings (SSWs) is largely agreed to be a reversal of the temperature gradient and of the zonal circulation polewards of 60 latitude at the 10 hPa level, as developed by the World Meteorological Organization (WMO) in the 1960s and 1970s. However, the details of the definition and its calculation are ambiguous, resulting in inconsistent classifications of SSW events. These discrepancies are problematic for understanding the observed frequency and statistical relationships with SSWs, and for maintaining a robust metric with which to assess wintertime stratospheric variability in observations and climate models. To provide a basis for community-wide discussion, we examine how the SSW definition has changed over time and how sensitive the detection of SSWs is to the definition used. We argue that the general form of the SSW definition should be clarified to ensure that it serves current research and forecasting purposes, and propose possible ways to update the definition.

  7. Explaining Warm Coronal Loops

    NASA Technical Reports Server (NTRS)

    Klimchuk, James A.; Karpen, Judy T.; Patsourakos, Spiros

    2008-01-01

    One of the great mysteries of coronal physics that has come to light in the last few years is the discovery that warn (- 1 INK) coronal loops are much denser than expected for quasi-static equilibrium. Both the excess densities and relatively long lifetimes of the loops can be explained with bundles of unresolved strands that are heated impulsively to very high temperatures. Since neighboring strands are at different stages of cooling, the composite loop bundle is multi-thermal, with the distribution of temperatures depending on the details of the "nanoflare storm." Emission hotter than 2 MK is predicted, but it is not clear that such emission is always observed. We consider two possible explanations for the existence of over-dense warm loops without corresponding hot emission: (1) loops are bundles of nanoflare heated strands, but a significant fraction of the nanoflare energy takes the form of a nonthermal electron beam rather then direct plasma heating; (2) loops are bundles of strands that undergo thermal nonequilibrium that results when steady heating is sufficiently concentrated near the footpoints. We present numerical hydro simulations of both of these possibilities and explore the observational consequences, including the production of hard X-ray emission and absorption by cool material in the corona.

  8. Warming up for Planck

    SciTech Connect

    Bartrum, Sam; Berera, Arjun; Rosa, Joo G. E-mail: ab@ph.ed.ac.uk

    2013-06-01

    The recent Planck results and future releases on the horizon present a key opportunity to address a fundamental question in inflationary cosmology of whether primordial density perturbations have a quantum or thermal origin, i.e. whether particle production may have significant effects during inflation. Warm inflation provides a natural arena to address this issue, with interactions between the scalar inflaton and other degrees of freedom leading to dissipative entropy production and associated thermal fluctuations. In this context, we present relations between CMB observables that can be directly tested against observational data. In particular, we show that the presence of a thermal bath warmer than the Hubble scale during inflation decreases the tensor-to-scalar ratio with respect to the conventional prediction in supercooled inflation, yielding r < 8|n{sub t}|, where n{sub t} is the tensor spectral index. Focusing on supersymmetric models at low temperatures, we determine consistency relations between the observables characterizing the spectrum of adiabatic scalar and tensor modes, both for generic potentials and particular canonical examples, and which we compare with the WMAP and Planck results. Finally, we include the possibility of producing the observed baryon asymmetry during inflation through dissipative effects, thereby generating baryon isocurvature modes that can be easily accommodated by the Planck data.

  9. Shyness Trajectories in Slow-to-Warm-Up Infants: Relations with Child Sex and Maternal Parenting

    ERIC Educational Resources Information Center

    Grady, Jessica Stoltzfus; Karraker, Katherine; Metzger, Aaron

    2012-01-01

    Little is known about slow-to-warm-up temperament in infancy. This study examined the trajectory of shyness in children who were slow-to-warm-up in infancy in comparison to children with other temperament profiles in infancy. Participants were 996 mothers and children in the NICHD SECC studied from 6 months to first grade. Latent growth curve

  10. Shyness Trajectories in Slow-to-Warm-Up Infants: Relations with Child Sex and Maternal Parenting

    ERIC Educational Resources Information Center

    Grady, Jessica Stoltzfus; Karraker, Katherine; Metzger, Aaron

    2012-01-01

    Little is known about slow-to-warm-up temperament in infancy. This study examined the trajectory of shyness in children who were slow-to-warm-up in infancy in comparison to children with other temperament profiles in infancy. Participants were 996 mothers and children in the NICHD SECC studied from 6 months to first grade. Latent growth curve…

  11. A quantitative microscopic approach to predict local recurrence based on in vivo intraoperative imaging of sarcoma tumor margins.

    PubMed

    Mueller, Jenna L; Fu, Henry L; Mito, Jeffrey K; Whitley, Melodi J; Chitalia, Rhea; Erkanli, Alaattin; Dodd, Leslie; Cardona, Diana M; Geradts, Joseph; Willett, Rebecca M; Kirsch, David G; Ramanujam, Nimmi

    2015-11-15

    The goal of resection of soft tissue sarcomas located in the extremity is to preserve limb function while completely excising the tumor with a margin of normal tissue. With surgery alone, one-third of patients with soft tissue sarcoma of the extremity will have local recurrence due to microscopic residual disease in the tumor bed. Currently, a limited number of intraoperative pathology-based techniques are used to assess margin status; however, few have been widely adopted due to sampling error and time constraints. To aid in intraoperative diagnosis, we developed a quantitative optical microscopy toolbox, which includes acriflavine staining, fluorescence microscopy, and analytic techniques called sparse component analysis and circle transform to yield quantitative diagnosis of tumor margins. A series of variables were quantified from images of resected primary sarcomas and used to optimize a multivariate model. The sensitivity and specificity for differentiating positive from negative ex vivo resected tumor margins was 82 and 75%. The utility of this approach was tested by imaging the in vivo tumor cavities from 34 mice after resection of a sarcoma with local recurrence as a bench mark. When applied prospectively to images from the tumor cavity, the sensitivity and specificity for differentiating local recurrence was 78 and 82%. For comparison, if pathology was used to predict local recurrence in this data set, it would achieve a sensitivity of 29% and a specificity of 71%. These results indicate a robust approach for detecting microscopic residual disease, which is an effective predictor of local recurrence. PMID:25994353

  12. Recent Warming of Lake Kivu

    PubMed Central

    Katsev, Sergei; Aaberg, Arthur A.; Crowe, Sean A.; Hecky, Robert E.

    2014-01-01

    Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient. PMID:25295730

  13. Recent warming of lake Kivu.

    PubMed

    Katsev, Sergei; Aaberg, Arthur A; Crowe, Sean A; Hecky, Robert E

    2014-01-01

    Lake Kivu in East Africa has gained notoriety for its prodigious amounts of dissolved methane and dangers of limnic eruption. Being meromictic, it is also expected to accumulate heat due to rising regional air temperatures. To investigate the warming trend and distinguish between atmospheric and geothermal heating sources, we compiled historical temperature data, performed measurements with logging instruments, and simulated heat propagation. We also performed isotopic analyses of water from the lake's main basin and isolated Kabuno Bay. The results reveal that the lake surface is warming at the rate of 0.12C per decade, which matches the warming rates in other East African lakes. Temperatures increase throughout the entire water column. Though warming is strongest near the surface, warming rates in the deep waters cannot be accounted for solely by propagation of atmospheric heat at presently assumed rates of vertical mixing. Unless the transport rates are significantly higher than presently believed, this indicates significant contributions from subterranean heat sources. Temperature time series in the deep monimolimnion suggest evidence of convection. The progressive deepening of the depth of temperature minimum in the water column is expected to accelerate the warming in deeper waters. The warming trend, however, is unlikely to strongly affect the physical stability of the lake, which depends primarily on salinity gradient. PMID:25295730

  14. Amplified Arctic warming by phytoplankton under greenhouse warming

    PubMed Central

    Park, Jong-Yeon; Kug, Jong-Seong; Bader, Jürgen; Rolph, Rebecca; Kwon, Minho

    2015-01-01

    Phytoplankton have attracted increasing attention in climate science due to their impacts on climate systems. A new generation of climate models can now provide estimates of future climate change, considering the biological feedbacks through the development of the coupled physical–ecosystem model. Here we present the geophysical impact of phytoplankton, which is often overlooked in future climate projections. A suite of future warming experiments using a fully coupled ocean−atmosphere model that interacts with a marine ecosystem model reveals that the future phytoplankton change influenced by greenhouse warming can amplify Arctic surface warming considerably. The warming-induced sea ice melting and the corresponding increase in shortwave radiation penetrating into the ocean both result in a longer phytoplankton growing season in the Arctic. In turn, the increase in Arctic phytoplankton warms the ocean surface layer through direct biological heating, triggering additional positive feedbacks in the Arctic, and consequently intensifying the Arctic warming further. Our results establish the presence of marine phytoplankton as an important potential driver of the future Arctic climate changes. PMID:25902494

  15. Amplified Arctic warming by phytoplankton under greenhouse warming.

    PubMed

    Park, Jong-Yeon; Kug, Jong-Seong; Bader, Jürgen; Rolph, Rebecca; Kwon, Minho

    2015-05-12

    Phytoplankton have attracted increasing attention in climate science due to their impacts on climate systems. A new generation of climate models can now provide estimates of future climate change, considering the biological feedbacks through the development of the coupled physical-ecosystem model. Here we present the geophysical impact of phytoplankton, which is often overlooked in future climate projections. A suite of future warming experiments using a fully coupled ocean-atmosphere model that interacts with a marine ecosystem model reveals that the future phytoplankton change influenced by greenhouse warming can amplify Arctic surface warming considerably. The warming-induced sea ice melting and the corresponding increase in shortwave radiation penetrating into the ocean both result in a longer phytoplankton growing season in the Arctic. In turn, the increase in Arctic phytoplankton warms the ocean surface layer through direct biological heating, triggering additional positive feedbacks in the Arctic, and consequently intensifying the Arctic warming further. Our results establish the presence of marine phytoplankton as an important potential driver of the future Arctic climate changes. PMID:25902494

  16. Compact intraoperative imaging device for sentinel lymph node mapping

    NASA Astrophysics Data System (ADS)

    Liu, Yang; Bauer, Adam Q.; Akers, Walter; Sudlow, Gail; Liang, Kexian; Shen, Duanwen; Berezin, Mikhail; Culver, Joseph P.; Achilefu, Samuel

    2011-03-01

    We have developed a novel real-time intraoperative fluorescence imaging device that can detect near-infrared (NIR) fluorescence and map sentinel lymph nodes (SLNs). In contrast to conventional imaging systems, this device is compact, portable, and battery-operated. It is also wearable and thus allows hands-free operation of clinicians. The system directly displays the fluorescence in its goggle eyepiece, eliminating the need for a remote monitor. Using this device in murine lymphatic mapping, the SLNs stained with indocyanine green (ICG) can be readily detected. Fluorescence-guided SLN resection under the new device was performed with ease. Ex vivo examination of resected tissues also revealed high fluorescence level in the SLNs. Histology further confirmed the lymphatic nature of the resected SLNs.

  17. Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma

    PubMed Central

    Salmasi, Vafi; Schiavi, Adam; Binder, Zev A.; Ruzevick, Jacob; Orr, Brent A.; Burger, Peter C.; Ball, Douglas W.; Blitz, Ari M.; Koch, Wayne M.; Ishii, Masaru; Gallia, Gary L.

    2015-01-01

    Background Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. Methods We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed intraoperative hypertensive crisis. Results A patient with history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Work-up revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade prior to the second stage. Serum catecholamine levels following this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in cathecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. Conclusion Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma. PMID:25352487

  18. Reliability of pre- and intraoperative tests for biliary lithiasis

    SciTech Connect

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  19. Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation.

    PubMed

    Frisch, Nicholas B; Charters, Michael A; Sikora-Klak, Jakub; Banglmaier, Richard F; Oravec, Daniel J; Silverton, Craig D

    2015-08-01

    Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading. Metallic constructs with a positive locking system performed the best, supporting the highest loads with minimal implant subsidence (both axial and angular) after loading. Overall, the CoCr cable and hose clamp had the highest construct stiffness and least reduction in stiffness with increased loading. They were not demonstrably different from each other. PMID:25765131

  20. Intraoperative raster photogrammetry--the PAR Corneal Topography System.

    PubMed

    Belin, M W

    1993-01-01

    The PAR Corneal Topography System (CTS) is a computer-driven corneal imaging system that uses close-range raster photogrammetry to measure and produce a topographic map of the corneal surface. The CTS determines distortion in a projected two-dimensional grid. Unlike Placido-disc-based videokeratoscopes, the PAR CTS produces a true topographic map (elevation map) and requires neither a smooth reflective surface nor precise spatial alignment for accurate imaging. Because the system uses two noncoaxial optical paths, it can be integrated into other optical devices. A modified CTS was integrated into an experimental erbium: YAG photoablative laser. The CTS successfully imaged corneas before, after, and during laser photoablation. Its ability to image nonreflective surfaces and to be integrated into other optical systems may make it suitable for intraoperative refractive monitoring. PMID:8450443

  1. Beyond conventional pathology: towards preoperative and intraoperative lymph node staging.

    PubMed

    Winter, Marnie; Gibson, Rachel; Ruszkiewicz, Andrew; Thompson, Sarah K; Thierry, Benjamin

    2015-02-15

    Accurate detection of lymph node metastases is critical for many solid tumours to guide treatment strategies and determine prognostic outcomes. The gold standard for detection of metastasis is by histological analysis of formalin-fixed paraffin-embedded (FFPE) sections of removed lymph nodes; this analysis method has remained largely unchanged for decades. Recent studies have highlighted limitations in the sensitivity of this approach, at least in its current clinical use, to detect very small metastatic deposits. Importantly, the poor prognostic outcomes associated with the presence of such small tumour deposits are now well established in a number of cancers. In addition, histological analysis of FFPE sections cannot be used practically for intraoperative node assessment. Novel lymph node staging technologies are therefore actively being developed. This review critically presents the main advances in this field and discusses why these technologies have not been able to provide a better alternative to the current gold standard diagnostic technique. PMID:24469881

  2. Hybrid intraoperative pulmonary artery stenting in redo congenital cardiac surgeries

    PubMed Central

    Sridhar, Anuradha; Subramanyan, Raghavan; Premsekar, Rajasekaran; Chidambaram, Shanthi; Agarwal, Ravi; Manohar, Soman Rema Krishna; Cherian, K.M.

    2014-01-01

    Objective Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. Methods We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. Results Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (1226) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. Conclusion Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy. PMID:24581095

  3. Single-trial detection for intraoperative somatosensory evoked potentials monitoring.

    PubMed

    Hu, L; Zhang, Z G; Liu, H T; Luk, K D K; Hu, Y

    2015-12-01

    Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring. PMID:26557929

  4. Treatment of symptomatic intraosseous pneumatocyst using intraoperative navigation.

    PubMed

    Formby, Peter M; Kang, Daniel G; Potter, Benjamin K; Forsberg, Jonathan A

    2015-03-01

    Intraosseous pneumatocysts are benign air-containing lesions that are most often found in the spine and pelvis and are nearly always treated nonoperatively. Although rarely clinically symptomatic, studies have shown pneumatocysts to be present in up to 10% of computed tomography (CT) scans of the pelvis and spine. Radiographic characteristics of these lesions include a localized collection of gas with a thin sclerotic rim, no bony destruction, no soft tissue masses, and no medullary abnormalities. Computed tomography is the diagnostic study of choice, with Hounsfield units ranging from -580 to -950, showing a gas-containing lesion. Few studies have described the management of symptomatic pneumatocysts, and all reported cases concern underwater divers, presumably because of greater pressure cycling and barotrauma encountered while underwater diving. The goal of this report is to describe the intraoperative CT-guided navigation and percutaneous injection of calcium sulfate-calcium phosphate composite bone graft substitute material for the treatment of a symptomatic pneumatocyst in the ilium of a Navy dive instructor. The patient reported a 1-year history of increasing buttock pain with increased depth of diving, consistently reproduced by diving past a depth of 20 to 30 feet. To the authors' knowledge, this is the first description in the English literature of the operative treatment of an intraosseous pneumatocyst of the ilium. The use of intraoperative CT guidance permitted accurate percutaneous localization, decompression, and filling of the lesion with synthetic bone graft substitute, with complete early relief of symptoms. At 6-month follow up, the patient had reached diving depths of 170 feet without pain. PMID:25760515

  5. Bacteremia during dacryocystorhinostomy: results of intra-operative blood cultures

    PubMed Central

    2014-01-01

    Background The aims of the study are to assess the prevalence of bacteremia during dacryocystorhinostomy (DCR) and to assess whether there is a need for post-operative prophylaxis. Prospective interventional study of 52 consecutive dacryocystorhinostomy performed in 50 patients over a period of 1year from 2013 to 2014. Blood was drawn under strict aseptic conditions during two separate time points: fashioning of the nasal mucosal and creation of lacrimal sac flaps. The blood was inoculated into two blood culture bottles: the dual media as well as Columbia broth. Following withdrawal of blood, all patients received an intraoperative single dose of a cephalosporin antibiotic. Clean cases of primary acquired nasolacrimal duct obstructions (PANDO) without any sac discharge upon marsupialization (22%, 11/50) were not prescribed routine post-operative prophylaxis, whereas the remaining were prescribed oral antibiotics for 5days. Results The mean age of patients was 41years (range, 461years). The most common diagnosis (70%, 35/50) was primary acquired nasolacrimal duct obstruction. Acute dacryocystitis was noted in 12% (6/50). External DCR was performed in 65% (34/52) and endoscopic DCR in 35% (18/52) of the cases. All the blood cultures were uniformly negative both in terms of abnormal physical changes in media as well subcultures; 22% (11/50) did not receive post-operative antibiotic prophylaxis. None of the patients developed any signs of wound infections. The anatomical and functional success rate was achieved in 98%. Conclusions This study did not find any intraoperative bacteremia during dacryocystorhinostomy and that none had wound infection irrespective of post-operative prophylaxis. PMID:25320650

  6. Intra-operative radiotherapy in soft tissue sarcomas.

    PubMed

    Dubois, J B; Debrigode, C; Hay, M; Gely, S; Rouanet, P; Saint-Aubert, B; Pujol, H

    1995-02-01

    We treated 31 soft tissue sarcoma bearing patients with intraoperative radiation therapy (IORT) with ages ranging from 26 to 71: first curative intent treatment, 16 patients; and recurrent tumors, 15 patients. The tumor site was the pelvis and the retroperitoneal spaces in 13 patients and the limbs or the trunk in 18 patients. The histological type was: malignant histiocytofibroma, 14 patients; liposarcomas, 10 patients; malignant schwanoma, 1 patient; leiomyosarcoma, 2 patients; hemangiopericytoma, 1 patient; embryonic rhabdomyosarcoma, 2 patients; and synovialosarcoma, 1 patient. All the patients were diagnosed without any distant metastatic evolution at the moment of the treatment. All the patients except one underwent a complete surgical excision without any gross residual disease and received an intraoperative radiation single dose of 10 Gy in one case, 12.5 Gy in one case, 13 Gy in one case, 15 Gy in 17 cases, 18 Gy in three cases, 20 Gy in seven cases and 25 Gy in one case. Thereafter the treatment was completed by a postoperative X-ray dose of 45-50 Gy in 4.5-5 weeks for 16 patients. Local control (LC) was obtained in 27 out of 31 patients (87%), with a minimal follow-up duration of 2 years. Eleven out of 31 patients died: seven with local control (one from an intercurrent disease, six from distant metastasis) and four with local failure inside the IORT fields. Twenty patients are alive with no evolutive disease in 19 cases and with a distant metastasis in one case.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7597215

  7. Does intraoperative fluoroscopy improve component positioning in total hip arthroplasty?

    PubMed

    Tischler, Eric H; Orozco, Fabio; Aggarwal, Vinay K; Pacheco, Haroldo; Post, Zachary; Ong, Alvin

    2015-01-01

    Accurate placement of components is imperative for successful outcomes after total hip arthroplasty (THA). Although technology-assisted techniques offer the potential for greater accuracy in prosthesis positioning, the need for additional resources prevents their widespread use. The goal of this study was to compare primary THA procedures performed with and without intraoperative fluoroscopic guidance with regard to accuracy of prosthesis placement, operative time, and postoperative complications. The authors reviewed 341 consecutive cases (330 patients) undergoing primary THA at the authors' institution from September 2007 to January 2010. Postoperative anteroposterior radiographs were used to measure acetabular inclination angle, leg length discrepancy, and femoral offset discrepancy. Operative time and postoperative complications related to implant positioning were recorded. Mean acetabular inclination angle, leg length discrepancy, and offset discrepancy for control vs study groups were 43.0° (range, 32.2°-61.4°) vs 43.8° (range, 29.0°-55.1°), 4.75 mm (range, 0-25) vs 4.24 mm (range, 0-27), and 8.47 mm (range, 0-9.7) vs 7.70 mm (range, 0-31), respectively. Complication rates were not significantly different between the control (8.1%) and study (5.3%) groups. Mean operative time was significantly higher in the study group compared with the control group (59.8 vs 52.8 minutes) (P<.0001). The findings showed that intraoperative fluoroscopy may not improve prosthesis accuracy or decrease postoperative complication rates compared with a freehand technique. Because of significantly increased operative time and cost associated with fluoroscopic guidance, the authors discourage the use of this technique in uncomplicated primary THA performed at high-volume arthroplasty institutions. PMID:25611413

  8. Predicting Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery to Middle Cerebral Artery Bypass based on Intraoperative Perfusion-Weighted Magnetic Resonance Imaging

    PubMed Central

    Wang, Defeng; Zhu, Fengping; Fung, Ka Ming; Zhu, Wei; Luo, Yishan; Chu, Winnie Chiu Wing; Tong Mok, Vincent Chung; Wu, Jinsong; Shi, Lin; Ahuja, Anil T.; Mao, Ying

    2015-01-01

    Moyamoya disease leads to the formation of stenosis in the cerebrovasculature. A superficial temporal artery to middle cerebral artery (STA-MCA) bypass is an effective treatment for the disease, yet it is usually associated with postoperative cerebral hyperperfusion syndrome (CHS). This study aimed to evaluate cerebral hemodynamic changes immediately after surgery and assess whether a semiquantitative analysis of an intraoperative magnetic resonance perfusion-weighted image (PWI) is useful for predicting postoperative CHS. Fourteen patients who underwent the STA-MCA bypass surgery were included in this study. An atlas-based registration method was employed for studying hemodynamics in different cerebral regions. Pre- versus intraoperative and group-wise comparisons were conducted to evaluate the hemodynamic changes. A postoperative increase in relative cerebral blood flow (CBF) at the terminal MCA territory (P?=?0.035) and drop in relative mean-time-transit at the central MCA territory (P?=?0.012) were observed in all patients. However, a significant raise in the increasing ratio of relative-CBF at the terminal MCA territory was only found in CHS patients (P?=?0.023). The cerebrovascular changes of the patients after revascularization treatment were confirmed. Intraoperative PWI might be helpful in predicting the change in relative-CBF at MCA terminal territory which might indicate a risk of CHS. PMID:26365751

  9. Glaciology: Repeat warming in Greenland

    NASA Astrophysics Data System (ADS)

    Smith, Benjamin E.

    2012-06-01

    Greenland's glaciers have lost significant amounts of ice over the past decade. Rediscovered historical images of the ice margin show a record of southeast Greenland's response to the last major warming event in the 1930s.

  10. Separating Contributions from Anthropogenic Warming and from Natural Oscillations to Global Warming

    NASA Astrophysics Data System (ADS)

    Konrad Stips, Adolf; Macias, Diego; Garcia-Gorriz, Elisa

    2014-05-01

    During the past five decades, global air temperatures have been warming at a rather high rate (IPCC-2013) resulting in scientific and social concern. This warming trend is observed in field data sampling and model simulations and affects both air temperatures over land and over the ocean. However, the warming rate changes with time and this has led to question the causes underlying the observed trends. Here, we analyze recent measured and modeled data on global mean surface air temperature anomalies (GMTA) covering the last 160 years using spectral techniques. The spectral analysis of the measured data does show a strong secular trend (ST) and a clear multidecadal sinusoidal oscillation (MDV) that resembles the Atlantic Multidecadal Oscillation (AMO). The observed acceleration of the warming during the period from 1970 to 2000 therefore appears to be caused by a superimposition of anthropogenic-induced warming (~60%) with the positive phase of a multidecadal oscillation (~40%), while the recent slowdown (hiatus) of this tendency is likely due to a shift in the MDV phase. It has been proposed that this change in the MDV phase could mask the effect of global warming in the forthcoming decades and our analysis indicates that this is quite likely, the current hiatus being already a manifestation of this phenomenon. Most current generation global circulation models (CMIP5) do not reproduce this MDV and are missing the actual temperature hiatus. Therefore, it is less likely that such models could correctly forecast the temperature evolution during the coming decades. We propose here to use the climate dynamics that is inherent in the GMTA data to forecast temperatures until 2100. These forecasts, based on the analyzed secular trend and the multidecadal oscillations are indeed capable of reproducing the actual hiatus and generally result, in comparison to CMIP5 forecasts, in much lower temperature increases for 2100 of only about 1oC. Global mean air temperatures could be even decreasing for the next 2-3 decades. Henceforth, for a correct assessment of the anthropogenic-induced warming of the global air temperatures in the future natural multidecadal temperature oscillations should be taken into account.

  11. Impact of Surface Curvature on Dose Delivery in Intraoperative High-Dose-Rate Brachytherapy

    SciTech Connect

    Oh, Moonseong Wang Zhou; Malhotra, Harish K.; Jaggernauth, Wainwright; Podgorsak, Matthew B.

    2009-04-01

    In intraoperative high-dose-rate (IOHDR) brachytherapy, a 2-dimensional (2D) geometry is typically used for treatment planning. The assumption of planar geometry may cause serious errors in dose delivery for target surfaces that are, in reality, curved. A study to evaluate the magnitude of these errors in clinical practice was undertaken. Cylindrical phantoms with 6 radii (range: 1.35-12.5 cm) were used to simulate curved treatment geometries. Treatment plans were developed for various planar geometries and were delivered to the cylindrical phantoms using catheters inserted into Freiburg applicators of varying dimension. Dose distributions were measured using radiographic film. In comparison to the treatment plan (for a planar geometry), the doses delivered to prescription points were higher on the concave side of the geometry, up to 15% for the phantom with the smallest radius. On the convex side of the applicator, delivered doses were up to 10% lower for small treated areas ({<=} 5 catheters) but, interestingly, the dose error was negligible for large treated areas (>5 catheters). Our measurements have shown inaccuracy in dose delivery when the original planar treatment plan is delivered with a curved applicator. Dose delivery errors arising from the use of planar treatment plans with curved applicators may be significant.

  12. Effect of Intraoperative Corneal Stromal Pocket Irrigation in Small Incision Lenticule Extraction

    PubMed Central

    Liu, Yu-Chi; Jayasinghe, Lasitha; Ang, Heng Pei; Lwin, Nyein Chan; Yam, Gary Hin Fai; Mehta, Jodhbir S.

    2015-01-01

    This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Sixteen rabbit eyes underwent a SMILE procedure, with 8 eyes having corneal pocket irrigation, while the other 8 eyes were without irrigation. Another 16 eyes underwent a FS-LASIK procedure for comparison, with 8 eyes having flap irrigation, while the other 8 eyes were without irrigation. The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness. However, at postoperative 8 hours, in vivo confocal microscopy showed that the interface reflectivity in the SMILE with irrigation group was significantly higher than that in other three groups. The presence of interface fluid was further confirmed by the identification of fluid pockets with undulated collagen shown on histological section in the post-SMILE with irrigation eyes. Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required. PMID:26273659

  13. Intraoperative Imaging Guidance for Sentinel Node Biopsy in Melanoma Using a Mobile Gamma Camera

    PubMed Central

    Dengel, Lynn T.; More, Mitali J.; Judy, Patricia G.; Petroni, Gina R.; Smolkin, Mark E.; Rehm, Patrice K.; Majewski, Stan; Williams, Mark B.; Slingluff, Craig L.

    2016-01-01

    Objective To evaluate the sensitivity and clinical utility of intraoperative mobile gamma camera (MGC) imaging in sentinel lymph node biopsy (SLNB) in melanoma. Background The false-negative rate for SLNB for melanoma is approximately 17%, for which failure to identify the sentinel lymph node (SLN) is a major cause. Intraoperative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. The present pilot study reports outcomes with a prototype MGC designed for rapid intraoperative image acquisition. We hypothesized that intraoperative use of the MGC would be feasible and that sensitivity would be at least 90%. Methods From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intraoperative MGC imaging. Sensitivity was calculated for each detection method. Intraoperative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded. Results Sensitivity for detecting SLN basins was 97% for the FGC and 90% for the MGC. A total of 46 SLN were identified: 32 (70%) were identified as distinct hot spots by preoperative FGC imaging, 31 (67%) by preoperative MGC imaging, and 43 (93%) by MGC imaging pre- or intraoperatively. The gamma probe identified 44 (96%) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25%) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 19 (1 = best). Conclusions Intraoperative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90% and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intraoperative imaging, which holds promise for reducing false negatives of SLNB for melanoma. PMID:21475019

  14. Intraoperative Imaging Guidance for Sentinel Node Biopsy in Melanoma Using a Mobile Gamma Camera

    SciTech Connect

    Dengel, Lynn T; Judy, Patricia G; Petroni, Gina R; Smolkin, Mark E; Rehm, Patrice K; Majewski, Stan; Williams, Mark B

    2011-04-01

    The objective is to evaluate the sensitivity and clinical utility of intraoperative mobile gamma camera (MGC) imaging in sentinel lymph node biopsy (SLNB) in melanoma. The false-negative rate for SLNB for melanoma is approximately 17%, for which failure to identify the sentinel lymph node (SLN) is a major cause. Intraoperative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. The present pilot study reports outcomes with a prototype MGC designed for rapid intraoperative image acquisition. We hypothesized that intraoperative use of the MGC would be feasible and that sensitivity would be at least 90%. From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intraoperative MGC imaging. Sensitivity was calculated for each detection method. Intraoperative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded. Sensitivity for detecting SLN basins was 97% for the FGC and 90% for the MGC. A total of 46 SLN were identified: 32 (70%) were identified as distinct hot spots by preoperative FGC imaging, 31 (67%) by preoperative MGC imaging, and 43 (93%) by MGC imaging pre- or intraoperatively. The gamma probe identified 44 (96%) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25%) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 1-9 (1 = best). Intraoperative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90% and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intraoperative imaging, which holds promise for reducing false negatives of SLNB for melanoma.

  15. Theory and Simulation of Warm Dense Matter Targets

    SciTech Connect

    Barnard, J J; Armijo, J; More, R M; Friedman, A; Kaganovich, I; Logan, B G; Marinak, M M; Penn, G E; Sefkow, A B; Santhanam, P; Wurtele, J S

    2006-07-13

    We present simulations and analysis of the heating of warm dense matter foils by ion beams with ion energy less than one MeV per nucleon to target temperatures of order one eV. Simulations were carried out using the multi-physics radiation hydrodynamics code HYDRA and comparisons are made with analysis and the code DPC. We simulate possible targets for a proposed experiment at LBNL (the so-called Neutralized Drift Compression Experiment, NDCXII) for studies of warm dense matter. We compare the dynamics of ideally heated targets, under several assumed equation of states, exploring dynamics in the two-phase (fluid-vapor) regime.

  16. MULTIGLAND DISEASE AND SLOWER DECLINE IN INTRAOPERATIVE PTH CHARACTERIZE MILD PRIMARY HYPERPARATHYROIDISM

    PubMed Central

    Schneider, David F.; Burke, Jocelyn F.; Ojomo, Kristin A.; Clark, Nicholas; Mazeh, Haggi; Sippel, Rebecca S.; Chen, Herbert

    2014-01-01

    BACKGROUND Many patients with primary hyperparathyroidism (PHPT) present with less severe biochemical parameters. The purpose of this study was to compare the presentation, operative findings, and outcomes of these patients with mild PHPT to patients with overt disease. METHODS A retrospective review of a prospectively collected parathyroid database was performed to identify cases of PHPT undergoing an initial neck operation. Patients were classified as mild when either the preoperative calcium or PTH was within the normal limits. Comparisons were made with the students t-test, Chi-squared test, or Wilcox on rank-sum test where appropriate. Kaplan-Meier estimates were plotted for disease-free survival and compared by the log-rank test. RESULTS Of the 1,429 patients who met inclusion criteria, 1,049 were classified as overt and 388 (27.1%) were mild. Within the mild group, 122 (31.4%) presented with normocalcemic PHPT and 266 (68.6%) had a normal PTH. The two groups had similar demographics and renal function. Interestingly, the mild group had more than double the rate of kidney stones (3.1% vs. 1.3%, p = 0.02). The mild group was less likely to localize on sestamibi scan (62.4% vs. 78.7%, p<0.01). Intraoperatively, more mild patients exhibited multigland disease (34.3% vs. 14.1%, p<0.01). When examining intraoperative PTH (IoPTH) kinetics where single adenomas were excised, the IoPTH fell at a rate of 6.9 pg/min in mild patients compared to 11.5 pg/min in the overt group (p<0.01). Accordingly, 62.2% of patients in the overt group and 53.3% in the mild group were cured at five minutes post-excision (p<0.01). There was no difference in the rates of persistence or recurrence between the groups, and disease-free survival estimates were identical (p = 0.27). CONCLUSIONS Patients with mild PHPT were more likely to have multigland disease and a slower decline in IoPTH, but these patients can be successfully treated with surgery. PMID:23943034

  17. The Great Warming Brian Fagan

    NASA Astrophysics Data System (ADS)

    Fagan, B. M.

    2010-12-01

    The Great Warming is a journey back to the world of a thousand years ago, to the Medieval Warm Period. Five centuries of irregular warming from 800 to 1250 had beneficial effects in Europe and the North Atlantic, but brought prolonged droughts to much of the Americas and lands affected by the South Asian monsoon. The book describes these impacts of warming on medieval European societies, as well as the Norse and the Inuit of the far north, then analyzes the impact of harsh, lengthy droughts on hunting societies in western North America and the Ancestral Pueblo farmers of Chaco Canyon, New Mexico. These peoples reacted to drought by relocating entire communities. The Maya civilization was much more vulnerable that small-scale hunter-gatherer societies and subsistence farmers in North America. Maya rulers created huge water storage facilities, but their civilization partially collapsed under the stress of repeated multiyear droughts, while the Chimu lords of coastal Peru adapted with sophisticated irrigation works. The climatic villain was prolonged, cool La Niñalike conditions in the Pacific, which caused droughts from Venezuela to East Asia, and as far west as East Africa. The Great Warming argues that the warm centuries brought savage drought to much of humanity, from China to Peru. It also argues that drought is one of the most dangerous elements in today’s humanly created global warming, often ignored by preoccupied commentators, but with the potential to cause over a billion people to starve. Finally, I use the book to discuss the issues and problems of communicating multidisciplinary science to the general public.

  18. How warm days increase belief in global warming

    NASA Astrophysics Data System (ADS)

    Zaval, Lisa; Keenan, Elizabeth A.; Johnson, Eric J.; Weber, Elke U.

    2014-02-01

    Climate change judgements can depend on whether today seems warmer or colder than usual, termed the local warming effect. Although previous research has demonstrated that this effect occurs, studies have yet to explain why or how temperature abnormalities influence global warming attitudes. A better understanding of the underlying psychology of this effect can help explain the public's reaction to climate change and inform approaches used to communicate the phenomenon. Across five studies, we find evidence of attribute substitution, whereby individuals use less relevant but available information (for example, today's temperature) in place of more diagnostic but less accessible information (for example, global climate change patterns) when making judgements. Moreover, we rule out alternative hypotheses involving climate change labelling and lay mental models. Ultimately, we show that present temperature abnormalities are given undue weight and lead to an overestimation of the frequency of similar past events, thereby increasing belief in and concern for global warming.

  19. Analysis of data from spacecraft (stratospheric warmings)

    NASA Technical Reports Server (NTRS)

    Anderson, A. D.

    1974-01-01

    Links between the upper atmosphere and the stratosphere were studied to explain stratospheric warmings, and to correlate the warmings with other terrestrial and solar phenomena. Physical mechanisms for warming, or which may act as a trigger are discussed along with solar and geophysical indices. Two stratospheric warming cases are analyzed.

  20. Active Movement Warm-Up Routines

    ERIC Educational Resources Information Center

    Walter, Teri; Quint, Ashleigh; Fischer, Kim; Kiger, Joy

    2011-01-01

    This article presents warm-ups that are designed to physiologically and psychologically prepare students for vigorous physical activity. An active movement warm-up routine is made up of three parts: (1) active warm-up movement exercises, (2) general preparation, and (3) the energy system. These warm-up routines can be used with all grade levels

  1. Activation of Sahelian monsoon under future warming

    NASA Astrophysics Data System (ADS)

    Schewe, Jacob; Levermann, Anders

    2015-04-01

    Rainfall variability in the Sahel has been affecting the lives of millions through devastating droughts, such as in the 1970s and 80s, but also destructive rain and flood events. Future climate change is likely to alter rainfall patterns, but model projections for the central Sahel diverge significantly, with climate models simulating anything between a slight drying and a substantial wetting trend. Here we analyze 30 coupled global climate model simulations from the CMIP5 archive. We identify seven models where central Sahel rainfall increases by 40% to 300% over the 21st century, under the RCP8.5 concentration pathway. The same models also outperform the rest of the ensemble in reproducing the magnitude of the 1970s/80s drought. The magnitude and seasonality of the projected future rainfall change, together with a concurrent increase in near-surface wind speed, indicate a northward expansion of the West African monsoon domain. We further find that Sahel rainfall does not increase linearly with rising global temperatures; it is insensitive to moderate warming but then abruptly intensifies beyond a certain temperature. This non-linearity is even more pronounced when instead of global warming, sea surface temperature change in the tropical Atlantic moisture source region is considered. We propose an explanation for this behavior based on a self-amplifying dynamic-thermodynamical feedback, and suggest that the gradual increase in oceanic moisture availability under climate change can trigger the sudden activation of a continental monsoon in the Sahel region, which reaches further inland than the present-day, predominantly coastal West African monsoon. Such an abrupt regime change in response to gradual forcing would be consistent with paleoclimatic records from the Sahel region. More detailed comparison between the model simulations that exhibit this sudden rainfall increase under future warming and those that do not may help to verify this hypothesis.

  2. Warming early Earth and Mars

    SciTech Connect

    Kasting, J.F.

    1997-05-23

    Sagan and Chyba, in their article on page 1217 of this issue, have revived an old debate about how liquid water was maintained on early Earth and Mars despite a solar luminosity 25 to 30% lower than that at present. A theory that has been popular for some time is that greatly elevated concentrations of atmospheric COD produced by the action of the carbonate-silicate cycle, provided enough of a greenhouse effect to warm early Earth. However, Rye et al. have placed geochemical constraints on early atmospheric CO{sub 2} abundances that fall well below the levels needed to warm the surface. These constraints are based on the absence of siderite (FeCO{sub 3}) in ancient soil profiles-a negative and, hence, rather weak form of evidence- and apply to the time period 2.2 to 2.8 billion years ago, when Earth was already middle aged. Nonetheless, the soil data provide some indication that atmospheric CO{sub 2} levels may have been lower than previously thought. An even more serious problem arises if one tries to keep early Mars warm with CO{sub 2}. Model calculations predict that CO{sub 2} clouds would form on Mars in the upper troposphere, reducing the lapse rate and severely limiting the amount of surface warming. A suggestion that CO{sub 2} clouds may have warmed the planet radiatively has yet to be borne out by detailed calculations. 26 refs.

  3. Alternative cost-effective method to record 3D intra-operative images: a technical note.

    PubMed

    Barone, Damiano Giuseppe; Ban, Vin Shen; Kirollos, Ramez W; Trivedi, Rikin A; Bulters, Diederik O; Ribas, Guilherme Carvalhal; Santarius, Thomas

    2014-12-01

    The educational value of stereoscopic imaging in neurosurgical training has increasingly been appreciated and its use increased during the last decade. We describe a technique that we developed to acquire and reproduce intra-operative stereoscopic images. PMID:24971491

  4. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery.

    PubMed

    De Witte, E; Satoer, D; Robert, E; Colle, H; Verheyen, S; Visch-Brink, E; Marin, P

    2015-01-01

    Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located. PMID:25526520

  5. Single high dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study

    SciTech Connect

    Goldson, A.L.; Ashaveri, E.; Espinoza, M.C.

    1981-07-01

    Phase I toxicity studies with intraoperative radiotherapy proved to be a feasible adjunct to surgery for unresectable malignancies of the pancreas at Howard University Hospital. There have been minimal side effects or complications related to the combination of limited surgical decompression and intraoperative radiotherapy alone. The toxic effects of intraoperative radiotherapy on normal tissues is being assessed on a dose volume basis. Doses of 2000 to 2500 rad in a single exposure to include the pancreas, regional nodes and duodenum are acceptable if the total treatment volume is less than or equal to 100 cm. The tumoricidal effects on the cancer are demonstratable when one reviews the pathological specimens that illustrate massive tumor necrosis and fibros replacement, but in all cases reviewed, viable cancer was noted. Intraoperative radiotherapy, therefore, represents a significant boost dose for resectable, partially resectable or non-resectable tumors when added to conventional external beam irradiation and/or chemotherapy. Preliminary clinical data and minimal toxicity justifies further investigation.

  6. Safe use of subdermal needles for intraoperative monitoring with MRI.

    PubMed

    Darcey, Terrance M; Kobylarz, Erik J; Pearl, Michael A; Krauss, Patricia J; Ferri, Stephanie A; Roberts, David W; Bauer, David F

    2016-03-01

    OBJECTIVE The purpose of this study was to develop safe, site-specific procedures for placing and leaving subdermal needle leads for intraoperative monitoring (IOM) during intraoperative MRI procedures. METHODS The authors tested a variety of standard subdermal needle electrodes designed and FDA-approved for IOM in the conventional operating room. Testing was used to determine the conditions necessary to avoid thermal injury and significant image artifacts with minimal disruption of IOM and MRI procedures. Phantom testing was performed with a fiber optic (lead) temperature monitoring system and was followed by testing of leads placed in a healthy volunteer. The volunteer testing used electrode placements typical of standard IOM cases, together with radiofrequency (RF) coil placement and imaging sequences routinely employed for these case types. Lead length was investigated to assess heating effects for electrodes placed within the RF coil. RESULTS The authors found that conventional stainless steel (SS) and platinum/iridium (Pt/Ir) subdermal needles can be used safely without significant heating when placed outside the RF coil, and this accounts for the majority or entirety of electrode placements. When placed within the RF coil, Pt/Ir leads produced minimal image artifacts, while SS leads produced potentially significant artifacts. In phantom testing, significant heating was demonstrated in both SS and Pt/Ir leads placed within the RF coil, but only during high-resolution T2-weighted scanning. This problem was largely, but not completely, eliminated when leads were shortened to 25 cm. Human testing was unremarkable except for nonpainful heating detected in a few electrodes during thin-slice (1.5 mm) FLAIR scanning. Transient irritation (skin reddening along the needle tract) was noted at 2 of the electrodes with detectable heating. CONCLUSIONS The authors were satisfied with the safety of their site-specific procedures and have begun with off-label use (following institutional review board approval and obtaining patient informed consent) of tested monitoring leads in cases that combine IOM and MRI. The authors recommend that all facilities perform their own site-specific testing of monitoring leads before proceeding with their routine use. PMID:26926059

  7. Warm measurements of CBA superconducting magnets

    SciTech Connect

    Engelmann, R.; Herrera, J.; Kahn, S.; Kirk, H.; Willen, E.; Yamin, P.

    1983-01-01

    We present results on magnetic field measurements of CBA dipole magnets in the warm (normal conductor) and cryogenic (superconducting) states. We apply two methods for the warm measurements, a dc and ac method. We find a good correlation between warm and cryogenic measurements which lends itself to a reliable diagnosis of magnet field errors using warm measurements early in the magnet assembly process. We further find good agreement between the two warm measurement methods, both done at low currents.

  8. Toward the next generation of simulator for intraoperative navigation of scoliotic spine surgeries.

    PubMed

    Cartiaux, Olivier; Aubin, Carl-ric; Labelle, Hubert; Cheriet, Farida

    2012-01-01

    Surgical navigation systems are useful for planning pedicle screw positioning and guiding drilling trajectories. However, it is not yet possible to intraoperatively predict the correction of the scoliotic spine resulting from specific screw and rod configuration and instrumentation maneuvers. In this context, the objective of this study is to develop a novel intraoperative simulator for navigated scoliotic spine surgeries. An instrumentation strategy (pedicle screw insertion, rod attachment and rotation, set screw tightening) was computationally simulated on a synthetic model of a scoliotic spine using the preoperative radiographs in the standing position and various parameters recreating the preoperative conditions. The intraoperative decubitus position was then simulated. The resulting geometry was identified using a navigation system and transferred to the simulator, which enabled the updating of the preoperative planning, computing of clinical indices (Cobb angles, etc.) and simulation of instrumentation maneuvers. The Cobb angle decreased from 34 to 24 between the simulated pre- and intraoperative spine (before the instrumentation). Difference in pedicle screw positioning between the preoperative planning and the intraoperative situation was less than 0.5 mm. The intraoperative simulation of the rod attachment and rotation maneuvers resulted in a 12 Cobb angle. In conclusion, this preliminary study is a first step toward developing an integrated simulator for preoperative planning and intraoperative navigation of scoliotic spine surgeries. Once completed, the new intraoperative simulator will enable the surgeon to obtain real-time biomechanical feedback during the navigated surgery of a scoliotic spine, and may contribute to improve the resulting correction and instrumentation parameters (instrumented levels, surgical maneuvers, generated forces, etc.). PMID:22744520

  9. Intraoperative recordings of monophasic action potentials with chronically implantable pacemaker leads.

    PubMed

    Zrenner, B; Müssig, D; Schreieck, J; Weyerbrock, S; Schneider, M; Schaldach, M; Schömig, A; Schmitt, C

    1998-01-01

    Since the development of fractally coated Iridium electrodes recordings of monophasic action potentials are possible. Intraoperative recordings of MAP from 15 pacemaker implantations were done after positioning the chronically implantable pacemaker leads (Biotronik, Berlin, Germany) in the right ventricle by using five screw-in electrodes and ten anchor electrodes. Intraoperative recordings of MAP are possible with all implanted pacemaker leads. The recordings of typical MAP signals were always accompanied with stable electrode positions and good sensing and pacing characteristics. PMID:9474679

  10. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients.

    PubMed

    Beaty, Rachel S; Moffett, Brady S; Hall, Stuart; Kim, Jeffrey

    2015-10-01

    Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating room (n = 23), and nearly half (n = 19) of all patients were discharged home on an antiarrhythmic medication. A high incidence of adverse events was associated with intraoperative administration of antiarrhythmic medications. PMID:25981562

  11. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model

    SciTech Connect

    Kinsella, T.J.; DeLuca, A.M.; Barnes, M.; Anderson, W.; Terrill, R.; Sindelar, W.F. )

    1991-04-01

    Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy.

  12. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty.

    PubMed

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-04-01

    Background and purpose - Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of-and risk factors for-intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods - This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8-8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results - The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9-17) and 3.4% (CI: 1.3-8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation - Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  13. Continuous intraoperative TEE monitoring for a child with Fontan pathway undergoing post spinal fusion.

    PubMed

    Farid, Ibrahim S; Reddy, Abelash; Lewis, Judith; Kendrick, Elizabeth J

    2013-02-01

    The following case report describes a very challenging surgical case where the use of intraoperative, continuous TEE monitoring in the prone position was crucial for the anesthetic management (diagnosis and treatment) of a patient with single ventricle physiology. The use of TEE monitoring enabled the anesthesia team to continuously assess hemodynamic stability and respond immediately to hypotension and bradycardia in our patient, thereby providing optimal anesthetic care of the intraoperative spinal fusion patient with Fontan physiology. PMID:23833861

  14. Cosmic Rays and Global Warming

    SciTech Connect

    Sloan, T.; Wolfendale, A. W.

    2008-01-24

    Some workers have claimed that the observed temporal correlations of (low level) terrestrial cloud cover with the cosmic ray intensity changes, due to solar modulation, are causal. The possibility arises, therefore, of a connection between cosmic rays and Global Warming. If true, the implications would be very great. We have examined this claim in some detail. So far, we have not found any evidence in support and so our conclusions are to doubt it. From the absence of corroborative evidence we estimate that less than 15% at the 95% confidence level, of the 11-year cycle warming variations are due to cosmic rays and less than 2% of the warming over the last 43 years is due to this cause. The origin of the correlation itself is probably the cycle of solar irradiance although there is, as yet, no certainty.

  15. Evaluating the dominant components of warming in Pliocene climate simulations

    NASA Astrophysics Data System (ADS)

    Hill, D. J.; Haywood, A. M.; Lunt, D. J.; Hunter, S. J.; Bragg, F. J.; Contoux, C.; Stepanek, C.; Sohl, L.; Rosenbloom, N. A.; Chan, W.-L.; Kamae, Y.; Zhang, Z.; Abe-Ouchi, A.; Chandler, M. A.; Jost, A.; Lohmann, G.; Otto-Bliesner, B. L.; Ramstein, G.; Ueda, H.

    2014-01-01

    The Pliocene Model Intercomparison Project (PlioMIP) is the first coordinated climate model comparison for a warmer palaeoclimate with atmospheric CO2 significantly higher than pre-industrial concentrations. The simulations of the mid-Pliocene warm period show global warming of between 1.8 and 3.6 C above pre-industrial surface air temperatures, with significant polar amplification. Here we perform energy balance calculations on all eight of the coupled ocean-atmosphere simulations within PlioMIP Experiment 2 to evaluate the causes of the increased temperatures and differences between the models. In the tropics simulated warming is dominated by greenhouse gas increases, with the cloud component of planetary albedo enhancing the warming in most of the models, but by widely varying amounts. The responses to mid-Pliocene climate forcing in the Northern Hemisphere midlatitudes are substantially different between the climate models, with the only consistent response being a warming due to increased greenhouse gases. In the high latitudes all the energy balance components become important, but the dominant warming influence comes from the clear sky albedo, only partially offset by the increases in the cooling impact of cloud albedo. This demonstrates the importance of specified ice sheet and high latitude vegetation boundary conditions and simulated sea ice and snow albedo feedbacks. The largest components in the overall uncertainty are associated with clouds in the tropics and polar clear sky albedo, particularly in sea ice regions. These simulations show that albedo feedbacks, particularly those of sea ice and ice sheets, provide the most significant enhancements to high latitude warming in the Pliocene.

  16. Evaluating the Dominant Components of Warming in Pliocene Climate Simulations

    NASA Technical Reports Server (NTRS)

    Hill, D. J.; Haywood, A. M.; Lunt, D. J.; Hunter, S. J.; Bragg, F. J.; Contoux, C.; Stepanek, C.; Sohl, L.; Rosenbloom, N. A.; Chan, W.-L.; Kamae, Y.; Zhang, Z.; Abe-Ouchi, A.; Chandler, M. A.; Jost, A.; Lohmann, G.; Otto-Bliesner, B. L.; Ramstein, G.; Ueda, H.

    2014-01-01

    The Pliocene Model Intercomparison Project (PlioMIP) is the first coordinated climate model comparison for a warmer palaeoclimate with atmospheric CO2 significantly higher than pre-industrial concentrations. The simulations of the mid-Pliocene warm period show global warming of between 1.8 and 3.6 C above pre-industrial surface air temperatures, with significant polar amplification. Here we perform energy balance calculations on all eight of the coupled ocean-atmosphere simulations within PlioMIP Experiment 2 to evaluate the causes of the increased temperatures and differences between the models. In the tropics simulated warming is dominated by greenhouse gas increases, with the cloud component of planetary albedo enhancing the warming in most of the models, but by widely varying amounts. The responses to mid-Pliocene climate forcing in the Northern Hemisphere midlatitudes are substantially different between the climate models, with the only consistent response being a warming due to increased greenhouse gases. In the high latitudes all the energy balance components become important, but the dominant warming influence comes from the clear sky albedo, only partially offset by the increases in the cooling impact of cloud albedo. This demonstrates the importance of specified ice sheet and high latitude vegetation boundary conditions and simulated sea ice and snow albedo feedbacks. The largest components in the overall uncertainty are associated with clouds in the tropics and polar clear sky albedo, particularly in sea ice regions. These simulations show that albedo feedbacks, particularly those of sea ice and ice sheets, provide the most significant enhancements to high latitude warming in the Pliocene.

  17. Polar terrestrial ecosystems, permafrost, and extreme warm paleoclimate dynamics (Invited)

    NASA Astrophysics Data System (ADS)

    Deconto, R.; Pagani, M.; Pollard, D.; Beerling, D. J.

    2009-12-01

    Coupled Global Climate Model (GCM)-vegetation simulations of Mesozoic and early Cenozoic greenhouse paleoclimates show the importance of terrestrial ecosystems in maintaining warm continental interiors and ice-free polar land areas. Such simulations also offer excellent potential for model-data comparison, because simulated distributions of vegetation reflect a more complete seasonal picture of regional climates than the mean annual conditions reflected in most geochemical proxies. Terrestrial ecosystems may have also played a critical role in extreme climate events, such as the Palaeocene-Eocene Thermal Maximum (PETM) hyperthermal event (~55 Ma). Hitherto, most explanations of this event point to a release of isotopically light (-60 ) marine gas hydrate (methane) as the most likely cause of the ~3 carbon isotope shift and sudden 5-9 deg C global warming that characterize the event. However, mass balance arguments suggest the mass of carbon from this reservoir is insufficient to cause the presumed warming, leaving the source of the carbon and/or the strength of amplifying warming feedbacks an open question. Here we use results from a GCM to show that Antarctica was a suitable location for massive carbon sequestration in peat and permafrost-dominated environments during the Palaeocene leading up the PETM event. Levels of assumed atmospheric CO2 and CH4 concentrations around the time of the event are shown to cross the threshold for melting vast areas of frozen soil on an unglaciated Antarctic continent, which had a subaerial surface area ~25% larger than today. This previously underappreciated potential source of carbon would have been large enough to account for a significant fraction of the total warming at the PETM once a warming threshold was reached, whereby permafrost began to melt and methane and relict soil carbon were suddenly released. If this mechanism did play a role in abrupt and extreme global warming events such as the PETM, it implies serious consequences for the thawing of similar environments in the modern boreal high latitudes.

  18. Intraoperative cone beam computed tomography in the management of facial fractures.

    PubMed

    Stuck, B A; Hlse, R; Barth, T J

    2012-10-01

    Computed tomography is currently the standard in preoperative evaluation of facial fractures, but cone beam computed tomography (CBCT) or digital volume tomography (DVT) offers potential advantages. Intraoperative imaging may facilitate adequate fracture reduction, optimising fracture repair. The aim of this article is to demonstrate the potential benefits of a new mobile CBCT system in a series of patients with complex facial fractures. Intraoperative imaging was performed with the xCAT ENT portable CBCT system. Images were provided in three planes and in a three-dimensional reconstruction. This system was used for intraoperative imaging of 46 consecutive facial trauma patients. The impact of intraoperative CBCT on the management of these cases is described and two select cases are presented to illustrate the potential benefits of this technique. Intraoperative CBCT was successfully performed in all patients and has led to immediate consequences in 12 (26%) cases. In 5 cases, fracture reduction turned out to be insufficient and was further optimized and in 5 other cases the titanium implant (orbital mesh) was not placed in the optimal position and the position was corrected. Bony fragments were detected and removed in 2 cases. Intraoperative imaging provides a number of advantages over post-therapeutic imaging in the management of facial fractures. PMID:22784654

  19. Predictive roles of intraoperative blood glucose for post-transplant outcomes in liver transplantation

    PubMed Central

    Park, Chul Soo

    2015-01-01

    Diabetogenic traits in patients undergoing liver transplantation (LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids, blood transfusions, and catecholamines, which lead to intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia (> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and post-transplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values, the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia (without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover, intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT. Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various post-transplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease. PMID:26078559

  20. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    PubMed Central

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement. PMID:25544898

  1. Electrical conductivity of warm expanded aluminum

    NASA Astrophysics Data System (ADS)

    Faussurier, G.; Blancard, C.; Renaudin, P.; Silvestrelli, P. L.

    2006-05-01

    The electronic and ionic structures of warm expanded aluminum are determined self-consistently using an average-atom formalism based on density-functional theory and Gibbs Bogolyubov inequality. Ion configurations are generated using a least-square fit of the pair distribution function deduced from the average-atom model calculations. The electrical conductivity of the system is computed from the Kubo Greenwood formula for the optical conductivity implemented in a molecular dynamics scheme based on density-functional theory. This method goes beyond the Ziman approach commonly used in the average-atom formalism. Moreover, it is faster than performing ab initio molecular dynamics simulations to obtain ion configurations for the conductivity calculation. Numerical results and comparisons with experiments are presented and discussed.

  2. Electrical conductivity of warm expanded aluminum

    NASA Astrophysics Data System (ADS)

    Faussurier, Gerald; Blancard, Christophe; Renaudin, Patrick; Silvestrelli, Pier-Luigi

    2006-03-01

    The electronic and ionic structures of warm expanded aluminum are determined self-consistently using an average-atom formalism based on density-functional theory and Gibbs-Bogolyubov inequality. Ion configurations are generated using a least-square fit of the pair distribution function deduced from the average-atom model calculations. The electrical conductivity is computed from the Kubo-Greenwood formula for the optical conductivity implemented in a molecular dynamics scheme based on density-functional theory. This method goes beyond the Ziman approach used in the average-atom formalism. Moreover, it is faster than performing quantum molecular dynamics simulations to obtain ion configurations for the conductivity calculation. Numerical results and comparisons with experiments are presented and discussed.

  3. Electrical conductivity of warm expanded Al

    NASA Astrophysics Data System (ADS)

    Faussurier, G.; Blancard, C.; Renaudin, P.; Silvestrelli, P. L.

    2006-02-01

    The electronic and ionic structures of warm expanded aluminum are determined self-consistently using an average-atom formalism based on density-functional theory and Gibbs-Bogolyubov inequality. Ion configurations are generated using a least-squares fit of the pair distribution function deduced from the average-atom model calculations. The electrical conductivity is computed from the Kubo-Greenwood formula for the optical conductivity implemented in a molecular dynamics scheme based on density-functional theory. This method allows us to go beyond the Ziman approach used in the average-atom formalism. Moreover, it is faster than performing quantum molecular dynamics simulations to obtain ion configurations for the conductivity calculation. Numerical results and comparisons with experiments are presented and discussed.

  4. Electrical conductivity of warm expanded Al

    SciTech Connect

    Faussurier, G.; Blancard, C.; Renaudin, P.

    2006-02-15

    The electronic and ionic structures of warm expanded aluminum are determined self-consistently using an average-atom formalism based on density-functional theory and Gibbs-Bogolyubov inequality. Ion configurations are generated using a least-squares fit of the pair distribution function deduced from the average-atom model calculations. The electrical conductivity is computed from the Kubo-Greenwood formula for the optical conductivity implemented in a molecular dynamics scheme based on density-functional theory. This method allows us to go beyond the Ziman approach used in the average-atom formalism. Moreover, it is faster than performing quantum molecular dynamics simulations to obtain ion configurations for the conductivity calculation. Numerical results and comparisons with experiments are presented and discussed.

  5. Electronic structure of warm dense silicon dioxide

    NASA Astrophysics Data System (ADS)

    Engelhorn, K.; Recoules, V.; Cho, B. I.; Barbrel, B.; Mazevet, S.; Krol, D. M.; Falcone, R. W.; Heimann, P. A.

    2015-06-01

    The electronic structure of warm dense silicon dioxide has been investigated by x-ray absorption near-edge spectroscopy. An ultrafast optical laser pulse was used to isochorically heat a thin silicon dioxide sample, and measured spectra were compared with simulations generated by molecular dynamics and density functional theory. In comparison with the room temperature spectrum, two features were observed: a peak below the band gap and absorption within the band gap. This behavior was also observed in the simulations. From consideration of the calculated spectra, the peak below the gap is attributed to valence electrons that have been promoted to the conduction band, while absorption within the gap is attributed to broken Si-O bonds.

  6. Effect of donor pneumoperitoneum on early allograft perfusion following renal transplantation in pediatric patients: an intraoperative Doppler ultrasound study.

    PubMed

    Dave, S; Farhat, W; Pace, K; Navarro, O; Hebert, D; Khoury, A E

    2008-08-01

    Decreased perfusion and trauma during laparoscopic harvesting are proposed causative factors for DGF and rejection in children following renal transplantation with laparoscopic donor nephrectomy (LDN) allograft. We performed a retrospective review of 11 children who underwent LDN transplant and 11 preceding patients who underwent ODN transplant. Intraoperative DUS findings, creatinine values and clearance, time to nadir creatinine and AR episodes were compared. There were no significant differences in the BMI, vascular anatomy, side of nephrectomy, or warm ischemia time in the two groups. Mean follow-up duration was 11.4 and 30.4 months in LDN and ODN groups. DUS showed initial turbulent flow in five of the LDN and four of the ODN group with an average RI of 0.59 and 0.66 in the ODN and LDN groups, respectively (NS). Three patients in the ODN group had an abnormal RI compared to none in the LDN group (p = 0.034). The creatinine values, creatinine clearances (at 24 h, one, four wk and last follow-up) and AR episodes were similar in both groups. Pneumoperitoneum during LDN does not appear to have an adverse impact on early graft reperfusion. PMID:18672483

  7. Global warming at the summit

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    During the recent summit meeting between Russian President Vladimir Putin and U.S. President Bill Clinton, the two leaders reaffirmed their concerns about global warming and the need to continue to take actions to try to reduce the threat.In a June 4 joint statement, they stressed the need to develop flexibility mechanisms, including international emissions trading, under the Kyoto Protocol to the United Nations Framework Convention on Climate Change. They also noted that initiatives to reduce the risk of greenhouse warming, including specific mechanisms of the Kyoto Protocol, could potentially promote economic growth.

  8. Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma.

    PubMed

    Oldhafer, F; Ringe, K I; Timrott, K; Kleine, M; Ramackers, W; Cammann, S; Jger, M D; Klempnauer, J; Bektas, H; Vondran, F W R

    2015-01-01

    Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small. PMID:26649219

  9. A survey of the accuracy of interpretation of intraoperative cholangiograms

    PubMed Central

    Sanjay, Pandanaboyana; Tagolao, Sherry; Dirkzwager, Ilse; Bartlett, Adam

    2012-01-01

    Objectives There are few data in the literature regarding the ability of surgical trainees and surgeons to correctly interpret intraoperative cholangiograms (IOCs) during laparoscopic cholecystectomy (LC). The aim of this study was to determine the accuracy of surgeons' interpretations of IOCs. Methods Fifteen IOCs, depicting normal, variants of normal and abnormal anatomy, were sent electronically in random sequence to 20 surgical trainees and 20 consultant general surgeons. Information was also sought on the routine or selective use of IOC by respondents. Results The accuracy of IOC interpretation was poor. Only nine surgeons and nine trainees correctly interpreted the cholangiograms showing normal anatomy. Six consultant surgeons and five trainees correctly identified variants of normal anatomy on cholangiograms. Abnormal anatomy on cholangiograms was identified correctly by 18 consultant surgeons and 19 trainees. Routine IOC was practised by seven consultants and six trainees. There was no significant difference between those who performed routine and selective IOC with respect to correct identification of normal, variant and abnormal anatomy. Conclusions The present study shows that the accuracy of detection of both normal and variants of normal anatomy was poor in all grades of surgeon irrespective of a policy of routine or selective IOC. Improving operators' understanding of biliary anatomy may help to increase the diagnostic accuracy of IOC interpretation. PMID:22954003

  10. Intraoperative and external beam irradiation for locally advanced colorectal cancer.

    PubMed Central

    Gunderson, L L; Martin, J K; Bart, R W; Nagorney, D M; Fieck, J M; Wieand, H S; Martinez, A; O'Connell, M J; Martenson, J A; McIlrath, D C

    1988-01-01

    In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real. PMID:3337561

  11. Multimodality intraoperative neurophysiological monitoring during Onyx embolization of cerebrovascular malformations.

    PubMed

    Deshaies, Eric M; Singla, Amit; Allott, Geoffrey; Villwock, Mark R; Li, Fenghua; Gorji, Reza

    2015-03-01

    General anesthesia prohibits neurological examination during embolization of cerebrovascular malformations when provocative testing prior to pedicle occlusion is needed. Intraoperative neurophysiological monitoring (IONM) has the potential to fill this gap but remains relatively unexplored. We conduct a retrospective review of consecutive patients with cerebrovascular malformations treated with Onyx (ethylene vinyl alcohol copolymer, dissolved in dimethyl sulfoxide) embolization under general anesthesia with IONM from 2009 to 2012. Somatosensory evoked potentials (SSEPs), transcranial motor evoked potentials (TcMEPs), visual evoked potential (VEPs), auditory brainstem response (ABR), and electroencephalography (EEG) were used selectively in all patients depending on the location of the malformation. Provocative testing combined with IONM was performed in 28 patients over 75 sessions. Three patients demonstrated changes in TcMEPs or ABR during provocative testing, which halted the planned embolization. Two patients demonstrated changes in baseline SSEPs after embolization, despite normal IONM during provocative testing, correlating with postprocedural contralateral weakness. Six patients developed visual deficits after arterial occlusion despite unchanged VEPs and occipital EEG during provocative testing and embolization. We therefore conclude that the sensitivity of TcMEPs and SSEPs is preferable to EEG, and we strongly caution against relying on occipital recorded VEPs to predict visual deficits. PMID:26036117

  12. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma

    PubMed Central

    Nasit, Jitendra; Vaghsiya, Viren; Hiryur, Srilaxmi; Patel, Smita

    2016-01-01

    Subependymal giant cell astrocytoma (SEGA) is a low grade (WHO Grade I) tumor, usually seen in patients with tuberous sclerosis complex and commonly occurs at a lateral ventricular location. Intraoperative squash cytologic features can help in differentiating SEGA from gemistocytic astrocytoma (GA), giant cell glioblastoma and ependymoma, in proper clinical context and radiological findings, which may alter the surgical management. Here, we present a case of SEGA with squash cytologic findings and a review of cytology findings of SEGA presently available in the literature. Loose cohesive clusters of large polygonal cells containing an eccentric nucleus, evenly distributed granular chromatin, distinct to prominent nucleoli, and moderate to the abundant eosinophilic cytoplasm in a hair-like fibrillar background are the key cytologic features of SEGA. Other important features are moderate anisonucleosis and frequent binucleation and multinucleation. The absence of mitoses, necrosis, and vascular endothelial proliferation are important negative features. Other consistent features are cellular smears, few dispersed cells, few spindly strap-like cells, rare intranuclear cytoplasmic inclusion, and perivascular pseudorosettes. PMID:27013816

  13. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

    Howick, Jeremy; Cohen, Bernard Allan; McCulloch, Peter; Thompson, Matthew; Skinner, Stanley A

    2016-01-01

    In this review, we recommend means to enhance the evidence-base for intraoperative neurophysiological monitoring (IONM). We address two preliminary issues: (1) whether IONM should be evaluated as a diagnostic test or an intervention, and (2) the state of the evidence for IONM (as presented in systematic reviews, for example). Three reasons may be suggested to evaluate at least some IONM applications as interventions (or as part of an "interventional cascade"). First, practical barriers limit our ability to measure IONM diagnostic accuracy. Second, IONM results are designed to be correlated with interventions during surgery. Third, IONM should improve patient outcomes when IONM-directed intervention alters the course of surgery. Observational evidence for IONM is growing yet more is required to understand the conditions under which IONM, in its variety of settings, can benefit patients. A multi-center observational cohort study would represent an important initial compromise between the pragmatic difficulties with conducting controlled trials in IONM and the Evidence-Based Medicine (EBM) view that large scale randomized trials are required. Such a cohort study would improve the evidence base and (if justified) provide the rationale for controlled trials. PMID:26268581

  14. Multimodal correlation and intraoperative matching of virtual models in neurosurgery

    NASA Technical Reports Server (NTRS)

    Ceresole, Enrico; Dalsasso, Michele; Rossi, Aldo

    1994-01-01

    The multimodal correlation between different diagnostic exams, the intraoperative calibration of pointing tools and the correlation of the patient's virtual models with the patient himself, are some examples, taken from the biomedical field, of a unique problem: determine the relationship linking representation of the same object in different reference frames. Several methods have been developed in order to determine this relationship, among them, the surface matching method is one that gives the patient minimum discomfort and the errors occurring are compatible with the required precision. The surface matching method has been successfully applied to the multimodal correlation of diagnostic exams such as CT, MR, PET and SPECT. Algorithms for automatic segmentation of diagnostic images have been developed to extract the reference surfaces from the diagnostic exams, whereas the surface of the patient's skull has been monitored, in our approach, by means of a laser sensor mounted on the end effector of an industrial robot. An integrated system for virtual planning and real time execution of surgical procedures has been realized.

  15. Intraoperative severe hypoglycemia indicative of post-hepatectomy liver failure.

    PubMed

    Chung, Kyudon; Bang, Seunguk; Kim, Yoona; Chang, Hyuntae

    2016-02-01

    We present the first reported case of a patient with intraoperative hypoglycemia, with no predisposing factors, that was indicative of post-hepatectomy liver failure due to liver injury. A 56-year-old man was hospitalized to undergo left lateral segmentectomy, cholecystectomy and T-tube choledocholithotripsy due to calculi in the intrahepatic and common bile ducts. His medical history was unremarkable. Three hours after surgery initiation, his glucose level decreased from 84 mg/dL to below detectable levels. We infused 20 % dextrose repeatedly until his glucose level returned to within normal limits. His aspartate aminotransferase and alanine aminotransferase levels increased to over 10,000 IU/L, and his blood urea nitrogen and creatinine levels increased postoperatively. Thus, we diagnosed post-hepatectomy liver failure and hepatorenal syndrome and treated the patient conservatively. This case illustrates that, if no other causative factors for severe hypoglycemia occurring during liver resection are present, the anesthesiologist should predict post-hepatectomy liver failure due to liver injury and inform the surgeon in order to enable rapid evaluation and treatment. PMID:26329532

  16. Intraoperative localization using an armless, frameless stereotactic wand. Technical note.

    PubMed

    Barnett, G H; Kormos, D W; Steiner, C P; Weisenberger, J

    1993-03-01

    A technique of "frameless" stereotaxy that allows real-time intraoperative neurosurgical localization is described. The system is composed of four components: a hand-held probe containing two ultrasonic emitters, a microphone array that is rigidly affixed to the operating table in proximity to the surgical field, hardware to control and detect timing of signal production and reception, and a color graphics computer workstation with software to calculate and present the location of the probe tip on reconstructed neuroimaging studies. Unlike previously reported mechanical or sonic navigational devices, this system is adaptable to a wide array of neurosurgical instruments, allows free movement of the operating table and conventional patient draping, and has accuracy in the hostile operating room environment that rivals that of frame stereotaxy. In the operating room environment, using four pulse pairs with the wand positioned optimally, reproducibility of a point in space is +/- 0.6 mm. The wand has a broad range of orientations that maintain error at or below 1.0 mm. The mean error when measuring distances within a 1000-cu cm cube is 1.1 +/- 1.0 mm (1.0% +/- 0.7%). The ability to localize a fourth point (a target) in space is typically within 1.5 mm (using computerized tomography scans with a 1-mm slice thickness) but is dependent on several variables. This technology provides a powerful yet flexible tool in the neurosurgical operating room. PMID:8433160

  17. Intraoperative electro-oculographic Monitoring for Skull Base Surgery

    PubMed Central

    Fukaya, Chikashi; Katayama, Yoichi; Kasai, Masahiko; Kurihara, Jun; Yamamoto, Takamitsu

    2000-01-01

    During surgery on the skull base, preservation of the integrity of the ocular motor nerves is vitally important. Intraoperative electrophysiological monitoring methods for protecting such functions have been reported by several investigators. However, these methods so far have not been popularized sufficiently, due to the difficulty and complexity of the procedures involved. The authors have developed an extremely simple but far more reliable method using electro-oculography under total intravenous anesthesia with propofol to preserve the integrity of the ocular motor nerves. The ocular motor nerves were stimulated with a monopolar electrode intracranially, and the polarity of the waves was recorded using surface electrodes placed around the eyeball, yielding precise information concerning the locations of the oculomotor nerve and/or abducent nerve. In addition, by performing continuous monitoring, invasive procedures affecting the ocular motor nerves could be detected as spontaneous ocular movements. In practice at our department, this method has been applied in 12 cases with tumors close to the ocular motor nerves, and has produced excellent results. ImagesFigure 2Figure 4Figure 5Figure 8 PMID:17171096

  18. Intraoperative mapping of sacral nervous system (S2-4).

    PubMed

    Kumar, G Samson Sujit; Rajshekhar, Vedantam; Babu, K Srinivasa

    2006-12-01

    Electrophysiological mapping of the sacral nervous system was used during operations on 80 patients with conus and cauda equina lesions. At surgery, under controlled muscle relaxation, the sacral neural elements (S2-4) were mapped using direct mono-polar stimulation and recording of compound muscle action potentials (CMAPs) from the external anal sphincter (EAS). Responses were obtained in 86.25% (69/80) of the patients. In 33 (82.5%) out of 40 patients with preoperative deficits involving the S2-4 segments, CMAPs could be elicited. Identification of nerve roots was useful in dissection of lipomyelomeningocoeles, tumour excisions and untethering of filum terminale. In three patients, stimulation of the filum terminale elicited motor responses and, hence, it was not sectioned. Intraoperative mapping of the S2-4 nerve roots under controlled muscle relaxation is feasible in a majority of patients, including those with deficits involving S2-4. This method was useful in sparing viable nerve roots during surgery in conus and cauda equina regions, and identification of 'functional' filum terminale. PMID:17439092

  19. Intraoperative localization of brachytherapy implants using intensity-based registration

    NASA Astrophysics Data System (ADS)

    KarimAghaloo, Z.; Abolmaesumi, P.; Ahmidi, N.; Chen, T. K.; Gobbi, D. G.; Fichtinger, G.

    2009-02-01

    In prostate brachytherapy, a transrectal ultrasound (TRUS) will show the prostate boundary but not all the implanted seeds, while fluoroscopy will show all the seeds clearly but not the boundary. We propose an intensity-based registration between TRUS images and the implant reconstructed from fluoroscopy as a means of achieving accurate intra-operative dosimetry. The TRUS images are first filtered and compounded, and then registered to the fluoroscopy model via mutual information. A training phantom was implanted with 48 seeds and imaged. Various ultrasound filtering techniques were analyzed, and the best results were achieved with the Bayesian combination of adaptive thresholding, phase congruency, and compensation for the non-uniform ultrasound beam profile in the elevation and lateral directions. The average registration error between corresponding seeds relative to the ground truth was 0.78 mm. The effect of false positives and false negatives in ultrasound were investigated by masking true seeds in the fluoroscopy volume or adding false seeds. The registration error remained below 1.01 mm when the false positive rate was 31%, and 0.96 mm when the false negative rate was 31%. This fully automated method delivers excellent registration accuracy and robustness in phantom studies, and promises to demonstrate clinically adequate performance on human data as well.

  20. Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

    PubMed Central

    Oldhafer, F.; Ringe, K. I.; Timrott, K.; Kleine, M.; Ramackers, W.; Cammann, S.; Jger, M. D.; Klempnauer, J.; Bektas, H.; Vondran, F. W. R.

    2015-01-01

    Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small. PMID:26649219

  1. Intraoperative electron-beam radiotherapy and ureteral obstruction

    SciTech Connect

    Miller, Robert C.; Haddock, Michael G.; Petersen, Ivy A.; Gunderson, Leonard L.; Furth, Alfred F.

    2006-03-01

    Purpose: To quantify the risk of ureteral obstruction (UO) after intraoperative electron-beam radiotherapy (IOERT). Methods and Materials: One hundred forty-six patients received IOERT of 7.5 to 30 Gy to 168 ureters; 132 patients received external radiotherapy. Results: Follow-up ranged from 0.01 to 19.1 years (median, 2.1 years). The rates of clinically apparent type 1 UO (UO from any cause) after IOERT at 2, 5, and 10 years were 47%, 63%, and 79%, respectively. The rates of clinically apparent type 2 UO (UO occurring at least 1 month after IOERT, excluding UO caused by tumor or abscess and patients with stents) at 2, 5, and 10 years were 27%, 47%, and 70%, respectively. Multivariate analysis revealed that the presence of UO before IOERT (p < 0.001) was associated with an increased risk of clinically apparent type 1 UO. Increasing IOERT dose (p < 0.04) was associated with an increased risk of clinically apparent type 2 UO. UO rates in ureters not receiving IOERT at 2, 5, and 10 years were 19%, 19%, and 51%, respectively. Conclusions: Risk of UO after IOERT increases with dose. However, UO risk for ureters not receiving IOERT was also high, which suggests an underlying risk of ureteral injury from other causes.

  2. Risk factors for intraoperative hypotension during thyroid surgery

    PubMed Central

    Kalezic, Nevena; Stojanovic, Marina; Ladjevic, Nebojsa; Markovic, Dejan; Paunovic, Ivan; Palibrk, Ivan; Milicic, Biljana; Sabljak, Vera; Antonijevic, Vesna; Ivanovic, Branislava; Ugrinovic, Djordje; Zivaljevic, Vladan

    2013-01-01

    Background Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. Material/Methods The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. Results IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). Conclusions IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period. PMID:23548975

  3. Intraoperative surgical photoacoustic microscopy (IS-PAM) using augmented reality

    NASA Astrophysics Data System (ADS)

    Lee, Changho; Han, Seunghoon; Kim, Sehui; Jeon, Mansik; Kim, Jeehyun; Kim, Chulhong

    2014-03-01

    We have developed an intraoperative surgical photoacoustic microscopy (IS-PAM) system by integrating an optical resolution photoacoustic microscopy (OR-PAM) and conventional surgical microscope. Based on the common optical path in the OR-PAM and microscope system, we can acquire the PAM and microscope images at the same time. Furthermore, by utilizing a mini-sized beam projector, 2D PAM images are back-projected onto the microscope view plane as augmented reality. Thus, both the conventional microscopic and 2D cross-sectional PAM images are displayed on the plane through an eyepiece lens of the microscope. In our method, additional image display tool is not required to show the PAM image. Therefore, it potentially offers significant convenience to surgeons without movement of their sights during surgeries. In order to demonstrate the performance of our IS-PAM system, first, we successfully monitored needle intervention in phantoms. Moreover, we successfully guided needle insertion into mice skins in vivo by visualizing surrounding blood vessels from the PAM images and the magnified skin surfaces from the conventional microscopic images simultaneously.

  4. A review of intraoperative monitoring for spinal surgery

    PubMed Central

    Stecker, Mark M.

    2012-01-01

    Background: Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery. Methods: This is a review of the field describing the basic mechanisms behind the techniques of IONM. These include the most often utilized trancranial motor evoked potentials (Tc-MEPs), somatosensory evoked potentials (SSEPs), and stimulated and spontaneous EMG activity. It also describes some of the issues regarding practices and qualifications of practitioners. Results: Although the anatomic pathways responsible for the Tc-MEP and SSEP are well known and these clinical techniques have a high sensitivity and specificity, there is little published data showing that monitoring actually leads to improved patient outcomes. It is evident that IONM has high utility when the risk of injury is high, but may be only marginally helpful when the risk of injury is very low. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams. Conclusions: Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. Maintaining a high quality of practice with appropriately trained personnel is critical. PMID:22905324

  5. The Value of Intraoperative OCT Imaging in Vitreoretinal Surgery

    PubMed Central

    Ehlers, Justis P.; Tao, Yuankai K.; Srivastava, Sunil K.

    2014-01-01

    Purpose of review To evaluate the role of intraoperative OCT (iOCT) in vitreoretinal surgery, assess the current state-of-the art and to examine possible future directions in the field. Recent findings Numerous vitreoretinal surgical conditions and procedures have been described utilizing iOCT. These conditions include macular holes, epiretinal membranes, retinal detachments, and retinopathy of prematurity. Significant alterations appear to occur during surgical manipulations in many of these conditions that can be identified with iOCT. The most common current systems used are portable OCT probes that are either mounted to a microscope or used in a handheld fashion. Prototypes are also being utilized that are integrated into the microscope to allow for true “real-time” imaging of instrument-tissue interactions. Current generation surgical instrument materials (e.g., metal) limit optimal visualization with integrated OCT systems due to shadowing and light scattering properties. Summary The role of iOCT in vitreoretinal surgery continues to be defined by active research and enhancements to integrative technologies. Further research is needed to better define the specific applications of iOCT that impact patient outcomes and surgical decision-making. Future advancements in integrative systems, OCT-friendly instrumentation, and software algorithms will further expand the horizon of iOCT in the vitreoretinal surgical theater. As OCT transformed the clinical management of the vitreoretinal conditions, iOCT has the potential to be a paradigm-shifting technology in the operating room. PMID:24614147

  6. Intraoperative visualization and assessment of electromagnetic tracking error

    NASA Astrophysics Data System (ADS)

    Harish, Vinyas; Ungi, Tamas; Lasso, Andras; MacDonald, Andrew; Nanji, Sulaiman; Fichtinger, Gabor

    2015-03-01

    Electromagnetic tracking allows for increased flexibility in designing image-guided interventions, however it is well understood that electromagnetic tracking is prone to error. Visualization and assessment of the tracking error should take place in the operating room with minimal interference with the clinical procedure. The goal was to achieve this ideal in an open-source software implementation in a plug and play manner, without requiring programming from the user. We use optical tracking as a ground truth. An electromagnetic sensor and optical markers are mounted onto a stylus device, pivot calibrated for both trackers. Electromagnetic tracking error is defined as difference of tool tip position between electromagnetic and optical readings. Multiple measurements are interpolated into the thin-plate B-spline transform visualized in real time using 3D Slicer. All tracked devices are used in a plug and play manner through the open-source SlicerIGT and PLUS extensions of the 3D Slicer platform. Tracking error was measured multiple times to assess reproducibility of the method, both with and without placing ferromagnetic objects in the workspace. Results from exhaustive grid sampling and freehand sampling were similar, indicating that a quick freehand sampling is sufficient to detect unexpected or excessive field distortion in the operating room. The software is available as a plug-in for the 3D Slicer platforms. Results demonstrate potential for visualizing electromagnetic tracking error in real time for intraoperative environments in feasibility clinical trials in image-guided interventions.

  7. Warming up to solar energy

    SciTech Connect

    Biondo, B.

    1996-07-01

    Increasingly alarmed by threats to their financial security posed by an escalating number of weather-related catastrophes, major insurance companaies, particularly those in Europe and Asia, are starting to support a variety of measures that would slowe the production of grenhouse gases worlwide. As the insurance and banking industries turn their attention to global warming, investments in solar energy take on growing appeal.

  8. Warming permafrost in European mountains

    NASA Astrophysics Data System (ADS)

    Harris, Charles; Vonder Mhll, Daniel; Isaksen, Ketil; Haeberli, Wilfried; Sollid, Johan Ludvig; King, Lorenz; Holmlund, Per; Dramis, Francesco; Guglielmin, Mauro; Palacios, David

    2003-11-01

    Here we present the first systematic measurements of European mountain permafrost temperatures from a latitudinal transect of six boreholes extending from the Alps, through Scandinavia to Svalbard. Boreholes were drilled in bedrock to depths of at least 100 m between May 1998 and September 2000. Geothermal profiles provide evidence for regional-scale secular warming, since all are nonlinear, with near-surface warm-side temperature deviations from the deeper thermal gradient. Topographic effects lead to variability between Alpine sites. First approximation estimates, based on curvature within the borehole thermal profiles, indicate a maximum ground surface warming of +1 C in Svalbard, considered to relate to thermal changes in the last 100 years. In addition, a 15-year time series of thermal data from the 58-m-deep Murtl-Corvatsch permafrost borehole in Switzerland, drilled in creeping frozen ice-rich rock debris, shows an overall warming trend, but with high-amplitude interannual fluctuations that reflect early winter snow cover more strongly than air temperatures. Thus interpretation of the deeper borehole thermal histories must clearly take account of the potential effects of changing snow cover in addition to atmospheric temperatures.

  9. Global warming on Capitol Hill

    SciTech Connect

    Berg, T.F.

    1991-09-01

    This article reports on hearings in both congressional houses on ozone depletion and global warming. Topics covered include the drought in California, effect on electric rates, administration policy relating to international efforts to cut greenhouse gas, freons phaseout, methane emission phaseout, and energy efficiency provisions for buildings and vehicles.

  10. Policy implications of greenhouse warming

    SciTech Connect

    Not Available

    1991-01-01

    Contents: background; the greenhouse gases and their effects; policy framework; adaptation; mitigation; international considerations; findings and conclusions; recommendations; questions and answers about greenhouse warming; background information on synthesis panel members and professional staff; and membership lists for effects, mitigation, and adaptation panels.

  11. Intraoperative respiratory failure in a patient after treatment with bleomycin: previous and current intraoperative exposure to 50% oxygen.

    PubMed

    Luis, M; Ayuso, A; Martinez, G; Souto, M; Ortells, J

    1999-01-01

    Patients treated with bleomycin (BLM) are at risk of developing acute respiratory distress syndrome (ARDS) post-operatively, and this has been associated with high intraoperative concentrations of oxygen. We report progressive arterial desaturation noticeable 2 h after the start of a 4-h radical neck dissection for which the anaesthesia included 50% O2 in N2O. The patient had received two courses of bleomycin within the previous 2 months and had undergone an uneventful right hemiglossectomy under shorter but otherwise similar anaesthesia 4 weeks previously. His pulmonary function tests before the second procedure showed a slight depression of diffusing capacity (DLco) to 80% of predicted and minimal airway obstruction consistent with his history of smoking. The pulse oximetric reading during his second procedure reached 75%, but rose to 95% after treatment with methylprednisolone salbutamol and inspired O2 concentrations between 80% and 100%. By the end of the procedure, he satisfied the criteria for ARDS and was transferred to the ICU, where he developed bilateral pneumonia, deteriorated and died of multiple organ failure. This case suggests that the risk of hyperoxic pulmonary damage in patients exposed to bleomycin may increase not only with the degree and duration of hyperoxia in a given exposure, but also with the latent effects of recent previous exposure. Near normality of pulmonary function tests cannot be taken as reassurance, and small changes may have more adverse prognostic significance than in patients who have not been exposed to bleomycin. PMID:10084104

  12. MetasinAn Intra-Operative RT-qPCR Assay to Detect Metastatic Breast Cancer in Sentinel Lymph Nodes

    PubMed Central

    Al-Ramadhani, Salma; Sai-Giridhar, Priya; George, Dilushana; Gopinath, Preethi; Arkoumani, Evdokia; Jader, Samar; Sundaresan, Maryse; Salgado, Roberto; Larsimont, Dennis; Bustin, Stephen A.; Sundaresan, Vasi

    2013-01-01

    Nodal status is one of the most important prognostic factors in breast cancer. Established tests such as touch imprint cytology and frozen sections currently used in the intra-operative setting show variations in sensitivity and specificity. This limitation has led to the development of molecular alternatives, such as GeneSearch, a commercial intra-operative real-time quantitative Polymerase Chain Reaction (RT-qPCR) assay that allows the surgeon to carry out axillary clearance as a one-step process. Since GeneSearch has been discontinued, we have developed the replacement Metasin assay, which targets the breast epithelial cell markers CK19 and mammaglobin mRNA and identifies metastatic disease in sentinel lymph nodes. The optimised assay can be completed within 32 min (6 min for RNA preparation and 26 min instrument run time), making its use feasible in the intraoperative setting. An analysis by Metasin of 154 archived lymph node homogenates previously analysed by both parallel histology and GeneSearch showed concordance for 148 cases. The sensitivity and specificity of Metasin compared with GeneSearch were 95% (CI 83%99%) and 97% (CI 91%99%) respectively; compared with histology they were 95% (CI 83%99%) and 97% (CI 91%99%), respectively. The sensitivity and specificity of GeneSearch compared with histology were 90% (CI 77%96%) and 97% (CI 93%99%) respectively. The positive predictive value of Metasin was 90% and negative predictive value was 98% for both histology and GeneSearch. The positive predictive value of GeneSearch was 92% and the negative predictive value was 97% compared to histology. The discordance rates of Metasin with both GeneSearch and histology were 3.89%. In comparison, the discordance rate of GeneSearch with histology was 4.5%. Metasins robustness was independently evaluated on 193 samples previously analysed by GeneSearch from the Jules Bordet Institute, where Metasin yielded comparable results. PMID:23797656

  13. Intraoperative myogenic motor evoked potentials induced by direct electrical stimulation of the exposed motor cortex under isoflurane and sevoflurane.

    PubMed

    Kawaguchi, M; Sakamoto, T; Ohnishi, H; Shimizu, K; Karasawa, J; Furuya, H

    1996-03-01

    We monitored myogenic motor evoked potentials (MEPS) during intracranial surgery in 21 patients anesthetized with nitrous oxide in oxygen, fentanyl, and 0.75-1.5 minimum alveolar anesthetic concentration (MAC) isoflurane (n = 11) or sevoflurane (n = 10). The exposed motor cortex was stimulated with a single or train-of-five rectangular pulses at a high frequency (500 Hz), while the compound muscle action potentials (CMAPS) were recorded from the abductor pollicis brevis muscle. Neuromuscular block was monitored by recording the CMAPs from the abductor pollicis brevis muscle in response to electrical stimulation of the median nerve at the wrist (M-response). Stimulation of the motor cortex with a single pulse elicited MEPs in none of the patients, while stimulation with a train-of-five rectangular pulses at high frequency elicited MEPs in all patients. The relationship between MEP amplitude and the level of neuromuscular block induced by vecuronium infusion was evaluated in seven patients. For comparison of the individual measurements, the MEP amplitude at a M-response amplitude of 100% was calculated by means of the individual regression curve as 100% of MEP amplitude. There was a linear correlation between percent MEP amplitude and percent M-response amplitude (r = 0.81; P < 0.01). Intraoperative monitoring of MEP could be performed at a M-response amplitude above 90 % of the baseline value in 10 patients and at a M-response amplitude of 20%-50% of the baseline value in 11 patients. During monitoring of the 21 patients, MEPs did not change in 18 patients and disappeared in two patients. In the remaining patient, MEP amplitudes were attenuated to approximately 10% of the baseline value and recovered after cessation of surgical manipulation. In the two patients in whom MEPs disappeared, motor paresis developed postoperatively. We conclude that 1) intraoperative myogenic MEP monitoring is feasible during isoflurane or sevoflurane anesthesia if stimulation is performed with a short train of rectangular pulses, and 2) that electromyographic monitoring of neuromuscular block is useful to assess intraoperative MEP changes under partial neuromuscular block. PMID:8623967

  14. Equatorial refuge amid tropical warming

    NASA Astrophysics Data System (ADS)

    Karnauskas, Kristopher B.; Cohen, Anne L.

    2012-07-01

    Upwelling across the tropical Pacific Ocean is projected to weaken in accordance with a reduction of the atmospheric overturning circulation, enhancing the increase in sea surface temperature relative to other regions in response to greenhouse-gas forcing. In the central Pacific, home to one of the largest marine protected areas and fishery regions in the global tropics, sea surface temperatures are projected to increase by 2.8C by the end of this century. Of critical concern is that marine protected areas may not provide refuge from the anticipated rate of large-scale warming, which could exceed the evolutionary capacity of coral and their symbionts to adapt. Combining high-resolution satellite measurements, an ensemble of global climate models and an eddy-resolving regional ocean circulation model, we show that warming and productivity decline around select Pacific islands will be mitigated by enhanced upwelling associated with a strengthening of the equatorial undercurrent. Enhanced topographic upwelling will act as a negative feedback, locally mitigating the surface warming. At the Gilbert Islands, the rate of warming will be reduced by 0.7+/-0.3C or 25+/-9% per century, or an overall cooling effect comparable to the local anomaly for a typical El Nio, by the end of this century. As the equatorial undercurrent is dynamically constrained to the Equator, only a handful of coral reefs stand to benefit from this equatorial island effect. Nevertheless, those that do face a lower rate of warming, conferring a significant advantage over neighbouring reef systems. If realized, these predictions help to identify potential refuges for coral reef communities from anticipated climate changes of the twenty-first century.

  15. Integration of intraoperative and model-updated images into an industry-standard neuronavigation system: initial results

    NASA Astrophysics Data System (ADS)

    Schaewe, Timothy J.; Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Hiemenz Holton, Leslie; Roberts, David W.; Paulsen, Keith D.; Simon, David A.

    2013-03-01

    Dartmouth and Medtronic have established an academic-industrial partnership to develop, validate, and evaluate a multimodality neurosurgical image-guidance platform for brain tumor resection surgery that is capable of updating the spatial relationships between preoperative images and the current surgical field. Previous studies have shown that brain shift compensation through a modeling framework using intraoperative ultrasound and/or visible light stereovision to update preoperative MRI appears to result in improved accuracy in navigation. However, image updates have thus far only been produced retrospective to surgery in large part because of gaps in the software integration and information flow between the co-registration and tracking, image acquisition and processing, and image warping tasks which are required during a case. This paper reports the first demonstration of integration of a deformation-based image updating process for brain shift modeling with an industry-standard image guided surgery platform. Specifically, we have completed the first and most critical data transfer operation to transmit volumetric image data generated by the Dartmouth brain shift modeling process to the Medtronic StealthStation® system. StealthStation® comparison views, which allow the surgeon to verify the correspondence of the received updated image volume relative to the preoperative MRI, are presented, along with other displays of image data such as the intraoperative 3D ultrasound used to update the model. These views and data represent the first time that externally acquired and manipulated image data has been imported into the StealthStation® system through the StealthLink® portal and visualized on the StealthStation® display.

  16. Intraoperative Electron Radiotherapy for the Management of Aggressive Fibromatosis

    SciTech Connect

    Roeder, Falk; Timke, Carmen; Oertel, Susanne; Hensley, Frank W.; Bischof, Marc; Muenter, Marc W.; Weitz, Juergen; Buchler, Markus W.; Lehner, Burkhard; Debus, Juergen; Krempien, Robert

    2010-03-15

    Purpose: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. Methods and Materials: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). Results: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. Conclusion: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.

  17. Intraoperative positioning of mobile C-arms using artificial fluoroscopy

    NASA Astrophysics Data System (ADS)

    Dressel, Philipp; Wang, Lejing; Kutter, Oliver; Traub, Joerg; Heining, Sandro-Michael; Navab, Nassir

    2010-02-01

    In trauma and orthopedic surgery, imaging through X-ray fluoroscopy with C-arms is ubiquitous. This leads to an increase in ionizing radiation applied to patient and clinical staff. Placing these devices in the desired position to visualize a region of interest is a challenging task, requiring both skill of the operator and numerous X-rays for guidance. We propose an extension to C-arms for which position data is available that provides the surgeon with so called artificial fluoroscopy. This is achieved by computing digitally reconstructed radiographs (DRRs) from pre- or intraoperative CT data. The approach is based on C-arm motion estimation, for which we employ a Camera Augmented Mobile C-arm (CAMC) system, and a rigid registration of the patient to the CT data. Using this information we are able to generate DRRs and simulate fluoroscopic images. For positioning tasks, this system appears almost exactly like conventional fluoroscopy, however simulating the images from the CT data in realtime as the C-arm is moved without the application of ionizing radiation. Furthermore, preoperative planning can be done on the CT data and then visualized during positioning, e.g. defining drilling axes for pedicle approach techniques. Since our method does not require external tracking it is suitable for deployment in clinical environments and day-to-day routine. An experiment with six drillings into a lumbar spine phantom showed reproducible accuracy in positioning the C-arm, ranging from 1.1 mm to 4.1 mm deviation of marker points on the phantom compared in real and virtual images.

  18. Patterns of complications following intraoperative radiofrequency ablation for liver metastases

    PubMed Central

    Desolneux, Grgoire; Vara, Jeremy; Razafindratsira, Tsiriniaina; Isambert, Milne; Brouste, Vronique; McKelvie-Sebileau, Pippa; Evrard, Serge

    2014-01-01

    Background Intraoperative radiofrequency ablation (IRFA) is added to surgery to obtain hepatic clearance of liver metastases. Complications occurring in IRFA should differ from those associated with wedge or anatomic liver resection. Methods Patients with liver metastases treated with IRFA from 2000 to 2010 were retrospectively analysed. Postoperative outcomes are reported according to the ClavienDindo system of classification. Results A total of 151 patients underwent 173 procedures for 430 metastases. Of these, 97 procedures involved IRFA plus liver resection and 76 involved IRFA only. The median number of lesions treated by IRFA was two (range: 111). A total of 123 (71.1%) procedures were carried out in patients who had received preoperative chemotherapy. The mortality rate was 1.2%. Thirty (39.5%) IRFA-only patients and 45 (46.4%) IRFA-plus-resection patients presented complications. Immediate complications (n = 4) were associated with IRFA plus resection. American Society of Anesthesiologists (ASA) class, previous abdominal surgery or hepatic resection, body mass index, number of IRFA procedures, portal pedicle clamping, total vascular exclusion and preoperative chemotherapy were not associated with a greater number of complications of Grade III or higher severity. Length of surgery >4?h [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.16.3; P < 0.05] and an associated contaminating procedure (OR 3.72, 95% CI 1.539.06; P < 0.005) led to a greater frequency of complications of Grade III or higher. Conclusions Mortality and morbidity after IRFA, with or without resection, are low. Nevertheless, long interventions and concurrent bowel operations increase the risk for septic complications. PMID:24830798

  19. Intraoperative radiotherapy with electrons: fundamentals, results, and innovation

    PubMed Central

    Calvo, FA; Sole, CV; Herranz, R; Lopez-Bote, M; Pascau, J; Santos, A; Muoz-Calero, A; Ferrer, C; Garcia-Sabrido, JL

    2013-01-01

    Rationale and objectives To analyse the programme activity and clinical innovation and/or technology developed over a period of 17 years with regard to the introduction and the use of intraoperative radiotherapy (IORT) as a therapeutic component in a medicalsurgical multidisciplinary cancer hospital. Material and methods To standardise and record this procedure, the Radiation Oncology service has an institutional programme and protocols that must be completed by the different specialists involved. For 17 years, IORT procedures were recorded on a specific database that includes 23 variables with information recorded on institutional protocols. As part of the development and innovation activity, two technological tools were implemented (RADIANCE and MEDTING) in line with the standardisation of this modality in clinical practice. Results During the 17 years studied, 1,004 patients were treated through 1,036 IORT procedures. The state of the disease at the time of IORT was 77% primary and 23% recurrent. The origin and distribution of cancers were 62% gastrointestinal, 18% sarcomas, 5% pancreatic, 2% paediatric, 3% breast, 7% less common locations, and 2% others. The research and development projects have generated a patent on virtual planning (RADIANCE) and proof of concept to explore as a professional social network (MEDTING). During 2012, there were 69 IORT procedures. There was defined treatment volume (target or target region) in all of them, and 43 were conducted by the virtual planning RADIANCE system. Eighteen have been registered on the platform MEDTING as clinical cases. Conclusion The IORT programme, developed in a university hospital with an academic tradition, and interdisciplinary surgical oncology, is a feasible care initiative, able to generate the necessary intense clinical activity for tending to the cancer patient. Moreover, it is a competitive source for research, development, and scientific innovation. PMID:24009641

  20. Morphometric analysis of cryofixed muscular tissue for intraoperative consultation.

    PubMed

    Bianciardi, Giorgio; Pontenani, Francesca; Vassallo, Loretta; Tacchini, Damiana; Buonsanti, Michele; Tripodi, Sergio

    2016-03-01

    For diagnostic purposes, cryofixation of tissues is a daily routine technique to investigate rapidly about the presence of tumours during a surgical procedure in patients. We performed morphometric analysis of cryofixed muscular tissues according to different techniques. About 1,000 muscle fibers and 1,493 nuclei, were automatically examined. After freezing, ice tissue interfaces shrinkage of the cells were present. Liquid isopentane or liquid nitrogen produced a statistical increase of fractal dimension, D, of the ice-tissue interfaces, P < 0.001 respect to the formalin-fixed samples, cryofixation performed inside the cryostat chamber at t = -20°C produced a D value close to the formalin-fixed samples. Shrinkage of the muscle fibers was higher in the samples cryofixed inside the cryostat chamber (P < 0.001). Cryofixation inside cryostat or by liquid nitrogen caused decreases of the nuclei dimensions and altered nuclear morphology (P < 0.01), liquid isopentane appeared not affecting the nuclei of the fibers. Cryofixation inside the cryostat chamber produced the highest shrinkage but it was reduced performing cryofixation in liquid nitrogen or isopentane. Freezing damage inside the muscle cells was absent in the samples cryofixed inside the cryostat, it was present after cryofixation by liquid nitrogen or isopentane. Subcellular components like the nuclei were preserved by isopentane. This paper present, for the first time, an objective method able to quantify and characterize the damages produced by cryofixation in biological sample for intraoperative consultation. Microsc. Res. Tech. 79:155-161, 2016. © 2016 Wiley Periodicals, Inc. PMID:26910641

  1. Intraoperative detection of differentiated thyroid carcinoma using iodine-131

    SciTech Connect

    Ricard, M.; Travagli, J.P.; Lumbroso, J.

    1996-05-01

    We evaluated the contribution of intraoperative detection when patients with differentiated thyroid carcinoma where reoperated for neck and mediastinal lymph node metastases. Twenty seven patients who had a positive scan underwent further surgery 50 to 6 days after a therapeutic administration of 4 GBq {approx} 100 mCi of iodine-131. We used the {open_quotes}Gammed 2{close_quotes} device provided by CIS biointernational (Gif-sur-Yvette, France); the probe consists of a cylinder 3 cm in diameter and 13.5 cm in length and is based on a CsI scintillator detector (O = 1 cm ; L = 1 cm). In order to minimize the influence of the non-specific uptake and to improve the spatial resolution, we used a tungsten collimator. The atomic number (55-53) and the density ({approx} 6 g cm{sup -3}) of the scintillator allowed a good detection efficiency ({approx} 2 cts s{sup -1} kBq{sup -1}). The FWHM in air is about 1 cm at 1 cm distance from an iodine-131 point source. Activity in blood and surrounding tissues was used as a reference level. The tumor count rate ranged from 50 to more than 1000 cts s{sup -1}. The ratios between tumoral and normal tissue were always higher than 3 and the surgeon considered the method helpful for localizing lymph node metastases in 18/27 surgical procedures. The preoperative detection was considered only partially contributory in 9 cases : in 6 patients post-operative scintigraphy remained positive ; in 3 patients the surgeon also removed metastatic lymph nodes with no detectable iodine-131 uptake. This method provides the surgeon with an additional tool able to distinguish between normal and tumoral tissue, even if the energy of iodine 131 (364 keV) is not optimal for short range localization. In order will be designed with a modified shape and a more efficient shielding, particularly with respect to background activity.

  2. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery.

    PubMed

    Gonzalez-Rivas, Diego; Stupnik, Tomaz; Fernandez, Ricardo; de la Torre, Mercedes; Velasco, Carlos; Yang, Yang; Lee, Wentao; Jiang, Gening

    2016-01-01

    Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy. PMID:26424873

  3. Does intraoperative neurophysiologic monitoring matter in noncomplex spine surgeries?

    PubMed Central

    van der Goes, David N.; Nuwer, Marc R.

    2015-01-01

    Objectives: To determine associations between intraoperative neurophysiologic monitoring (IOM) for spinal decompressions and simple fusions with neurologic complications, length of stay, and hospitalization charges. Methods: Adult discharges in the Nationwide/National Inpatient Sample (NIS) (20072012) with spinal decompressions and simple spinal fusions were included. Revision surgeries, instrumentations, complicated approaches, and tumor- and trauma-related surgeries were excluded. Extracted data included patient demographics, medical comorbidities, primary spinal surgery type, and hospital characteristics. Bivariate and multiple regression analyses using NIS survey design variables correlated IOM use with neurologic complications, hospital charges, and length of stay. Results: IOM was reported in 4.9% of an estimated 1.1 million discharges in the weighted sample. Discharges reporting IOM were more often privately insured (61% vs 57%, p < 0.001) and had slightly more comorbidities (25% vs 24% with 3+ comorbidities, p = 0.01). Spinal fusions more often reported IOM than decompressions. The IOM group had fewer neurologic complications (0.8% vs 1.4% of controls) with no difference in length of stay (3.0 days for each group), but increased hospital charges (39% greater). Multiple regression adjustment showed significant associations of IOM with fewer neurologic complications (odds ratio 0.60, 95% confidence interval [CI] 0.47, 0.76, p < 0.001), while the estimated percentage of hospital charges was sizably diminished from the unadjusted analysis (IOM effect +9%, 95% CI +4%, +13%, p < 0.001), and length of stay was reduced (IOM effect ?0.26 days, 95% CI ?0.42, ?0.11, p < 0.001). Conclusions: IOM was associated with better clinical outcomes and some increased hospital charges among discharges of simple spinal fusions and laminectomies in a large, multiyear, nationally representative dataset. PMID:26446062

  4. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-10-15

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 {+-} 0.10 after main-body deployment, 0.63 {+-} 0.12 after leg deployment (P < 0.01), and 0.56 {+-} 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 {+-} 21 mmHg, 23 {+-} 15 mmHg (P < 0.01), and 16 {+-} 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 {+-} 0.13 vs. 0.54 {+-} 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 {+-} 0.10 to 0.55 {+-} 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 {+-} 0.12 vs. 0.55 {+-} 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 {+-} 0.12 vs. 0.57 {+-} 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  5. Quantification of tumor fluorescence during intraoperative optical cancer imaging

    PubMed Central

    Judy, Ryan P.; Keating, Jane J.; DeJesus, Elizabeth M.; Jiang, Jack X.; Okusanya, Olugbenga T.; Nie, Shuming; Holt, David E.; Arlauckas, Sean P.; Low, Phillip S.; Delikatny, E. James; Singhal, Sunil

    2015-01-01

    Intraoperative optical cancer imaging is an emerging technology in which surgeons employ fluorophores to visualize tumors, identify tumor-positive margins and lymph nodes containing metastases. This study compares instrumentation to measure tumor fluorescence. Three imaging systems (Spectropen, Glomax, Flocam) measured and quantified fluorescent signal-to-background ratios (SBR) in vitro, murine xenografts, tissue phantoms and clinically. Evaluation criteria included the detection of small changes in fluorescence, sensitivity of signal detection at increasing depths and practicality of use. In vitro, spectroscopy was superior in detecting incremental differences in fluorescence than luminescence and digital imaging (Ln[SBR] = 6.8 ± 0.6, 2.4 ± 0.3, 2.6 ± 0.1, p = 0.0001). In fluorescent tumor cells, digital imaging measured higher SBRs than luminescence (6.1 ± 0.2 vs. 4.3 ± 0.4, p = 0.001). Spectroscopy was more sensitive than luminometry and digital imaging in identifying murine tumor fluorescence (SBR = 41.7 ± 11.5, 5.1 ± 1.8, 4.1 ± 0.9, p = 0.0001), and more sensitive than digital imaging at detecting fluorescence at increasing depths (SBR = 7.0 ± 3.4 vs. 2.4 ± 0.5, p = 0.03). Lastly, digital imaging was the most practical and least time-consuming. All methods detected incremental differences in fluorescence. Spectroscopy was the most sensitive for small changes in fluorescence. Digital imaging was the most practical considering its wide field of view, background noise filtering capability, and sensitivity to increasing depth. PMID:26563091

  6. Intraoperative Radiotherapy for Parotid Cancer: A Single-Institution Experience

    SciTech Connect

    Zeidan, Youssef H.; Shiue, Kevin; Weed, Daniel; Johnstone, Peter A.; Terry, Colin; Freeman, Stephen; Krowiak, Edward; Borrowdale, Robert; Huntley, Tod; Yeh, Alex

    2012-04-01

    Purpose: Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland. Methods and Materials: Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years. Results: Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT. Conclusions: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.

  7. Label-free Intraoperative Parathyroid Localization With Near-Infrared Autofluorescence Imaging

    PubMed Central

    Paras, Constantine; White, Lisa M.; Phay, John E.; Solrzano, Carmen C.; Broome, James T.; Mahadevan-Jansen, Anita

    2014-01-01

    Context: The inability to accurately localize the parathyroid glands during parathyroidectomy and thyroidectomy procedures can prevent patients from achieving postoperative normocalcemia. There is a critical need for an improved intraoperative method for real-time parathyroid identification. Objective: The objective of the study was to test the accuracy of a real-time, label-free technique that uses near-infrared (NIR) autofluorescence imaging to localize the parathyroid. Setting: The study was conducted at the Vanderbilt University endocrine surgery center. Subjects and Methods: Patients undergoing parathyroidectomy and/or thyroidectomy were included in this study. To validate the intrinsic fluorescence signal in parathyroid, point measurements from 110 patients were collected using NIR fluorescence spectroscopy. Fluorescence imaging was performed on 6 patients. Imaging contrast is based on a previously unreported intrinsic NIR fluorophore in the parathyroid gland. The accuracy of fluorescence imaging was analyzed in comparison with visual assessment and histological findings. Main Outcome Measure: The detection rate of parathyroid glands was measured. Results: The parathyroid glands in 100% of patients measured with fluorescence imaging were successfully detected in real time. Fluorescence images consistently showed 2.4 to 8.5 times higher emission intensity from the parathyroid than surrounding tissue. Histological validation confirmed that the high intrinsic fluorescence signal in the parathyroid gland can be used to localize the parathyroid gland regardless of disease state. Conclusion: NIR fluorescence imaging represents a highly sensitive, real-time, label-free tool for parathyroid localization during surgery. The elegance and effectiveness of NIR autofluorescence imaging of the parathyroid gland makes it highly attractive for clinical application in endocrine surgery. PMID:25148235

  8. Intraoperative Radiotherapy for Pancreatic Cancer: 30-Year Experience in a Single Institution in Japan

    SciTech Connect

    Jingu, Keiichi; Tanabe, Takaya; Nemoto, Kenji; Ariga, Hisanori; Umezawa, Rei; Ogawa, Yoshihiro; Takeda, Ken; Koto, Masashi; Sugawara, Toshiyuki; Kubozono, Masaki; Shimizu, Eiji; Abe, Keiko; Yamada, Shogo

    2012-07-15

    Purpose: To analyze retrospectively the results of intraoperative radiotherapy (IORT) with or without external beam radiotherapy ({+-} EBRT) for localized pancreatic cancer in the past three decades and to analyze prognostic factors by multivariate analysis. Methods and Materials: Records for 322 patients with pancreatic cancer treated by IORT {+-} EBRT in Tohoku University Hospital between 1980 and 2009 were reviewed. One hundred ninety-two patients who had no distant organ metastases or dissemination at the time of laparotomy were enrolled in the present study. Results: Eighty-three patients underwent gross total resection (R0: 48 patients, R1: 35 patients), and 109 patients underwent only biopsy or palliative resection. Fifty-five patients underwent adjuvant EBRT, and 124 underwent adjuvant chemotherapy. The median doses of IORT and EBRT were 25 and 40 Gy, respectively. The median follow-up period was 37.5 months. At the time of the analysis, 166 patients had disease recurrence, and 35 patients had local failure. The 2-year local control (LC) and overall survival (OS) rates were 71.0% and 16.9%, respectively. Comparison of the results for each decade showed that OS was significantly improved decade by decade (2-year: 25.0% vs. 18.8% vs. 4.2%, p < 0.001). Multivariate analysis showed that degree of resection (R0-1 vs. R2, hazard ratio = 1.97, p = 0.001) and adjuvant chemotherapy (yes vs. no, hazard ratio = 1.54, p = 0.028) had significant impacts on OS. Late gastrointestinal morbidity of Common Terminology Criteria for Adverse Events version 3.0 grade 4 or 5 was observed in four patients. Conclusion: Excellent local control for pancreatic cancer with few cases of severe late toxicity was achieved by using IORT. OS of patients with pancreatic cancer treated by IORT {+-} EBRT improved significantly decade by decade. Multivariate analysis showed that degree of resection and adjuvant chemotherapy had significant impacts on OS.

  9. Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management.

    PubMed

    Morrison, Clinton S; Taylor, Helena O; Collins, Scott; Oyelese, Adetokunbo; Sullivan, Stephen R

    2014-12-01

    The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair. PMID:25383151

  10. Warming trends: Adapting to nonlinear change

    SciTech Connect

    Jonko, Alexandra K.

    2015-01-28

    As atmospheric carbon dioxide concentrations rise, some regions are expected to warm more than others. Research suggests that whether warming will intensify or slow down over time also depends on location.

  11. Trophic mismatch requires seasonal heterogeneity of warming.

    PubMed

    Straile, Dietmar; Kerimoglu, Onur; Peeters, Frank

    2015-10-01

    Climate warming has been shown to advance the phenology of species. Asynchronous changes in phenology between interacting species may disrupt feeding interactions (phenological mismatch), which could have tremendous consequences for ecosystem functioning. Long-term field observations have suggested asynchronous shifts in phenology with warming, whereas experimental studies have not been conclusive. Using proxy-based modeling of three trophic levels (algae, herbivores, and fish), we .show that asynchronous changes in phenology only occur if warming is seasonally heterogeneous, but not if warming is constant throughout the year. If warming is seasonally heterogeneous, the degree and even direction of asynchrony depends on the specific seasonality of the warming. Conclusions about phenological mismatches in food web interactions may therefore produce controversial results if the analyses do not distinguish between seasonally constant and seasonal specific warming. Furthermore, our results suggest that predicting asynchrony between interacting species requires reliable warming predictions that resolve sub-seasonal time scales. PMID:26649399

  12. Intraoperative Tension Pneumothorax in a Patient With Remote Trauma and Previous Tracheostomy

    PubMed Central

    Mavarez-Martinez, Ana; Soghomonyan, Suren; Sandhu, Gurneet; Rankin, Demicha

    2016-01-01

    Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma. We report a case of a 25-year-old patient with remote thoracic trauma, who developed an intraoperative tension pneumothorax and hemodynamic instability while undergoing an elective cranioplasty. The intraoperative patient assessment was made even more challenging by unexpected massive blood loss from the surgical site. Timely recognition and management of intraoperative pneumothorax along with adequate blood replacement stabilized the patient and helped avoid an unfavorable outcome. This case highlights the risks of intraoperative pneumothorax in trauma patients, which may develop even months after injury. A high index of suspicion and timely decompression can be life saving in this type of situation. PMID:27006957

  13. [Intraoperative computer tomography control within the scope of maxillofacial traumatology using a mobile scanner].

    PubMed

    Hoffmann, J; Dammann, F; Troitzsch, D; Krimmel, M; Glicher, D; Reinert, S

    2002-06-01

    Advances in intra-operative imaging and the development of new minimally invasive techniques are having an ever greater impact on modern surgery. Mobile CT scanners in the operating room is a new technique that permits image-guided surgery, and helps minimize postoperative complications. We report on our initial experience with intraoperative CT scanning during surgery on patients suffering lateral midface trauma. A mobile CT unit, the Tomoscan M (Philips, Utrecht, Netherlands) set up in the operating room, was evaluated in 6 patients with zygomatic bone fractures. The patients were placed on the CT scanner table, which is detachable from the gantry. The unit is powered by batteries charged from an ordinary ring mains supply via a conventional plug. The CT images obtained were of good quality in all cases. No technical problems were observed during surgery. Using repeat CT scans, the procedure also permits accurate intraoperative monitoring of the anatomical repositioning of the bone fragments, and accurate implantation. No intraoperative or early postoperative complications were observed. This new technical aid ensures highly accurate reduction of the bone fragments, and minimizes the need for reoperation. High-quality intraoperative imaging with surgical navigation increase surgical outcome, and expand the spectrum of minimally invasive surgery. PMID:12149802

  14. Intraoperative cholangiography. A review of indications and analysis of age-sex groups.

    PubMed Central

    Levine, S B; Lerner, H J; Leifer, E D; Lindheim, S R

    1983-01-01

    A retrospective review was performed of patients who had biliary tract stone formation as the primary diagnosis for hospitalization and indication for surgery. Five hundred and eighty-nine consecutive charts were reviewed of patients admitted between 1975 and 1979. Intraoperative cholangiography was performed in 166 patients of whom 22 had common duct exploration. Choledochotomy in this series was performed in 63 cases without utilizing pre-exploratory cholangiography. A normal intraoperative cholangiogram was found to be 100% accurate; however, an abnormal cholangiogram was associated with a 16% false positive rate of exploration of the common duct. The incidence of unsuspected common duct stones detected only by intraoperative cholangiography was 2.3%. Age-sex analysis confirms a 10-year mean age difference between men and women within the population of this study (p less than 0.001). This age-sex difference is maintained in patients without common duct pathology as well as in patients with sterile bile. However, the mean age difference between male and female patients with either demonstrable common duct obstruction by stones or infected bile as determined by routine intraoperative culture is not statistically significant. A review of the role of intraoperative cholangiography, and the experience at Northeastern Hospital is discussed. PMID:6639173

  15. Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls

    PubMed Central

    El-Husseiny, Moatasem; Seitz, Berthold; Langenbucher, Achim; Akhmedova, Elena; Szentmary, Nora; Hager, Tobias; Tsintarakis, Themistoklis; Janunts, Edgar

    2015-01-01

    Purpose. To assess the intraoperative results comparing two non-mechanical laser assisted penetrating keratoplasty approaches in keratoconus and Fuchs dystrophy. Patients and Methods. 68 patients (age 18 to 87 years) with keratoconus or Fuchs dystrophy were randomly distributed to 4 groups. 35 eyes with keratoconus and 33 eyes with Fuchs dystrophy were treated with either excimer laser ([Exc] groups I and II) or femtosecond laser-assisted ([FLAK] groups III and IV) penetrating keratoplasty. Main intraoperative outcome measures included intraoperative decentration, need for additional interrupted sutures, alignment of orientation markers, and intraocular positive pressure (vis a tergo). Results. Intraoperative recipient decentration occurred in 4 eyes of groups III/IV but in none of groups I/II. Additional interrupted sutures were not necessary in groups I/II but in 5 eyes of groups III/IV. Orientation markers were all aligned in groups I/II but were partly misaligned in 8 eyes of groups III/IV. Intraocular positive pressure grade was recognized in 12 eyes of groups I/II and in 19 eyes of groups III/IV. In particular, in group III, severe vis a tergo occurred in 8 eyes. Conclusions. Intraoperative decentration, misalignment of the donor in the recipient bed, and need for additional interrupted sutures as well as high percentage of severe intraocular positive pressure were predominantly present in the femtosecond laser in keratoconus eyes. PMID:26483974

  16. Bilateral femoral artery compression as a technique to increase vital organ perfusion during intraoperative hypotension.

    PubMed

    Rajab, Taufiek Konrad; Schmitto, Jan Dieter

    2014-07-01

    Intraoperative hypotension is associated with adverse outcomes. The preferred treatment for intraoperative hypotension is to address its cause. In the interim the blood pressure can be supported by the anesthesia team with volume resuscitation and vasopressors. Additionally, preferential perfusion of vital organs, such as the myocardium and cerebrum, at the expense of non-vital vascular beds, such as the extremities, is desirable. In the state of shock, the flight or fight response will ensure perfusion of the extremities in order to prepare the organism for a physical confrontation. However, in the context of intraoperative hypotension this response is counter-productive. Therefore we propose bilateral femoral artery compression as a new technique to increase vital organ perfusion during intraoperative hypotension. This results in shunting of blood flow from the legs and towards the vital organs. Bilateral femoral artery compression can be employed by the surgical team to immediately improve blood pressure until other counter-measures against intraoperative hypotension take effect. PMID:24746515

  17. Hydrological consequences of global warming

    SciTech Connect

    Miller, Norman L.

    2009-06-01

    The 2007 Intergovernmental Panel for Climate Change indicates there is strong evidence that the atmospheric concentration of carbon dioxide far exceeds the natural range over the last 650,000 years, and this recent warming of the climate system is unequivocal, resulting in more frequent extreme precipitation events, earlier snowmelt runoff, increased winter flood likelihoods, increased and widespread melting of snow and ice, longer and more widespread droughts, and rising sea level. The effects of recent warming has been well documented and climate model projections indicate a range of hydrological impacts with likely to very likely probabilities (67 to 99 percent) of occurring with significant to severe consequences in response to a warmer lower atmosphere with an accelerating hydrologic cycle.

  18. Multidecadal warming of Antarctic waters.

    PubMed

    Schmidtko, Sunke; Heywood, Karen J; Thompson, Andrew F; Aoki, Shigeru

    2014-12-01

    Decadal trends in the properties of seawater adjacent to Antarctica are poorly known, and the mechanisms responsible for such changes are uncertain. Antarctic ice sheet mass loss is largely driven by ice shelf basal melt, which is influenced by ocean-ice interactions and has been correlated with Antarctic Continental Shelf Bottom Water (ASBW) temperature. We document the spatial distribution of long-term large-scale trends in temperature, salinity, and core depth over the Antarctic continental shelf and slope. Warming at the seabed in the Bellingshausen and Amundsen seas is linked to increased heat content and to a shoaling of the mid-depth temperature maximum over the continental slope, allowing warmer, saltier water greater access to the shelf in recent years. Regions of ASBW warming are those exhibiting increased ice shelf melt. PMID:25477461

  19. Lagrangian description of warm plasmas

    NASA Technical Reports Server (NTRS)

    Kim, H.

    1970-01-01

    Efforts are described to extend the averaged Lagrangian method of describing small signal wave propagation and nonlinear wave interaction, developed by earlier workers for cold plasmas, to the more general conditions of warm collisionless plasmas, and to demonstrate particularly the effectiveness of the method in analyzing wave-wave interactions. The theory is developed for both the microscopic description and the hydrodynamic approximation to plasma behavior. First, a microscopic Lagrangian is formulated rigorously, and expanded in terms of perturbations about equilibrium. Two methods are then described for deriving a hydrodynamic Lagrangian. In the first of these, the Lagrangian is obtained by velocity integration of the exact microscopic Lagrangian. In the second, the expanded hydrodynamic Lagrangian is obtained directly from the expanded microscopic Lagrangian. As applications of the microscopic Lagrangian, the small-signal dispersion relations and the coupled mode equations are derived for all possible waves in a warm infinite, weakly inhomogeneous magnetoplasma, and their interactions are examined.

  20. Carbon cycle and climate warming

    SciTech Connect

    Kerr, R.A.

    1983-12-09

    The increase in carbon dioxide in the atmosphere is expected to cause a warming of the earth. This increase is due to the fact that more carbon is released into the atmosphere than is removed by the biota and the oceans. Understanding the carbon cycle is important in predicting future warming. A major uncertainty is the timing and magnitude of future releases of CO/sub 2/ from the burning of fossil fuels. Today, 1.1 tons of carbon as CO/sub 2/ are released every year for every person on Earth. Estimates are given on how much CO/sub 2/ has been released into the atmosphere since fossil fuels have been burned. The ultimate aim of carbon cycle research is to predict how the concentration of CO/sub 2/ in the atmosphere will vary as mankind pumps more and more of it into the atmosphere.

  1. Economic Theory and Global Warming

    NASA Astrophysics Data System (ADS)

    Uzawa, Hirofumi

    2003-08-01

    Hirofumi Uzawa's theoretical framework addresses three major problems concerning global warming and other environmental hazards. First, it considers all phenomena involved with global environmental issues that exhibit externalities of one kind or another. Secondly, it covers global environmental issues involving international and intergenerational equity and justice. Lastly, it deals with global environmental issues concerning the management of the atmosphere, the oceans, water, soil, and other natural resources having to be decided by a consensus of affected countries.

  2. Analysis of data from spacecraft (stratospheric warmings)

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The details of the stratospheric warming processes as to time, area, and intensity were established, and the warmings with other terrestrial and solar phenomena occurring at satellite platform altitudes, or observable from satellite platforms, were correlated. Links were sought between the perturbed upper atmosphere (mesosphere and thermosphere) and the stratosphere that might explain stratospheric warmings.

  3. Is the world warming or not?

    SciTech Connect

    Kerr, R.A.

    1995-02-03

    Articles in the popular press indicate controversy surrounding the reality of global warming. However greenhouse models predict more warming that is presently apparent. For climate change to live up to predictions, the minimal warming of the 1980`s will have to accelerate into the next millenium.

  4. Global warming: Economic policy responses

    SciTech Connect

    Dornbusch, R.; Poterba, J.M.

    1991-01-01

    This volume contains the proceedings of a conference that brought together economic experts from Europe, the US, Latin America, and Japan to evaluate key issues in the policy debate in global warming. The following issues are at the center of debates on alternative policies to address global warming: scientific evidence on the magnitude of global warming and the extent to which it is due to human activities; availability of economic tools to control the anthropogenic emissions of greenhouse gases, and how vigorously should they be applied; and political economy considerations which influence the design of an international program for controlling greenhouse gases. Many perspectives are offered on the approaches to remedying environmental problems that are currently being pursued in Europe and the Pacific Rim. Deforestation in the Amazon is discussed, as well as ways to slow it. Public finance assessments are presented of both the domestic and international policy issues raised by plans to levy a tax on the carbon emissions from various fossil fuels. Nine chapters have been processed separately for inclusion in the appropriate data bases.

  5. Bone necrosis and tumor induction following experimental intraoperative irradiation.

    PubMed

    Powers, B E; Gillette, E L; McChesney, S L; LeCouteur, R A; Withrow, S J

    1989-09-01

    The bone of the lumbar vertebrae of 153 dogs was examined 2 and 5 years after intraoperative irradiation (IORT), fractionated external beam irradiation (EBRT), or the combination. Groups of dogs received 15 to 55 Gy IORT only, 10 to 47.5 Gy IORT combined with 50 Gy EBRT in 2 Gy fractions or 60 to 80 Gy EBRT in 30 fractions. Six MeV electrons were used for IORT, and EBRT was done using photons from a 6 MV linear accelerator. The paraaortic region was irradiated and the ventral part of the lumbar vertebrae was in the 90% isodose level. Two years after irradiation, the dose causing significant bone necrosis as determined by at least 50% empty lacunae in the vertebral cortex was 38.2 Gy IORT alone and 32.5 Gy IORT combined with EBRT. Five years after irradiation, the dose causing 50% empty lacunae was 28.5 Gy IORT only and 14.4 Gy IORT combined with EBRT. The ED50 for lesions of the ventral vertebral artery was 21.7 Gy IORT only and 20.1 Gy IORT combined with 50 Gy EBRT 2 years after irradiation and 27.0 Gy IORT only and 20.0 Gy IORT combined with 50 Gy EBRT 5 years after irradiation. All lesions after EBRT only were mild. Eight dogs developed osteosarcomas 4 to 5 years after irradiation, one at 47.5 Gy IORT only and the remainder at 25.0 Gy IORT and above combined with 50 Gy EBRT. In conclusion, the extent of empty lacunae, indicating bone necrosis, was more severe 5 years after irradiation than after 2 years. The effect of 50 Gy EBRT in 2 Gy fractions was equivalent to about 6 Gy IORT 2 years after irradiation and to about 14 Gy 5 years after irradiation. Based on these estimates, IORT doses of 10 to 15 Gy have an effect 5 times or greater than the amount given in 2 Gy fractions. Osteosarcomas occurred in 21% of dogs which received doses greater than 25 Gy IORT. Doses of 15 to 20 Gy IORT in combination with 50 Gy EBRT in 2 Gy fractions may be near the tolerance level for late developing bone injury. PMID:2506159

  6. Intraoperative Facial Nerve Monitoring During Cochlear Implant Surgery

    PubMed Central

    Hsieh, Hui-Shan; Wu, Che-Ming; Zhuo, Ming-Ying; Yang, Chao-Hui; Hwang, Chung-Feng

    2015-01-01

    Abstract Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (CI) surgery. Intraoperative facial nerve monitoring (IFNM) is used as an adjunctive modality in a variety of neurotologic surgeries. The purpose of this retrospective study was to assess whether the use of IFNM is associated with postoperative facial nerve injury during CI surgery. The medical charts of 645 patients who underwent CI from 1999 to 2014 were reviewed to identify postoperative facial nerve palsy between those who did and did not receive IFNM. Four patients (3 children and 1 adult) were found to have delayed onset facial nerve weakness. IFNM was used in 273 patients, of whom 2 had postoperative facial nerve weakness (incidence of 0.73%). The incidence of facial nerve weakness was 0.54% (2/372) in the patients who did not receive IFNM. IFNM had no significant effect on postoperative delayed facial palsy (P?=?1.000). All patients completely recovered within 3 months after surgery. Interestingly, all 4 cases of facial palsy received right CI, which may be because all of the surgeons in this study used their right hand to hold the drill. When right CI surgery is performed by a right-handed surgeon, the shaft of the drill is closer to the inferior angle of the facial recess, and it is easier to place the drilling shaft against the medial boundary (facial nerve) when the facial recess is small. The facial nerve sheaths of another 3 patients were unexpectedly dissected by a diamond burr during the surgery, and the monitor sounded an alarm. None of these 3 patients developed facial palsy postoperatively. This suggests that IFNM could be used as an alarm system for mechanical compression even without current stimulation. Although there appeared to be no relationship between the use of monitoring and delayed facial nerve palsy, IFNM is of great value in the early identification of a dehiscent facial nerve and assisting in the maintenance of its integrity. IFNM can still be used as an additional technique to optimize surgical success. PMID:25793243

  7. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis?

    PubMed Central

    Ding, Guo-Qian; Cai, Wang; Qin, Ming-Fang

    2015-01-01

    AIM: To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic cholelithiasis. METHODS: Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January 2012 and January 2014 for management of symptomatic cholelithiasis were recruited for this prospective randomized trial. Study enrollment was offered to patients with clinical presentation of biliary colic symptoms, radiological findings suggestive of gallstones, and normal serum biochemistry results. Study participants were randomized to receive either routine LC treatment or LC + IOC treatment. The routine LC procedure was carried out using the standard four-port technique; the LC + IOC procedure was carried out with the addition of meglumine diatrizoate (1:1 dilution with normal saline) injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors. Operative data and postoperative outcomes, including operative time, retained common bile duct (CBD) stones, CBD injury, other complications and length of hospital stay, were recorded for comparative analysis. Inter-group differences were statistically assessed by the ?2 test (categorical variables) and Fishers exact test (binary variables), with the threshold for statistical significance set at P < 0.05. RESULTS: A total of 371 patients were enrolled in the trial (late-adolescent to adult, age range: 16-70 years), with 185 assigned to the routine LC group and 186 to the LC + IOC group. The two treatment groups were similar in age, sex, body mass index, duration of symptomology, number and size of gallstones, and clinical symptoms. The two treatment groups also showed no significant differences in the rates of successful LC (98.38% vs 97.85%), CBD stone retainment (0.54% vs 0.00%), CBD injury (0.54% vs 0.53%) and other complications (2.16% vs 2.15%), as well as in duration of hospital stay (5.10 1.41 d vs 4.99 1.53 d). However, the LC + IOC treatment group showed significantly longer mean operative time (routine LC group: 43.00 4.15 min vs 52.86 4.47 min, P < 0.01). There were no cases of fatal complications in either group. At the one-year follow-up assessment, one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC + IOC group reported on-going intermittent epigastric discomfort, but radiological examination provided no abnormal findings. CONCLUSION: IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time. PMID:25717250

  8. Intraoperative vascular monitoring of ipsilateral vs. contralateral TRAM flaps.

    PubMed

    Clugston, P A; Lennox, P A; Thompson, R P

    1998-12-01

    Transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction has become an increasingly common procedure in the 1990s. The original description of the procedure was that of an ipsilaterally based pedicled procedure. However, because of concerns about potential folding of the pedicle with possible compromise of the vascular supply, with full muscle harvest the contralateral flap soon became the flap of choice. Subsequently there have been several large clinical series of pedicled TRAM flaps reported showing a relatively high complication rate related to problems with flap vascularity. These findings resulted in many centers favoring free TRAM flap breast reconstruction, despite an increased resource utilization and negligible differences in complication rates. Ipsilateral pedicled TRAM flap breast reconstruction is not a commonly reported procedure, and is reserved for patients in whom scars preclude use of the contralateral pedicle. The ease of flap shaping and lack of tension on the pedicle is recognized by some, and the ipsilateral procedure has become the flap of choice for these surgeons. The authors hypothesized that ipsilateral TRAM flaps have less compromise of venous outflow as a result of the rotational tension effect of transposing the flap to the mastectomy site. To determine if the vascularity of the pedicled TRAM procedure is influenced by pedicle choice, an intraoperative clinical study was designed to compare intravascular pressures in the deep inferior epigastric artery and vein pedicle at various times from pedicle division to flap insetting. Ten consecutive ipsilateral TRAM flaps were compared with eight contralateral flaps. The deep inferior epigastric pedicle was cannulated with both an arterial and venous catheter, and pressures were monitored from the time of division of the inferior pedicle through to the time of flap insetting. The venous pressures of the contralateral flaps were significantly higher at flap rotation and flap insetting compared with the ipsilateral group (p = 0.014 and p = 0.022 respectively). Perfusion pressures showed a greater decrease in the contralateral group from the time of pedicle division to the point of flap rotation and flap insetting compared with the ipsilateral group (p = 0.081 and p = 0.055). The authors conclude that pedicle tension in contralateral TRAM flaps is more common and results in greater venous resistance and decreased perfusion pressures. Versatility in flap shaping, improved maintenance of the IMF, and lack of disruption of the natural xyphoid hollow gives ipsilateral TRAM flaps additional advantages. PMID:9869135

  9. Climate model and proxy data constraints on ocean warming across the Paleocene-Eocene Thermal Maximum

    NASA Astrophysics Data System (ADS)

    Dunkley Jones, Tom; Lunt, Daniel J.; Schmidt, Daniela N.; Ridgwell, Andy; Sluijs, Appy; Valdes, Paul J.; Maslin, Mark

    2013-10-01

    Constraining the greenhouse gas forcing, climatic warming and estimates of climate sensitivity across ancient large transient warming events is a major challenge to the palaeoclimate research community. Here we provide a new compilation and synthesis of the available marine proxy temperature data across the largest of these hyperthermals, the Paleocene-Eocene Thermal Maximum (PETM). This includes the application of consistent temperature calibrations to all data, including the most recent set of calibrations for archaeal lipid-derived palaeothermometry. This compilation provides the basis for an informed discussion of the likely range of PETM warming, the biases present in the existing record and an initial assessment of the geographical pattern of PETM ocean warming. To aid interpretation of the geographic variability of the proxy-derived estimates of PETM warming, we present a comparison of this data with the patterns of warming produced by high pCO2 simulations of Eocene climates using the Hadley Centre atmosphere-ocean general circulation model (AOGCM) HadCM3L. On the basis of this comparison and taking into account the patterns of intermediate-water warming we estimate that the global mean surface temperature anomaly for the PETM is within the range of 4 to 5 C.

  10. Quantitative wavelength analysis and image classification for intraoperative cancer diagnosis with hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-03-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery.

  11. Intraoperative magnetic resonance imaging-conditional robotic devices for therapy and diagnosis.

    PubMed

    Fisher, Taylor; Hamed, Abbi; Vartholomeos, Panagiotis; Masamune, Ken; Tang, Guoyi; Ren, Hongliang; Tse, Zion T H

    2014-03-01

    Magnetic resonance imaging presents high-resolution preoperative scans of target tissue and allows for the availability of intraoperative real-time images without the exposure of patients to ionizing radiation. This has motivated scientists and engineers to integrate medical robotics with the magnetic resonance imaging modality to allow robot-assisted, image-guided diagnosis and therapy. This article provides a review of the state-of-the-art medical robotic systems available for use in conjunction with intraoperative magnetic resonance imaging. The robot functionalities and mechanical designs for a wide range of magnetic resonance imaging interventions are presented, including their magnetic resonance imaging compatibility, actuation, kinematics and the mechanical and electrical designs of the robots. Classification and comparative study of various intraoperative magnetic resonance image guided robotic systems are provided. The robotic systems reviewed are summarized in a table in detail. Current technologies for magnetic resonance imaging-conditional robotics are reviewed and their potential future directions are sketched. PMID:24534419

  12. Quantitative Wavelength Analysis and Image Classification for Intraoperative Cancer Diagnosis with Hyperspectral Imaging

    PubMed Central

    Lu, Guolan; Qin, Xulei; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2015-01-01

    Complete surgical removal of tumor tissue is essential for postoperative prognosis after surgery. Intraoperative tumor imaging and visualization are an important step in aiding surgeons to evaluate and resect tumor tissue in real time, thus enabling more complete resection of diseased tissue and better conservation of healthy tissue. As an emerging modality, hyperspectral imaging (HSI) holds great potential for comprehensive and objective intraoperative cancer assessment. In this paper, we explored the possibility of intraoperative tumor detection and visualization during surgery using HSI in the wavelength range of 450 nm - 900 nm in an animal experiment. We proposed a new algorithm for glare removal and cancer detection on surgical hyperspectral images, and detected the tumor margins in five mice with an average sensitivity and specificity of 94.4% and 98.3%, respectively. The hyperspectral imaging and quantification method have the potential to provide an innovative tool for image-guided surgery. PMID:26523083

  13. Chromogranin A and cortisol at intraoperative repeated noxious stimuli: Surgical stress in a dog model

    PubMed Central

    Hagman, Ragnvi; Stridsberg, Mats

    2015-01-01

    Objectives: Biomarkers representing sympathetic tone and the surgical stress response are measured to objectively evaluate surgical techniques and anaesthetic protocols. If a part of the intraoperative procedure is repeated on the contralateral organ, one animal may potentially serve as its own control and, if so, may minimize the problem of individual differences of the stress response to anaesthesia and surgery. This study aimed to investigate the use of chromogranin A for measurement of the intraoperative sympathetic tone. Additional aims were to investigate chromogranin A and cortisol as indicators of the intraoperative surgical stress response caused by repeated noxious stimuli in dogs subjected to ovariohysterectomy and thereby to investigate the possibility of one dog serving as its own control. Methods: Experiments were carried out on 10 dogs subjected to ovariohysterectomy. Perioperative blood samples (0–6) were collected after premedication, immediately before induction of anaesthesia (0), after induction of anaesthesia and before incision (1), before (2) and after (3) removal of the first ovary, after a 15-min pause before removal of the second ovary (4), after removal of the second ovary (5) and after closing the abdomen (6). Plasma chromogranin A and cortisol were analysed. Results: Plasma chromogranin A did not change. Plasma cortisol concentration did not change between before anaesthesia and opening of the abdomen. Plasma cortisol increased at removal of the first ovary. Cortisol did not change at removal of the second ovary but remained increased compared to initial sample. Conclusion: The results suggest chromogranin A is a poor indicator of intraoperative sympathetic tone during elective surgery in dogs. Cortisol measurement was useful for assessment of intraoperative noxious stimuli. However, at these test conditions, neither plasma chromogranin A nor plasma cortisol was useful for assessment of repeated intraoperative noxious stimuli where one dog served as its own control. PMID:26770773

  14. Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review

    PubMed Central

    Najafipour, Farshad; Hamouzadeh, Pejman; Arabloo, Jalal; Mobinizadeh, Mohammadreza; Norouzi, Amir

    2015-01-01

    Background: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy. Methods: The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis. Results: Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer. Conclusion: According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology. PMID:26793649

  15. Intraoperative detection of radiolabeled compounds using a hand held gamma probe

    NASA Astrophysics Data System (ADS)

    Ricard, Marcel

    2001-02-01

    Scintillation cameras in Nuclear Medicine allow external detection of cancerous lesions after administration of a specific radiopharmaceutical to the patient. In some particular cases the affinity of the tracer is sufficient to consider the use of an intraoperative probe which enables the surgeon to identify radioactive tissues. A radiopharmaceutical consists of a radioisotope bound to a carrier molecule. The radioactive emissions must represent certain criteria in terms of half-life and energy to be detected during an operation. In the field of intraoperative detection radionuclides like 99mTc, 111In, 125I and 131I fall into this category. Their energy, which ranges from some 10 to 364 keV, cannot be properly detected by a single type of detector. Two technologies have been developed to yield detectors which are handy and sufficiently sensitive: semiconductor CdTe or CdZnTe to detect low energies and scintillator CsI(Tl) for higher energies. Today the intraoperative detection has been evaluated in the case of several pathologies such as osteoid osteoma, colorectal cancer, neuroblastoma, reoperation of differentiated thyroid carcinoma and localization of sentinel node in breast cancer and cutaneous melanoma. Obviously, the results obtained are not comparable from one indication to the other. Nevertheless, the surgeons have noted a considerable advantage in using the intraoperative probe in the case of neuroblastoma and thyroid surgery, especially when the reoperation is difficult or the localizations are ectopic or unusual. As regards the sentinel node, this concept represents a major new opportunity in the field of intraoperative detection and the results actually reported in the literature demonstrate that, when it is detected, elective node excision renders the staging of the disease more accurate. In conclusion, intraoperative detection supplies the surgeon with additional knowledge to be used in correlation with the patient's medical history.

  16. Dual-Phase Warming of the Cold Wake of Typhoon Fanapi, 2010

    NASA Astrophysics Data System (ADS)

    Mrvaljevic, R.

    2012-12-01

    Tens of thousands of temperature profiles were taken in and around the cold wake of category 3 Typhoon Fanapi between September and November 2010 as part of the Impact of Typhoons on the Ocean in the Pacific (ITOP) research program. This unprecedented data set presents outstanding opportunities for model verification as well as comparisons with remote sensing products. Fanapi's SST cold wake took under two weeks to disappear, however a subsurface cold wake signature was observed to persist for more than three weeks. Fanapi was a late-season typhoon, therefore the ocean affected by the cold wake never fully recovered to the pre-storm thermal structure. The cold wake warmed in two distinct phases; a rapid warming phase where the wake was capped by a shallow, warm mixed layer in 4-5 days, followed by a slower warming phase that gradually brought the cold wake to equilibrium with the surrounding ocean. One dimensional air-sea interaction modeling reveals that preferential warming took place over the cold wake, forming the warm cap, thereby isolating the subsurface cold wake from the atmosphere. After this, the warm cap slowly deepened and warmed as it interacted with the subsurface cold wake layer below and the atmosphere above.

  17. Cardiopulmonary Bypass and Extracorporeal Life Support for Emergent Intraoperative Thoracic Situations.

    PubMed

    Machuca, Tiago N; Cypel, Marcelo; Keshavjee, Shaf

    2015-08-01

    Intraoperative thoracic surgical catastrophes may require extracorporeal circulation modes to support the patient while the appropriate repair is made. Teamwork is key and, given the evidence supporting better performance with the use of simulation and surgical-crisis checklists, their use should be encouraged. Anticipation is another important factor because the results of intrathoracic malignancy resection are clearly superior in the setting of planned cardiopulmonary support. In addition, familiarity with the different modes of support that are currently available can direct the decision-making process toward the best option to facilitate resolution of the intraoperative catastrophe with the least related morbidity. PMID:26210928

  18. Intraoperative imaging and fluorescence image guidance in oncologic surgery using a wearable fluorescence goggle system

    NASA Astrophysics Data System (ADS)

    Mondal, Suman B.; Gao, Shengkui; Zhu, Nan; Liu, Yang; Sudlow, Gail P.; Akers, Walter J.; Liang, Rongguang; Gruev, Viktor; Achilefu, Samuel

    2014-03-01

    We have developed a wearable, fluorescence goggle based system for intraoperative imaging of tumors and image guidance in oncologic surgery. Our system can detect fluorescence from cancer selective near infra-red (NIR) contrast agent, facilitating intraoperative visualization of surgical margins and tumors otherwise not apparent to the surgeon. The fluorescence information is displayed directly to the head mounted display (HMD) of the surgeon in real time, allowing unhindered surgical procedure under image guidance. This system has the potential of improving surgical outcomes in oncologic surgery and reduce the chances of cancer recurrence.

  19. Warm/cold cloud processes

    NASA Technical Reports Server (NTRS)

    Bowdle, D. A.

    1979-01-01

    Technical assistance continued in support of the Atmospheric Cloud Physics Laboratory is discussed. A study of factors affecting warm cloud formation showed that the time of formation during an arbitrary expansion is independent of carrier gas composition for ideal gases and independent of aerosol concentration for low concentrations of very small aerosols. Equipment and procedures for gravimetric evaluation of a precision saturator were laboratory tested. A numerical feasibility study was conducted for the stable levitation of charged solution droplets by an electric field in a one-g static diffusion chamber. The concept, operating principles, applications, limits, and sensitivity of the levitation technique are discussed.

  20. Primordial non-Gaussianity in noncanonical warm inflation

    NASA Astrophysics Data System (ADS)

    Zhang, Xiao-Min; Zhu, Jian-Yang

    2015-03-01

    We study the bispectrum of the primordial curvature perturbation on uniform density hypersurfaces generated by a kind of the noncanonical warm inflation, wherein the inflation is provided by a noncanonical scalar inflaton field that is coupled to radiation through a thermal dissipation effect. We obtain an analytic form for the nonlinear parameter fNL that describes the non-Gaussianity in first-order cosmological perturbation theory and analyze the magnitude of this nonlinear parameter. We make a comparison between our result and those of the standard inflation and the canonical warm inflation. We also discuss when the contribution to the non-Gaussianity due to the second-order perturbation theory becomes more important and what the observations predict. We take the Dirac-Born-Infeld inflation as a concrete example to find how the sound speed and the thermal dissipation strength to decide the non-Gaussianity and get a lower bound of the sound speed constrained by Planck.

  1. Line shape modeling in warm and dense hydrogen plasmas

    NASA Astrophysics Data System (ADS)

    Ferri, S.; Calisti, A.; Moss, C.; Talin, B.; Gigosos, M. A.; Gonzlez, M. A.

    2007-05-01

    A study of hydrogen lines emitted in warm ( T1eV) and dense ( N?1018cm -3) plasmas is presented. Under such plasma conditions, the electronic and the ionic contributions to the line width are comparable, and the general question related to a transition from impact to quasi-static broadening arises not only for the far wings but also for the core of spectral lines. The transition from impact to quasi-static broadening for electrons is analyzed by means of Frequency Fluctuation Model (FFM). In parallel, direct integration of the semi-classical evolution equation is performed using electron electric fields calculated by Molecular Dynamics (MD) simulations that permit one to correctly describe the emitter environment. New cross comparisons between benchmark MD simulations and FFM are carried out for electron broadening of the Balmer series lines, and, especially, for the H? line, for which a few experiments in the warm and dense plasma regimes are available.

  2. SOFIA Observations of S106: Dynamics of the Warm Gas

    NASA Technical Reports Server (NTRS)

    Simon, R.; Schneider, N.; Stutzki, J.; Gusten, R.; Graf, U. U.; Hartogh, P.; Guan, X.; Staguhn, J. G.; Benford, D. J.

    2012-01-01

    Context The H II region/PDR/molecular cloud complex S106 is excited by a single O-star. The full extent of the warm and dense gas close to the star has not been mapped in spectrally resolved high-J CO or [C II] lines, so the kinematics of the warm. partially ionized gas, are unknown. Whether the prominent dark lane bisecting the hourglass-shaped nebula is due solely to the shadow cast by a small disk around the exciting star or also to extinction in high column foreground gas was an open question until now. Aims. To disentangle the morphology and kinematics of warm neutral and ionized gas close to the star, study their relation to the bulk of the molecular gas. and to investigate the nature of the dark lane. Methods. We use the heterodyne receiver GREAT on board SOFIA to observe velocity resolved spectral lines of [C II] and CO 11 yields 10 in comparison with so far unpublished submm continuum data at 350 micron (8HARC-Il) and complementary molecular line data. Results. The high angular and spectral resolution observations show a very complex morphology and kinematics of the inner S106 region, with many different components at different excitation conditions contributing to the observed emission. The [C II] lines are found to be bright and very broad. tracing high velocity gas close to the interface of molecular cloud and H II region. CO 11 yields 10 emission is more confined.. both spatially and in velocity, to the immediate surroundings of S 106 IR showing the presence of warm, high density (clumpy) gas. Our high angular resolution submm continuum observations rule out the scenario where the dark lane separating the two lobes is due solely to the shadow cast by a small disk close to the star. The lane is clearly seen also as warm, high column density gas at the boundary of the molecular cloud and H II region.

  3. Warm gas TVC design study

    NASA Technical Reports Server (NTRS)

    Moorhead, S. B., Jr.

    1973-01-01

    A warm gas thrust vector control system was studied to optimize the injection geometry for a specific engine configuration, and an injection valve was designed capable of meeting the base line requirements. To optimize injection geometry, studies were made to determine the performance effects of varying injection location, angle, port size, and port configuration. Having minimized the injection flow rate required, a warm gas valve was designed to handle the required flow. A direct drive hydraulic servovalve capable of operating with highly contaminated hydraulic fluid was designed. The valve is sized to flow 15 gpm at 3000 psia and the direct drive feature is capable of applying a spool force of 200 pounds. The baseline requirements are the development of 6 deg of thrust vector control utilizing 2000 F (total temperature) gas for 180 seconds on a 1.37 million pound thrust engine burning LOX and RP-1 at a chamber pressure of 250 psia with a 155 inch long conical nozzle having a 68 inch diameter throat and a 153 inch diameter exit.

  4. Population growth and global warming.

    PubMed

    Short, R V

    2009-01-01

    When I was born in 1930, the human population of the world was a mere 2 billion. Today, it has already reached 6.8?billion, and is projected to reach 9.1 billion by 2050. That is unsustainable. It is slowly beginning to dawn on us that Global Warming is the result of increasing human CO2 emissions, and the more people there are in the world, the worse it will become. Ultimately, it is the sky that will prove to be the limit to our numbers. The developed countries of the world are the most affluent, and also the most effluent, so we must lead by example and contain our own population growth and per capita emissions. We also have a big debt to repay to former colonial territories in Africa, Asia and South America, who desperately need our help to contain their excessive rates of population growth. Belgian and Dutch obstetricians and gynaecologists can play a critical role in this endeavour. After all, we already have a pill that will stop global warming - the oral contraceptive pill. PMID:25478068

  5. Forecasting phenology under global warming

    PubMed Central

    Ibáñez, Inés; Primack, Richard B.; Miller-Rushing, Abraham J.; Ellwood, Elizabeth; Higuchi, Hiroyoshi; Lee, Sang Don; Kobori, Hiromi; Silander, John A.

    2010-01-01

    As a consequence of warming temperatures around the world, spring and autumn phenologies have been shifting, with corresponding changes in the length of the growing season. Our understanding of the spatial and interspecific variation of these changes, however, is limited. Not all species are responding similarly, and there is significant spatial variation in responses even within species. This spatial and interspecific variation complicates efforts to predict phenological responses to ongoing climate change, but must be incorporated in order to build reliable forecasts. Here, we use a long-term dataset (1953–2005) of plant phenological events in spring (flowering and leaf out) and autumn (leaf colouring and leaf fall) throughout Japan and South Korea to build forecasts that account for these sources of variability. Specifically, we used hierarchical models to incorporate the spatial variability in phenological responses to temperature to then forecast species' overall and site-specific responses to global warming. We found that for most species, spring phenology is advancing and autumn phenology is getting later, with the timing of events changing more quickly in autumn compared with the spring. Temporal trends and phenological responses to temperature in East Asia contrasted with results from comparable studies in Europe, where spring events are changing more rapidly than are autumn events. Our results emphasize the need to study multiple species at many sites to understand and forecast regional changes in phenology. PMID:20819816

  6. Intraoperative ultrasound-guided retrieval of an airgun pellet from the tongue: a case report.

    PubMed

    Sharma, P K; Songra, A K; Ng, S Y

    2002-04-01

    Real-time intraoperative ultrasonography was used to detect and facilitate removal of an airgun pellet from the tongue of a 14-year-old boy. Diagnostic ultrasound was crucial in clarifying the positional relation between the foreign body and the instrument used, enabling safe, precise and rapid retrieval during a potentially hazardous surgical operation. PMID:12180211

  7. Virtual slide telepathology with scanner systems for intraoperative frozen-section consultation.

    PubMed

    Ribback, Silvia; Flessa, Steffen; Gromoll-Bergmann, Katrin; Evert, Matthias; Dombrowski, Frank

    2014-06-01

    Telepathology provides pathology services over a distance using digital imaging and telecommunication for primary diagnostic practice, including intraoperative frozen sections. Virtual slide technology provides digitizing of histological slides by scanner systems and improved remote assessment substantially. In this retrospective study, diagnostic accuracy of intraoperative frozen sections assessed as virtual slide was determined. Tissue assessment was mainly requested for urological, gynecological and dermatological resections. Issues of time consumption, cost and cost effectiveness of this diagnostic method are discussed. 1204 intraoperative frozen sections were conducted in the course of this study at our department over a period of 2.5 years. 98.59% of all intraoperative frozen sections were accurately diagnosed in the initial telepathological assessment. Tumor affection was present in 15.6% of frozen sections, in 174 instances already assessed in the initial slides (sensitivity 92.6%). Discrepant diagnoses compared to the final diagnosis occurred in 1.41%. Our determined averaged time for virtual slide technology of 10.588.19min can be ranged in well. Our study did not allow a full economic assessment, but some preliminary insights are pointed out. The quality of services is highly acceptable and the investment costs and the labor cost of virtual slide technology are lower than those of robotic microscopy. PMID:24674453

  8. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation

    PubMed Central

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; dInzeo, Guglielmo; Liberti, Micaela

    2015-01-01

    An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers. PMID:25745397

  9. Impact of Intraoperative Acetaminophen Administration on Postoperative Opioid Consumption in Patients Undergoing Hip or Knee Replacement

    PubMed Central

    Vaughan, Cathy; McGee, Ann

    2014-01-01

    Abstract Background: Opioid utilization for acute pain has been associated with numerous adverse events, potentially resulting in longer inpatient stays and increased costs. Objective: To examine the effect of intravenous (IV) acetaminophen administered intraoperatively on postoperative opioid consumption in adult subjects who underwent hip or knee replacement. Methods: This retrospective cohort study evaluated postoperative opioid consumption in 176 randomly selected adult subjects who underwent hip or knee replacement at Duke University Hospital (DUH). Eighty-eight subjects received a single, intraoperative, 1 g dose of IV acetaminophen. The other subjects did not receive any IV acetaminophen. This study evaluated mean opioid consumption (in oral morphine equivalents) during the 24-hour postoperative period in the 2 groups. Other endpoints included length of stay in the postanesthesia care unit (PACU), incidence of oversedation, need for acute opioid reversal, and adjunctive analgesic utilization. Results: Subjects who were given a single dose of intraoperative acetaminophen received an average of 149.3 mg of oral morphine equivalents during the 24 hours following surgery compared to 147.2 mg in participants who were not exposed to IV acetaminophen (P = .904). The difference in average length of PACU stay between the IV acetaminophen group (163 minutes) and those subjects not exposed to IV acetaminophen (169 minutes) was not statistically significant (P = .588). No subjects in the study experienced oversedation or required acute opioid reversal. Conclusion: There was not a statistically significant difference in postoperative opioid consumption between patients receiving and not receiving IV acetaminophen intraoperatively. PMID:25673891

  10. Automatic pre- to intra-operative CT registration for image-guided cochlear implant surgery

    PubMed Central

    Reda, Fitsum A.; Noble, Jack H.; Labadie, Robert F.; Dawant, Benoit M.

    2015-01-01

    Percutaneous cochlear implantation (PCI) is a minimally invasive image-guided cochlear implant approach, where access to the cochlea is achieved by drilling a linear channel from the skull surface to the cochlea. The PCI approach requires pre- and intra-operative planning. Computation of a safe linear drilling trajectory is performed in a pre-operative CT. This trajectory is mapped to intra-operative space using the transformation matrix that registers the pre- and intra-operative CTs. However, the difference in orientation between the pre- and intra-operative CTs is too extreme to be recovered by standard, gradient descent based registration methods. Thus far, the registration has been initialized manually by an expert. In this work we present a method that aligns the scans completely automatically. We compared the performance of the automatic approach to the registration approach when an expert does the manual initialization on 11 pairs of scans. There is a maximum difference of 0.18 mm between the entry and target points of the trajectory mapped with expert initialization and the automatic registration method. This suggests that the automatic registration method is accurate enough to be used in a PCI surgery. PMID:22922692

  11. Automatic pre- to intra-operative CT registration for image-guided cochlear implant surgery

    NASA Astrophysics Data System (ADS)

    Reda, Fitsum A.; Dawant, Benoit M.; Labadie, Robert F.; Noble, Jack H.

    2012-02-01

    Percutaneous cochlear implantation (PCI) is a minimally invasive image-guided cochlear implant approach, where access to the cochlea is achieved by drilling a linear channel from the outer skull to the cochlea. The PCI approach requires pre- and intra-operative planning. Segmentation of critical ear anatomy and computation of a safe drilling trajectory are performed in a pre-operative CT. The computed safe drilling trajectory must then be mapped to the intraoperative space. The mapping can be done using the transformation matrix that registers the pre- and intra-operative CTs. However, the difference in orientation between the pre- and intra-operative CTs is too extreme to be recovered by standard, gradient descent-based registration methods. Thus, we have so far relied on an expert to manually initialize the registration. In this work we present a method that aligns the scans automatically. We compared the performance of the automatic approach to the registration approach when an expert does the manual initialization on ten pairs of scans. There is a maximum difference of 0.19 mm between the entry and target points resulting from the automatic and manually initialized registration processes. This suggests that the automatic registration method is accurate enough to be used in a PCI surgery.

  12. Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

    NASA Astrophysics Data System (ADS)

    D'Haese, Pierre-Francois; Pallavaram, Srivatsan; Kao, Chris; Konrad, Peter E.; Dawant, Benoit M.

    2005-04-01

    The long term objective of our research is to develop a system that will automate as much as possible DBS implantation procedures. It is estimated that about 180,000 patients/year would benefit from DBS implantation. Yet, only 3000 procedures are performed annually. This is so because the combined expertise required to perform the procedure successfully is only available at a limited number of sites. Our goal is to transform this procedure into a procedure that can be performed by a general neurosurgeon at a community hospital. In this work we report on our current progress toward developing a system for the computer-assisted pre-operative selection of target points and for the intra-operative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the pre-operative target, of an electrophysiological atlas, and of an intra-operative interface. The atlas is deformed using a rigid then a non-rigid registration algorithm developed at our institution. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information can be used to resolve structures not visible in anatomic images, thus improving both pre-operative and intra-operative guidance. Our intra-operative system has reached the stage of a working prototype that is clinically used at our institution.

  13. Intraoperative Transcranial Motor-Evoked Potential Monitoring of the Facial Nerve during Cerebellopontine Angle Tumor Resection

    PubMed Central

    Cosetti, Maura K.; Xu, Ming; Rivera, Andrew; Jethanamest, Daniel; Kuhn, Maggie A.; Beric, Aleksandar; Golfinos, John G.; Roland, J. Thomas

    2012-01-01

    Objective?To determine whether transcranial motor-evoked potential (TCMEP) monitoring of the facial nerve (FN) during cerebellopontine angle (CPA) tumor resection can predict both immediate and long-term postoperative FN function. Design?Retrospective review. Setting?Tertiary referral center. Main Outcome Measures?DeltaTCMEP (final-initial) and immediate and long-term facial nerve function using House Brackmann (HB) rating scale. Results?Intraoperative TCMEP data and immediate and follow-up FN outcome are reported for 52 patients undergoing CPA tumor resection. Patients with unsatisfactory facial outcome (HB >2) at follow-up had an average deltaTCMEP of 57?V, whereas those with HB I or II had a mean deltaTCMEP of 0.04?V (t?=?-2.6, p?Intraoperative deltaTCMEP did not differ significantly between groups with satisfactory (HB I, II) and unsatisfactory (HB?>?2) facial function in the immediate postoperative period. Conclusion?Intraoperative TCMEP of the facial nerve can be a valuable adjunct to conventional facial nerve electromyography during resection of tumors at the CPA. Intraoperative deltaTCMEP >57?V may be worrisome for long-term recovery of satisfactory facial nerve function. PMID:24083121

  14. Initial experience of using high field strength intraoperative MRI for neurosurgical procedures.

    PubMed

    Raheja, Amol; Tandon, Vivek; Suri, Ashish; Sarat Chandra, P; Kale, Shashank S; Garg, Ajay; Pandey, Ravindra M; Kalaivani, Mani; Mahapatra, Ashok K; Sharma, Bhawani S

    2015-08-01

    We report our initial experience to optimize neurosurgical procedures using high field strength intraoperative magnetic resonance imaging (IOMRI) in 300 consecutive patients as high field strength IOMRI rapidly becomes the standard of care for neurosurgical procedures. Three sequential groups (groups A, B, C; n=100 each) were compared with respect to time management, complications and technical difficulties to assess improvement in these parameters with experience. We observed a reduction in the number of technical difficulties (p<0.001), time to induction (p<0.001) and total anesthesia time (p=0.007) in sequential groups. IOMRI was performed for neuronavigation guidance (n=252) and intraoperative validation of extent of resection (EOR; n=67). Performing IOMRI increased the EOR over and beyond the primary surgical attempt in 20.5% (29/141) and 18% (11/61) of patients undergoing glioma and pituitary surgery, respectively. Overall, EOR improved in 59.7% of patients undergoing IOMRI (40/67). Intraoperative tractography and real time navigation using re-uploaded IOMRI images (accounting for brain shift) helps in intraoperative planning to reduce complications. IOMRI is an asset to neurosurgeons, helping to augment the EOR, especially in glioma and pituitary surgery, with no significant increase in morbidity to the patient. PMID:26077939

  15. Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model

    SciTech Connect

    Johnstone, P.A.S.; DeLuca, A.M.; Terrill, R.E.

    1995-07-15

    The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. All animals treated with {>=} 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED{sub 50}) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED{sub 50} determined here is in keeping with data from other animal trials, and from clinical trials in humans. 11 refs., 2 figs.

  16. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists.

    PubMed

    Peng, Yong G; Song, Haibo; Wang, E; Wang, Weipeng; Liu, Jin

    2015-03-01

    Guidelines for the intraoperative transesophageal echocardiography (TEE) examination have defined a detailed standard for medical professionals, particularly anesthesiologists, on how a TEE exam should proceed. Over the years, TEE has gained substantial popularity and emerged as a preferred monitoring modality to aid in perioperative management and decision making during hemodynamic instability situations or critical care settings. TEE training pathways and practice guidelines have been well established in western countries and many regions of the world. However, TEE training and practice information for anesthesiologists are lacking in China. As innovative technologies develop, other educational models have emerged to aid in obtaining competency in basic TEE exam. Hence, establishing a consensus on the ideal TEE training approach for anesthesiologists in China is urgently needed. Developing an effective curriculum that can be incorporated into an anesthesiology resident's overall training is also necessary to provide knowledge and skills toward competency in basic TEE exam. With evolving medical system reforms and increasing demands for intraoperative hemodynamic monitoring to accommodate surgical innovations, anesthesiology professionals are increasingly obliged to perform intraoperative TEE exams in their current and future practices. To overcome obstacles and achieve significant progress in using the TEE modality to help in intraoperative management and surgical decision making, publishing basic TEE training guidelines for China's anesthesiologists is an important endeavor. PMID:25337689

  17. Dissociation of Subtraction and Multiplication in the Right Parietal Cortex: Evidence from Intraoperative Cortical Electrostimulation

    ERIC Educational Resources Information Center

    Yu, Xiaodan; Chen, Chuansheng; Pu, Song; Wu, Chenxing; Li, Yongnian; Jiang, Tao; Zhou, Xinlin

    2011-01-01

    Previous research has consistently shown that the left parietal cortex is critical for numerical processing, but the role of the right parietal lobe has been much less clear. This study used the intraoperative cortical electrical stimulation approach to investigate neural dissociation in the right parietal cortex for subtraction and…

  18. Dissociation of Subtraction and Multiplication in the Right Parietal Cortex: Evidence from Intraoperative Cortical Electrostimulation

    ERIC Educational Resources Information Center

    Yu, Xiaodan; Chen, Chuansheng; Pu, Song; Wu, Chenxing; Li, Yongnian; Jiang, Tao; Zhou, Xinlin

    2011-01-01

    Previous research has consistently shown that the left parietal cortex is critical for numerical processing, but the role of the right parietal lobe has been much less clear. This study used the intraoperative cortical electrical stimulation approach to investigate neural dissociation in the right parietal cortex for subtraction and

  19. Analysis of endocardial acceleration during intraoperative optimization of cardiac resynchronization therapy

    PubMed Central

    Hernandez, Alfredo I.; Ziglio, Filippo; Amblard, Amel; Senhadji, Lotfi; Leclercq, Christophe

    2013-01-01

    Cardiac resynchronization therapy (CRT) is the therapy of choice for selected patients suffering from drug-refractory congestive heart failure and presenting an interventricular desynchronization. CRT is delivered by an implantable biventricular pacemaker, which stimulates the right atrium and both ventricles at specific timings. The optimization and personalization of this therapy requires to quantify both the electrical and the mechanical cardiac functions during the intraoperative and postoperative phases. The objective of this paper is to evaluate the feasibility of the calculation of features extracted from endocardial acceleration (EA) signals and the potential utility of these features for the intraoperative optimization of CRT. Endocardial intraoperative data from one patient are analyzed for 33 different pacing configurations, including changes in the atrio-ventricular and inter-ventricular delays and different ventricular stimulation sites. The main EA features are extracted for each pacing configuration and analyzed so as to estimate the intra-configuration and inter-configuration variability. Results show the feasibility of the proposed approach and suggest the potential utility of EA for intraoperative monitoring of the cardiac function and defining optimal, adaptive pacing configurations. PMID:24111356

  20. Evaluation of INPRES--Intraoperative Presentation of surgical planning and simulation results.

    PubMed

    Salb, Tobias; Brief, Jakob; Burgert, Oliver; Gockel, Tilo; Hassfeld, Stefan; Muehling, Joachim; Dillmann, Ruediger

    2003-01-01

    In this paper we present fundamental results of the first evaluation of INPRES in a laboratory environment. While the system itself--an HMD-based approach for intraoperative augmented reality in head and neck surgery--has been described elsewhere several times, this paper will focus on methods and outcome of recently accomplished test procedures. PMID:15455913

  1. INTRAOPERATIVE ANEURYSMAL RUPTURE: CLINICAL OUTCOME FOLLOWING OPEN SURGERY OR ENDOVASCULAR TREATMENT.

    PubMed

    Laki?evi?, Novak; Prstojevi?, Branko; Rasuli?, Lukas; Vujoti?, Ljiljana; Vukainovi? Ivan; Mili?i?, Biljana; Savi?, Andrija; ivkovi?, Bojana; Rotim, Kreimir; Samardi?, Miroslav

    2015-09-01

    The aim of this study was to evaluate and compare the outcomes of intraoperative aneurysmal rupture in patients with subarachnoid hemorrhage undergoing open surgical or endovascular treatment. This retrospective study included 742 patients with aneurysmal subarachnoid hemorrhage treated at the Clinical Department of Neurosurgery, Clinical Center of Serbia, during a three-year period. Among them, 167 (31.15%) were treated by clipping and 33 (16.01%) by coiling in the early phase (?72 hours). The overall outcome and pretreatment variables were analyzed for each group, including between-group difference according to the occurrence of intraoperative aneurysmal rupture. Intraoperative aneurysmal rupture occurred in 14.7% of microsurgical and 2.4% of endovascular procedures. It was more frequent in early procedures as compared with delayed procedures (27.5% and 9.7% vs. 2.2% and 1.1%, respectively). On the contrary, mortality rates were lower in the surgical group (11.4%) than in the endovascular one (60.0%). On the basis of the results obtained, it is concluded that intraoperative aneurysmal rupture is more frequent after open than after endovascular treatment, but clinical outcome is more favorable in the former group. PMID:26666097

  2. Three intraoperative methods to determine limb-length discrepancy in THA.

    PubMed

    Rice, Ian S; Stowell, R Lee; Viswanath, Purab C; Cortina, Gary J

    2014-05-01

    Limb-length discrepancy (LLD) is a common concern for both surgeon and patient in the setting of elective total hip arthroplasty (THA). There is a paucity of evidence guiding surgeons to an optimal method for measuring intraoperative LLD and minimizing postoperative LLD. The primary objective of this prospective, randomized, double-blinded study was to determine which of 3 intraoperative methods used at the authors' institution was best correlated to postoperative radiographic LLD. From 2011 to 2012, 81 patients undergoing either primary (75) or revision (6) THA with an anterolateral (Watson-Jones) approach were prospectively randomized and received intraoperative measurement of LLD via 1 of 3 methods: abductor shuck (AS), tranosseous pins with calibrated caliper (TP), or patella electrocardiogram (EKG) leads (PL). Intraoperative measurements of LLD were compared to clinical and radiographic postoperative measurements of LLD, and absolute differences and correlation coefficients were calculated for each method. Overall, the mean LLD preoperatively was 8.09 mm, and mean radiographic LLD postoperatively was 4.20 mm. The AS method was associated with the highest correlation to postoperative radiographic LLD (R=0.360; P<.05), whereas the other methods had mildly positive but statistically insignificant correlations (TP R=0.275; P>.05; PL R=0.301; P>.05). The AS method best correlates to postoperative radiographic LLD among the 3 techniques, although all methods were positively correlated. Clinical measurements of LLD correlate poorly with radiographic measurements and may be of limited utility. PMID:24810827

  3. Trends in hemispheric warm and cold anomalies

    NASA Astrophysics Data System (ADS)

    Robeson, Scott M.; Willmott, Cort J.; Jones, Phil D.

    2014-12-01

    Using a spatial percentile approach, we explore the magnitude of temperature anomalies across the Northern and Southern Hemispheres. Linear trends in spatial percentile series are estimated for 1881-2013, the most recent 30 year period (1984-2013), and 1998-2013. All spatial percentiles in both hemispheres show increases from 1881 to 2013, but warming occurred unevenly via modification of cold anomalies, producing a reduction in spatial dispersion. In the most recent 30 year period, trends also were consistently positive, with warm anomalies having much larger warming rates than those of cold anomalies in both hemispheres. This recent trend has largely reversed the decrease in spatial dispersion that occurred during the twentieth century. While the period associated with the recent slowdown of global warming, 1998-2013, is too brief to estimate trends reliably, cooling was evident in NH warm and cold anomalies during January and February while other months in the NH continued to warm.

  4. "Live cadavers" for training in the management of intraoperative aneurysmal rupture.

    PubMed

    Aboud, Emad; Aboud, Ghaith; Al-Mefty, Ossama; Aboud, Talal; Rammos, Stylianos; Abolfotoh, Mohammad; Hsu, Sanford P C; Koga, Sebastian; Arthur, Adam; Krisht, Ali

    2015-11-01

    OBJECT Intraoperative rupture occurs in approximately 9.2% of all cranial aneurysm surgeries. This event is not merely a surgical complication, it is also a real surgical crisis that requires swift and decisive action. Neurosurgical residents may have little exposure to this event, but they may face it in their practice. Laboratory training would be invaluable for developing competency in addressing this crisis. In this study, the authors present the "live cadaver" model, which allows repetitive training under lifelike conditions for residents and other trainees to practice managing this crisis. METHODS The authors have used the live cadaver model in 13 training courses from 2009 to 2014 to train residents and neurosurgeons in the management of intraoperative aneurysmal rupture. Twenty-three cadaveric head specimens harboring 57 artificial and 2 real aneurysms were used in these courses. Specimens were specially prepared for this technique and connected to a pump that sent artificial blood into the vessels. This setting created a lifelike situation in the cadaver that simulates live surgery in terms of bleeding, pulsation, and softness of tissue. RESULTS A total of 203 neurosurgical residents and 89 neurosurgeons and faculty members have practiced and experienced the live cadaver model. Clipping of the aneurysm and management of an intraoperative rupture was first demonstrated by an instructor. Then, trainees worked for 20- to 30-minute sessions each, during which they practiced clipping and reconstruction techniques and managed intraoperative ruptures. Ninety-one of the participants (27 faculty members and 64 participants) completed a questionnaire to rate their personal experience with the model. Most either agreed or strongly agreed that the model was a valid simulation of the conditions of live surgery on cerebral aneurysms and represents a realistic simulation of aneurysmal clipping and intraoperative rupture. Actual performance improvement with this model will require detailed measurement for validating its effectiveness. The model lends itself to evaluation using precise performance measurements. CONCLUSIONS The live cadaver model presents a useful simulation of the conditions of live surgery for clipping cerebral aneurysms and managing intraoperative rupture. This model provides a means of practice and promotes team management of intraoperative cerebrovascular critical events. Precise metric measurement for evaluation of training performance improvement can be applied. PMID:26140492

  5. Persistent and automatic intraoperative 3D digitization of surfaces under dynamic magnifications of an operating microscope

    PubMed Central

    Kumar, Ankur N.; Miga, Michael I.; Pheiffer, Thomas S.; Chambless, Lola B.; Thompson, Reid C.; Dawant, Benoit M.

    2014-01-01

    One of the major challenges impeding advancement in image-guided surgical (IGS) systems is the soft-tissue deformation during surgical procedures. These deformations reduce the utility of the patients preoperative images and may produce inaccuracies in the application of preoperative surgical plans. Solutions to compensate for the tissue deformations include the acquisition of intraoperative tomographic images of the whole organ for direct displacement measurement and techniques that combines intraoperative organ surface measurements with computational biomechanical models to predict subsurface displacements. The later solution has the advantage of being less expensive and amenable to surgical workflow. Several modalities such as textured laser scanners, conoscopic holography, and stereo-pair cameras have been proposed for the intraoperative 3D estimation of organ surfaces to drive patient-specific biomechanical models for the intraoperative update of preoperative images. Though each modality has its respective advantages and disadvantages, stereo-pair camera approaches used within a standard operating microscope is the focus of this article. A new method that permits the automatic and near real-time estimation of 3D surfaces (at 1Hz) under varying magnifications of the operating microscope is proposed. This method has been evaluated on a CAD phantom object and on full-length neurosurgery video sequences (~1 hour) acquired intraoperatively by the proposed stereovision system. To the best of our knowledge, this type of validation study on full-length brain tumor surgery videos has not been done before. The method for estimating the unknown magnification factor of the operating microscope achieves accuracy within 0.02 of the theoretical value on a CAD phantom and within 0.06 on 4 clinical videos of the entire brain tumor surgery. When compared to a laser range scanner, the proposed method for reconstructing 3D surfaces intraoperatively achieves root mean square errors (surface-to-surface distance) in the 0.28-0.81mm range on the phantom object and in the 0.54-1.35mm range on 4 clinical cases. The digitization accuracy of the presented stereovision methods indicate that the operating microscope can be used to deliver the persistent intraoperative input required by computational biomechanical models to update the patients preoperative images and facilitate active surgical guidance. PMID:25189364

  6. Persistent and automatic intraoperative 3D digitization of surfaces under dynamic magnifications of an operating microscope.

    PubMed

    Kumar, Ankur N; Miga, Michael I; Pheiffer, Thomas S; Chambless, Lola B; Thompson, Reid C; Dawant, Benoit M

    2015-01-01

    One of the major challenges impeding advancement in image-guided surgical (IGS) systems is the soft-tissue deformation during surgical procedures. These deformations reduce the utility of the patient's preoperative images and may produce inaccuracies in the application of preoperative surgical plans. Solutions to compensate for the tissue deformations include the acquisition of intraoperative tomographic images of the whole organ for direct displacement measurement and techniques that combines intraoperative organ surface measurements with computational biomechanical models to predict subsurface displacements. The later solution has the advantage of being less expensive and amenable to surgical workflow. Several modalities such as textured laser scanners, conoscopic holography, and stereo-pair cameras have been proposed for the intraoperative 3D estimation of organ surfaces to drive patient-specific biomechanical models for the intraoperative update of preoperative images. Though each modality has its respective advantages and disadvantages, stereo-pair camera approaches used within a standard operating microscope is the focus of this article. A new method that permits the automatic and near real-time estimation of 3D surfaces (at 1 Hz) under varying magnifications of the operating microscope is proposed. This method has been evaluated on a CAD phantom object and on full-length neurosurgery video sequences (∼1 h) acquired intraoperatively by the proposed stereovision system. To the best of our knowledge, this type of validation study on full-length brain tumor surgery videos has not been done before. The method for estimating the unknown magnification factor of the operating microscope achieves accuracy within 0.02 of the theoretical value on a CAD phantom and within 0.06 on 4 clinical videos of the entire brain tumor surgery. When compared to a laser range scanner, the proposed method for reconstructing 3D surfaces intraoperatively achieves root mean square errors (surface-to-surface distance) in the 0.28-0.81 mm range on the phantom object and in the 0.54-1.35 mm range on 4 clinical cases. The digitization accuracy of the presented stereovision methods indicate that the operating microscope can be used to deliver the persistent intraoperative input required by computational biomechanical models to update the patient's preoperative images and facilitate active surgical guidance. PMID:25189364

  7. Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride

    PubMed Central

    Horvath, K; Vultur, F; Simon, V; Voidazan, S; Mhlfay, Gh

    2015-01-01

    Aim: The purpose of this study was to investigate intraoperative iris behavior during some phacoemulsification maneuvers in rabbits treated with tamsulosin or finasteride. Material and Method: An experimental study was conducted on 26 Metis male rabbits aged 1.5 - 2 years, body weight between 3.4 and 5.6 kg, divided into three groups: Group 1 - Control, 6 rabbits; Group 2 - tamsulosin, 10 rabbits; Group 3 - finasteride, 10 rabbits. Dose calculation was performed according to body surface area ratio man/rabbit, taking into account the median lethal dose LD50. Surgery study in rabbits was done over two days by the same specialist using an adapted protocol. He was not informed before or during surgeries which group the animal belonged to, the order being random with a quasi-uniform distribution. Valid results for a modified iris behavior were obtained from two steps of the procedure (cannula irrigation maneuver and irrigation-aspiration). The iris billowing was graded from 0 to 3, according to severity. Results: The risk of intraoperative iris billowing was higher in rabbits included in tamsulosin group [OR=8.33 (CI 95% 0.63-110.09)], but insignificant statistically compare with control group (p= 0.13). In rabbits treated with finasteride the risk of intraoperative iris billowing is increased compared with those without treatment [OR=11.6 (CI 95% 0.92-147.6)], but insignificant statistically (p= 0.11). Conclusion: In our research, we showed an increased risk of intraoperative iris billowing in rabbits treated with finasteride, almost similar with those obtained in rabbits treated with tamsulosin. Further experimental or clinical studies to confirm the role of finasteride in the etiology of intraoperative floppy iris syndrome in humans are needed. Hippokratia 2015, 19 (1): 20-24. PMID:26435641

  8. Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy

    SciTech Connect

    Kudchadker, Rajat J.; Pugh, Thomas J.; Swanson, David A.; Bruno, Teresa L.; Bolukbasi, Yasemin; Frank, Steven J.

    2012-01-01

    Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R{sup 2} = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.

  9. Strategy of Surgical Resection for Glioma Based on Intraoperative Functional Mapping and Monitoring

    PubMed Central

    TAMURA, Manabu; MURAGAKI, Yoshihiro; SAITO, Taiichi; MARUYAMA, Takashi; NITTA, Masayuki; TSUZUKI, Shunsuke; ISEKI, Hiroshi; OKADA, Yoshikazu

    2015-01-01

    A growing number of papers have pointed out the relationship between aggressive resection of gliomas and survival prognosis. For maximum resection, the current concept of surgical decision-making is in information-guided surgery using multimodal intraoperative information. With this, anatomical information from intraoperative magnetic resonance imaging (MRI) and navigation, functional information from brain mapping and monitoring, and histopathological information must all be taken into account in the new perspective for innovative minimally invasive surgical treatment of glioma. Intraoperative neurofunctional information such as neurophysiological functional monitoring takes the most important part in the process to acquire objective visual data during tumor removal and to integrate these findings as digitized data for intraoperative surgical decision-making. Moreover, the analysis of qualitative data and threshold-setting for quantitative data raise difficult issues in the interpretation and processing of each data type, such as determination of motor evoked potential (MEP) decline, underestimation in tractography, and judgments of patient response for neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional diagnosis of false-positives in these situations may affect the extent of resection, while false-negatives influence intra- and postoperative complication rates. Additionally, even though the various intraoperative visualized data from multiple sources contribute significantly to the reliability of surgical decisions when the information is integrated and provided, it is not uncommon for individual pieces of information to convey opposing suggestions. Such conflicting pieces of information facilitate higher-order decision-making that is dependent on the policies of the facility and the priorities of the patient, as well as the availability of the histopathological characteristics from resected tissue. PMID:26185825

  10. Preoperative coil marking to facilitate intraoperative localization of spinal dural arteriovenous fistulas

    PubMed Central

    Berkefeld, Joachim; Seifert, Volker; Gerlach, Rdiger

    2009-01-01

    Considering surgical treatment of spinal dural arteriovenous fistulas, the major difficulty is to localize them reliably during surgery. Usually the affected spinal level is sought by counting of bony structures using fluoroscopy. However, quite frequently, anatomical particularities impede adequate counting resulting in surgery performed at erroneous spinal levels. The objective of this study was therefore to evaluate the potential benefits of preoperative coil marking in order to facilitate intraoperative localization of spinal dural arteriovenous fistulas. After detection of the fistula with spinal angiography, selective catheterization of the feeding vessel was performed, and a GDC coil was detached in the lumen of the vessel adjacent to the respective bony pedicle. Coil marking was effected in 8 patients (group A), 20 patients were operated without such a marking (group B). The data of both groups of patients were compared with regard to accurateness of the surgical approach, duration of surgery, and dosage of intraoperative fluoroscopy. In all patients of group A, the coil was easily identified by intraoperative fluoroscopy. A partial hemilaminectomy was sufficient for localization and microsurgical treatment of the spinal dural arteriovenous fistula in each patient. In patients of group B, the correct spinal level was approached in 12 patients (60%), in 8 patients (40%) surgery was performed initially at an erroneous level (P=0.048). Mean duration of surgery was 130min in group A and 177min in group B (P=0.031). Likewise, mean dosage of intraoperative fluoroscopy was higher in group B (119.5 vs. 394.3cGy/cm2; P=0.036). Preoperative coil marking allows exact intraoperative localization of spinal dural arteriovenous fistulas. Thus, surgery at erroneous spinal levels is avoided, and it is feasible to perform a straightforward, minimally invasive surgical approach. This reflects in significant reduction of duration of anesthesia and surgery. Moreover, radiation exposure of the patient is significantly reduced. PMID:19330362

  11. Intraoperative Spectroscopy with Ultrahigh Sensitivity for Image-Guided Surgery of Malignant Brain Tumors.

    PubMed

    Kairdolf, Brad A; Bouras, Alexandros; Kaluzova, Milota; Sharma, Abhinav K; Wang, May Dongmei; Hadjipanayis, Constantinos G; Nie, Shuming

    2016-01-01

    Intraoperative cancer imaging and fluorescence-guided surgery have attracted considerable interest because fluorescence signals can provide real-time guidance to assist a surgeon in differentiating cancerous and normal tissues. Recent advances have led to the clinical use of a natural fluorophore called protoporphyrin IX (PpIX) for image-guided surgical resection of high-grade brain tumors (glioblastomas). However, traditional fluorescence imaging methods have only limited detection sensitivity and identification accuracy and are unable to detect low-grade or diffuse infiltrating gliomas (DIGs). Here we report a low-cost hand-held spectroscopic device that is capable of ultrasensitive detection of protoporphyrin IX fluorescence in vivo, together with intraoperative spectroscopic data obtained from both animal xenografts and human brain tumor specimens. The results indicate that intraoperative spectroscopy is at least 3 orders of magnitude more sensitive than the current surgical microscopes, allowing ultrasensitive detection of as few as 1000 tumor cells. For detection specificity, intraoperative spectroscopy allows the differentiation of brain tumor cells from normal brain cells with a contrast signal ratio over 100. In vivo animal studies reveal that protoporphyrin IX fluorescence is strongly correlated with both MRI and histological staining, confirming that the fluorescence signals are highly specific to tumor cells. Furthermore, ex vivo spectroscopic studies of excised brain tissues demonstrate that the hand-held spectroscopic device is capable of detecting diffuse tumor margins with low fluorescence contrast that are not detectable with current systems in the operating room. These results open new opportunities for intraoperative detection and fluorescence-guided resection of microscopic and low-grade glioma brain tumors with invasive or diffusive margins. PMID:26587976

  12. Global warming; What needs to be done

    SciTech Connect

    Not Available

    1991-04-01

    This paper names global warming as a high-level risk. However, global warming's risk status is a point of debate in some circles, reflecting one of the complexities of using risk-based criteria to establish priorities for action. The position that global warming is a long-term environmental trend that must be halted. In this paper, argument son both sides of the global warming issue are presented to illustrate the difficulties associated with establishing the existence and magnitude of environmental and health risks, an issue that must be faced if the SAB recommendations for EPA policy change are implemented.

  13. DPIS for warm dense matter

    SciTech Connect

    Kondo, K.; Kanesue, T.; Horioka, K.; Okamura, M.

    2010-05-23

    Warm Dense Matter (WDM) offers an challenging problem because WDM, which is beyond ideal plasma, is in a low temperature and high density state with partially degenerate electrons and coupled ions. WDM is a common state of matter in astrophysical objects such as cores of giant planets and white dwarfs. The WDM studies require large energy deposition into a small target volume in a shorter time than the hydrodynamical time and need uniformity across the full thickness of the target. Since moderate energy ion beams ({approx} 0.3 MeV/u) can be useful tool for WDM physics, we propose WDM generation using Direct Plasma Injection Scheme (DPIS). In the DPIS, laser ion source is connected to the Radio Frequency Quadrupole (RFQ) linear accelerator directly without the beam transport line. DPIS with a realistic final focus and a linear accelerator can produce WDM.

  14. Modern Physics and Warm Friendship

    NASA Astrophysics Data System (ADS)

    Yang, Chen Ning

    2013-05-01

    During the academic year 1941-42 I was a senior in the Physics Department at the National Southwest Associated University in Kunming. The Department was quite small, with about 10 faculty members, 10 instructors, a few graduate students and not more than 20 students in each undergraduate class. When the academic year started in the fall of 1941, a new face appeared, auditing many of the senior and graduate courses and participating in all discussions. That was Huang Kun. He had already received his bachelor's degree in physics from Yenching University in Beiping, and had come to Kunming to join the Southwest Associated University as an instructor. Soon we got to know each other well, and that was the beginning of half of a century of warm friendship...

  15. End Calorimeter Warm Tube Heater

    SciTech Connect

    Primdahl, K.; /Fermilab

    1991-08-06

    The Tevatron accelerator beam tube must pass through the End Calorimeter cryostats of the D-Zero Collider Detector. Furthermore, the End Calorimeter cryostats must be allowed to roll back forty inches without interruption of the vacuum system; hence, the Tev tube must slide through the End Calorimeter cryostat as it is rolled back. The Tev pass through the End Calorimeter can actually be thought of as a cluster of concentric tubes: Tev tube, warm (vacuum vessel) tube, IS layers of superinsulation, cold tube (argon vessel), and Inner Hadronic center support tube. M. Foley generated an ANSYS model to study the heat load. to the cryostat. during collider physics studies; that is, without operation of the heater. A sketch of the model is included in the appendix. The vacuum space and superinsulation was modeled as a thermal solid, with conductivity derived from tests performed at Fermilab. An additional estimate was done. by this author, using data supplied by NR-2. a superinsulation manufacturer. The ANSYS result and hand calculation are in close agreement. The ANSYS model was modified. by this author. to incorporate the effect of the heater. Whereas the earlier model studied steady state operation only. the revised model considers the heater-off steady state mode as the initial condition. then performs a transient analysis with a final load step for time tending towards infinity. Results show the thermal gradient as a function of time and applied voltage. It should be noted that M. Foley's model was generated for one half the warm tube. implying the tube to be symmetric. In reality. the downstream connection (relative to the collision point) attachment to the vacuum shell is via several convolutions of a 0.020-inch wall bellows; hence. a nearly adiabatic boundary condition. Accordingly. the results reported in the table reflect extrapolation of the curves to the downstream end of the tube. Using results from the ANSYS analysis, that is, tube temperature and corresponding heat flux, temperature of the nichrome wire can be estimated. The possibility of frost is of genuine concern, as evidenced by the 250 K minimum temperature for the warm tube while heaters are not operating. Noting that steady state operation at 1 Amp (40 volts) allows the nichrome wire to stay below the critical temperature for Kapton, a conservative plan is to allow several days of heater operation, at 1 Amp (40 volts), before roll-back. Warm-up can be accelerated by operating the heaters in excess of 1 Amp, as evidenced by the test where a maximum of 3.2 Amp was supplied. Operating the heaters in excess of 1 Amp must be done with care since a rapid rise in temperature will likely occur once any ice present has been melted.

  16. Meteorology: hurricanes and global warming.

    PubMed

    Landsea, Christopher W

    2005-12-22

    Anthropogenic climate change has the potential for slightly increasing the intensity of tropical cyclones through warming of sea surface temperatures. Emanuel has shown a striking and surprising association between sea surface temperatures and destructiveness by tropical cyclones in the Atlantic and western North Pacific basins. However, I question his analysis on the following grounds: it does not properly represent the observations described; the use of his Atlantic bias-removal scheme may not be warranted; and further investigation of a substantially longer time series for tropical cyclones affecting the continental United States does not show a tendency for increasing destructiveness. These factors indicate that instead of "unprecedented" tropical cyclone activity having occurred in recent years, hurricane intensity was equal or even greater during the last active period in the mid-twentieth century. PMID:16371953

  17. Liquid Cooling/Warming Garment

    NASA Technical Reports Server (NTRS)

    Koscheyev, Victor S.; Leon, Gloria R.; Dancisak, Michael J.

    2010-01-01

    The NASA liquid cooling/ventilating garment (LCVG) currently in use was developed over 40 years ago. With the commencement of a greater number of extra-vehicular activity (EVA) procedures with the construction of the International Space Station, problems of astronaut comfort, as well as the reduction of the consumption of energy, became more salient. A shortened liquid cooling/warming garment (SLCWG) has been developed based on physiological principles comparing the efficacy of heat transfer of different body zones; the capability of blood to deliver heat; individual muscle and fat body composition as a basis for individual thermal profiles to customize the zonal sections of the garment; and the development of shunts to minimize or redirect the cooling/warming loop for different environmental conditions, physical activity levels, and emergency situations. The SLCWG has been designed and completed, based on extensive testing in rest, exercise, and antiorthostatic conditions. It is more energy efficient than the LCVG currently used by NASA. The total length of tubing in the SLCWG is approximately 35 percent less and the weight decreased by 20 percent compared to the LCVG. The novel features of the innovation are: 1. The efficiency of the SLCWG to maintain thermal status under extreme changes in body surface temperatures while using significantly less tubing than the LCVG. 2. The construction of the garment based on physiological principles of heat transfer. 3. The identification of the body areas that are most efficient in heat transfer. 4. The inclusion of a hood as part of the garment. 5. The lesser consumption of energy.

  18. Keeping cool on global warming

    SciTech Connect

    Seitz, F. Rockefeller Univ., New York, NY ); Hawkins, W.; Nierenberg, W.; Salmon, J. ); Jastrow, R. Dartmouth College, Hanover, NH ); Moore, J.H. George Mason Univ., Fairfax, VA )

    1992-07-01

    A number of scientific groups have concluded that the greenhouse effect caused by the man-made emissions of carbon dioxide and other bases has produced much or all of the rise in global temperatures. They predict that there will be an increase in greenhouse gases equivalent to a doubling of carbon dioxide by the middle of the 21st century, and that this will cause the temperature of the earth to rise by as much as 5C. According to these scientists, a temperature rise of this magnitude would cause major disruptions in the earth's ecosystem, including severe summer drought in the midwestern US and other agricultural regions. The worst-case scenarios predict a major rise in sea level as a result of the greenhouse warming, inundating areas of New York, Miami and other coastal cities as well as low-lying river deltas and islands. The lives of hundreds of millions of people would be disrupted. The available data on climate change, however, do not support these predictions, nor do they support the idea that human activity has caused, or will cause, a dangerous increase in global temperatures. As the authors make this statement, they are aware that it contradicts widespread popular opinion, as well as the technical judgments of some of their colleagues. But it would be imprudent to ignore the facts on global warming that have accumulated over the last two years. These facts indicate that theoretical estimates of the greenhouse problem have greatly exaggerated its seriousness. Enormous economic stakes ride on forthcoming government decisions regarding carbon taxes and other restrictions on CO{sub 2} emissions. Due attention must therefore be given to the scientific evidence, no matter how contrary to popular opinion its implications appear to be. This article discusses the scientific evidence.

  19. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe

    NASA Astrophysics Data System (ADS)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.

    2014-02-01

    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  20. Design and performance of combined infrared canopy and belowground warming in the B4WarmED (Boreal Forest Warming at an Ecotone in Danger) experiment.

    PubMed

    Rich, Roy L; Stefanski, Artur; Montgomery, Rebecca A; Hobbie, Sarah E; Kimball, Bruce A; Reich, Peter B

    2015-06-01

    Conducting manipulative climate change experiments in complex vegetation is challenging, given considerable temporal and spatial heterogeneity. One specific challenge involves warming of both plants and soils to depth. We describe the design and performance of an open-air warming experiment called Boreal Forest Warming at an Ecotone in Danger (B4WarmED) that addresses the potential for projected climate warming to alter tree function, species composition, and ecosystem processes at the boreal-temperate ecotone. The experiment includes two forested sites in northern Minnesota, USA, with plots in both open (recently clear-cut) and closed canopy habitats, where seedlings of 11 tree species were planted into native ground vegetation. Treatments include three target levels of plant canopy and soil warming (ambient, +1.7C, +3.4C). Warming was achieved by independent feedback control of voltage input to aboveground infrared heaters and belowground buried resistance heating cables in each of 72-7.0 m(2) plots. The treatments emulated patterns of observed diurnal, seasonal, and annual temperatures but with superimposed warming. For the 2009 to 2011 field seasons, we achieved temperature elevations near our targets with growing season overall mean differences (?Tbelow ) of +1.84C and +3.66C at 10 cm soil depth and (?T(above) ) of +1.82C and +3.45C for the plant canopies. We also achieved measured soil warming to at least 1 m depth. Aboveground treatment stability and control were better during nighttime than daytime and in closed vs. open canopy sites in part due to calmer conditions. Heating efficacy in open canopy areas was reduced with increasing canopy complexity and size. Results of this study suggest the warming approach is scalable: it should work well in small-statured vegetation such as grasslands, desert, agricultural crops, and tree saplings (<5 m tall). PMID:25640748

  1. Efficient Warm-ups: Creating a Warm-up That Works.

    ERIC Educational Resources Information Center

    Lauffenburger, Sandra Kay

    1992-01-01

    Proper warm-up is important for any activity, but designing an effective warm-up can be time consuming. An alternative approach is to take a cue from Laban Movement Analysis (LMA) and consider movement design from the perspective of space and planes of motion. Efficient warm-up exercises using LMA are described. (SM)

  2. Warm Pressurant Gas Effects on the Liquid Hydrogen Bubble Point

    NASA Technical Reports Server (NTRS)

    Hartwig, Jason W.; McQuillen, John B.; Chato, David J.

    2013-01-01

    This paper presents experimental results for the liquid hydrogen bubble point tests using warm pressurant gases conducted at the Cryogenic Components Cell 7 facility at the NASA Glenn Research Center in Cleveland, Ohio. The purpose of the test series was to determine the effect of elevating the temperature of the pressurant gas on the performance of a liquid acquisition device. Three fine mesh screen samples (325 x 2300, 450 x 2750, 510 x 3600) were tested in liquid hydrogen using cold and warm noncondensible (gaseous helium) and condensable (gaseous hydrogen) pressurization schemes. Gases were conditioned from 0 to 90 K above the liquid temperature. Results clearly indicate a degradation in bubble point pressure using warm gas, with a greater reduction in performance using condensable over noncondensible pressurization. Degradation in the bubble point pressure is inversely proportional to screen porosity, as the coarsest mesh demonstrated the highest degradation. Results here have implication on both pressurization and LAD system design for all future cryogenic propulsion systems. A detailed review of historical heated gas tests is also presented for comparison to current results.

  3. Exploring the Sociopolitical Dimensions of Global Warming

    ERIC Educational Resources Information Center

    Sadler, Troy D.; Klosterman, Michelle L.

    2009-01-01

    The authors present an activity to help high school students conceptualize the sociopolitical complexity of global warming through an exploration of varied perspectives on the issue. They argue that socioscientific issues such as global warming present important contexts for learning science and that the social and political dimensions of these…

  4. Greenhouse warming and the tropical water budget

    NASA Technical Reports Server (NTRS)

    Betts, Alan K.

    1990-01-01

    The present work takes issue with some of the theses of Lindzen's (1990) work on global warming, arguing in particular that Lindzen's work is hampered by the use of oversimplified models. Lindzen then presents a detailed reply to these arguments, emphasizing the fundamental importance of the upper tropospheric water-vapor budget to the question of global warming.

  5. Global Warming: Lessons from Ozone Depletion

    ERIC Educational Resources Information Center

    Hobson, Art

    2010-01-01

    My teaching and textbook have always covered many physics-related social issues, including stratospheric ozone depletion and global warming. The ozone saga is an inspiring good-news story that's instructive for solving the similar but bigger problem of global warming. Thus, as soon as students in my physics literacy course at the University of…

  6. Global Warming: Understanding and Teaching the Forecast.

    ERIC Educational Resources Information Center

    Andrews, Bill

    1995-01-01

    A resource for teaching about the consequences of global warming. Discusses feedback from the temperature increase, changes in the global precipitation pattern, effects on agriculture, weather extremes, effects on forests, effects on biodiversity, effects on sea levels, and actions which will help the global community cope with global warming. (LZ)

  7. Exploring the Sociopolitical Dimensions of Global Warming

    ERIC Educational Resources Information Center

    Sadler, Troy D.; Klosterman, Michelle L.

    2009-01-01

    The authors present an activity to help high school students conceptualize the sociopolitical complexity of global warming through an exploration of varied perspectives on the issue. They argue that socioscientific issues such as global warming present important contexts for learning science and that the social and political dimensions of these

  8. Cryosphere: Warming ocean erodes ice sheets

    NASA Astrophysics Data System (ADS)

    Kusahara, Kazuya

    2016-01-01

    Antarctic ice sheets are a key player in sea-level rise in a warming climate. Now an ice-sheet modelling study clearly demonstrates that an Antarctic ice sheet/shelf system in the Atlantic Ocean will be regulated by the warming of the surrounding Southern Ocean, not by marine-ice-sheet instability.

  9. Turkish Students' Ideas about Global Warming

    ERIC Educational Resources Information Center

    Kilinc, Ahmet; Stanisstreet, Martin; Boyes, Edward

    2008-01-01

    A questionnaire was used to explore the prevalence of ideas about global warming in Year 10 (age 15-16 years) school students in Turkey. The frequencies of individual scientific ideas and misconceptions about the causes, consequences and "cures" of global warming were identified. In addition, several general findings emerged from this study.…

  10. Nonlinear electron oscillations in a warm plasma

    SciTech Connect

    Sarkar, Anwesa; Maity, Chandan; Chakrabarti, Nikhil

    2013-12-15

    A class of nonstationary solutions for the nonlinear electron oscillations of a warm plasma are presented using a Lagrangian fluid description. The solution illustrates the nonlinear steepening of an initial Gaussian electron density disturbance and also shows collapse behavior in time. The obtained solution may indicate a class of nonlinear transient structures in an unmagnetized warm plasma.

  11. Global Warming: Understanding and Teaching the Forecast.

    ERIC Educational Resources Information Center

    Andrews, Bill

    1994-01-01

    A resource for the teaching of the history and causes of climate change. Discusses evidence of climate change from the Viking era, early ice ages, the most recent ice age, natural causes of climate change, human-made causes of climate change, projections of global warming, and unequal warming. (LZ)

  12. Warm-up: A Psychophysiological Phenomenon.

    ERIC Educational Resources Information Center

    Lopez, Richard; Dausman, Cindy

    1981-01-01

    The effectiveness of warm-up as an aid to athletic performance is related to an interaction of both psychological and physiological factors. Benefits of warm-up include an increase in blood and muscle temperatures and an increased muscular endurance. (JN)

  13. Global Warming: Lessons from Ozone Depletion

    ERIC Educational Resources Information Center

    Hobson, Art

    2010-01-01

    My teaching and textbook have always covered many physics-related social issues, including stratospheric ozone depletion and global warming. The ozone saga is an inspiring good-news story that's instructive for solving the similar but bigger problem of global warming. Thus, as soon as students in my physics literacy course at the University of

  14. Global Warming: How Much and Why?

    ERIC Educational Resources Information Center

    Lanouette, William

    1990-01-01

    Summarizes the history of the study of global warming and includes a discussion of the role of gases, like carbon dioxide, methane, and chlorofluorocarbon (CFC). Discusses modern research on the global warming, including computer modelling and the super-greenhouse effect. (YP)

  15. Intra-operative visualization of brain tumors with 5-aminolevulinic acid-induced fluorescence.

    PubMed

    Widhalm, Georg

    2014-01-01

    Precise histopathological diagnosis of brain tumors is essential for the correct patient management. Furthermore, complete resection of brain tumors is associated with an improved patient prognosis. However, histopathological undergrading and incomplete tumor removal are not uncommon, especially due to insufficient intra-operative visualization of brain tumor tissue. The fluorescent dye 5-aminolevulinic acid (5-ALA) is currently applied for fluorescence-guided resections of high-grade gliomas. The value of 5-ALA-induced protoporphyrin (PpIX) fluorescence for intra-operative visualization of other tumors than high-grade gliomas remains unclear. Within the frame of this thesis, we found a significantly higher rate of complete resections of our high-grade gliomas as compared to control cases by using the newly established 5-ALA fluorescence technology at our department. Additionally, we showed that MRI spectroscopy-based chemical shift imaging (CSI) is capable to identify intratumoral high-grade glioma areas (= anaplastic foci) during navigation guided resections to avoid histopathological undergrading. However, the accuracy of navigation systems with integrated pre-operative imaging data such as CSI declines during resections due to intra-operative brainshift. In two further studies, we found that 5-ALA induced PpIX fluorescence is capable as a novel intra-operative marker to detect anaplastic foci within initially suspected low-grade gliomas independent of brainshift. Finally, we showed that the application of 5-ALA is also of relevance in needle biopsies for intra-operative identification of representative brain tumor tissue. These data indicate that 5-ALA is not only of major importance for resection of high-grade gliomas, but also for intra-operative visualization of anaplastic foci as well as representative brain tumor tissue in needle biopsies unaffected by brainshift. Consequently, this new technique might become a novel standard in brain tumor surgery that optimizes the patient management and improves the patient prognosis by maximizing the extent of tumor resection and enabling a precise histopathological tumor diagnosis. PMID:24986206

  16. Warm Disks from Giant Impacts

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2015-10-01

    In the process of searching for exoplanetary systems, weve discovered tens of debris disks close around distant stars that are especially bright in infrared wavelengths. New research suggests that we might be looking at the late stages of terrestrial planet formation in these systems.Forming Terrestrial PlanetsAccording to the widely-accepted formation model for our solar-system, protoplanets the size of Mars formed within a protoplanetary disk around our Sun. Eventually, the depletion of the gas in the disk led the orbits of these protoplanets to become chaotically unstable. Finally, in the giant impact stage, many of the protoplanets collided with each other ultimately leading to the formation of the terrestrial planets and their moons as we know them today.If giant impact stages occur in exoplanetary systems, too leading to the formation of terrestrial exoplanets how would we detect this process? According to a study led by Hidenori Genda of the Tokyo Institute of Technology, we might be already be witnessing this stage in observations of warm debris disks around other stars. To test this, Genda and collaborators model giant impact stages and determine what we would expect to see from a system undergoing this violent evolution.Modeling CollisionsSnapshots of a giant impact in one of the authors simulations. The collision causes roughly 0.05 Earth masses of protoplanetary material to be ejected from the system. Click for a closer look! [Genda et al. 2015]The collaborators run a series of simulations evolving protoplanetary bodies in a solar system. The simulations begin 10 Myr into the lifetime of the solar system, i.e., after the gas from the protoplanetary disk has had time to be cleared and the protoplanetary orbits begin to destabilize. The simulations end when the protoplanets are done smashing into each other and have again settled into stable orbits, typically after ~100 Myr.The authors find that, over an average giant impact stage, the total amount of mass ejected from colliding protoplanets is typically around 0.4 Earth masses. This mass is ejected in the form of fragments that then spread into the terrestrial planet region around the star. The fragments undergo cascading collisions as they orbit, forming an infrared-emitting debris disk at ~1 AU from the star.The authors then calculate the infrared flux profile expected from these simulated disks. They show that the warm disks can exist and radiate for up to ~100 Myr before the fragments are smashed into micrometer-sized pieces small enough to be blown out of the solar system by radiation pressure.The Spitzer Space Telescope has, thus far, observed tens of warm-debris-disk signatures roughly consistent with the authors predictions, primarily located at roughly 1 AU around stars with ages of 10100 Myr. This region is near the habitable zone of these stars, which makes it especially interesting that these systems may currently be undergoing a giant impact stage perhaps on the way to forming terrestrial planets.CitationH. Genda et al 2015 ApJ 810 136. doi:10.1088/0004-637X/810/2/136

  17. Warm Disks from Giant Impacts

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2016-01-01

    In the process of searching for exoplanetary systems, weve discovered tens of debris disks close around distant stars that are especially bright in infrared wavelengths. New research suggests that we might be looking at the late stages of terrestrial planet formation in these systems.Forming Terrestrial PlanetsAccording to the widely-accepted formation model for our solar-system, protoplanets the size of Mars formed within a protoplanetary disk around our Sun. Eventually, the depletion of the gas in the disk led the orbits of these protoplanets to become chaotically unstable. Finally, in the giant impact stage, many of the protoplanets collided with each other ultimately leading to the formation of the terrestrial planets and their moons as we know them today.If giant impact stages occur in exoplanetary systems, too leading to the formation of terrestrial exoplanets how would we detect this process? According to a study led by Hidenori Genda of the Tokyo Institute of Technology, we might be already be witnessing this stage in observations of warm debris disks around other stars. To test this, Genda and collaborators model giant impact stages and determine what we would expect to see from a system undergoing this violent evolution.Modeling CollisionsSnapshots of a giant impact in one of the authors simulations. The collision causes roughly 0.05 Earth masses of protoplanetary material to be ejected from the system. Click for a closer look! [Genda et al. 2015]The collaborators run a series of simulations evolving protoplanetary bodies in a solar system. The simulations begin 10 Myr into the lifetime of the solar system, i.e., after the gas from the protoplanetary disk has had time to be cleared and the protoplanetary orbits begin to destabilize. The simulations end when the protoplanets are done smashing into each other and have again settled into stable orbits, typically after ~100 Myr.The authors find that, over an average giant impact stage, the total amount of mass ejected from colliding protoplanets is typically around 0.4 Earth masses. This mass is ejected in the form of fragments that then spread into the terrestrial planet region around the star. The fragments undergo cascading collisions as they orbit, forming an infrared-emitting debris disk at ~1 AU from the star.The authors then calculate the infrared flux profile expected from these simulated disks. They show that the warm disks can exist and radiate for up to ~100 Myr before the fragments are smashed into micrometer-sized pieces small enough to be blown out of the solar system by radiation pressure.The Spitzer Space Telescope has, thus far, observed tens of warm-debris-disk signatures roughly consistent with the authors predictions, primarily located at roughly 1 AU around stars with ages of 10100 Myr. This region is near the habitable zone of these stars, which makes it especially interesting that these systems may currently be undergoing a giant impact stage perhaps on the way to forming terrestrial planets.CitationH. Genda et al 2015 ApJ 810 136. doi:10.1088/0004-637X/810/2/136

  18. Global warming, insurance losses and financial industry

    SciTech Connect

    Low, N.C.

    1996-12-31

    Global warming causes extremely bad weather in the near term. They have already caught the attention of the insurance industry, as they suffered massive losses in the last decade. Twenty-one out of the 25 largest catastrophes in the US, mainly in the form of hurricanes have occurred in the last decade. The insurance industry has reacted by taking the risk of global warming in decisions as to pricing and underwriting decisions. But they have yet to take a more active role in regulating the factors that contributes to global warming. How global warming can impact the financial industry and the modern economy is explored. Insurance and modern financial derivatives are key to the efficient functioning of the modern economy, without which the global economy can still function but will take a giant step backward. Any risk as global warming that causes economic surprises will hamper the efficient working of the financial market and the modern economy.

  19. Intraoperative photodynamic therapy on spontaneous canine nasal tumors

    NASA Astrophysics Data System (ADS)

    Fonda, Diego; Mortellaro, Carlo M.; Romussi, Stefano; Taroni, Paola; Cubeddu, Rinaldo

    1994-09-01

    Promising results obtained by photodynamic therapy (PDT) with porphyrins on superficial spontaneous canine tumors suggested the experiment of this technique on intracavitary tumors, specifically at the endonasal site. The supposed neoplastic residual bed was irradiated directly during surgery at the end of the debulking. Five dogs referred to the surgical department of the veterinary school, University of Milan and affected by endonasal neoplasias were submitted to PDT after radiologic and cyto-histologic diagnosis and TNM stadiation. All the selected tumors were included in the clinical stage 1 (T1NOMO). Mean and median survival time (from the day of treatment) were 11.6 - 5.4 and 12 months, respectively. Different staging of the treated tumors limits the possibility of an objective comparison with other alternative therapeutic procedures.

  20. Comparing the model-simulated global warming signal to observations using empirical estimates of unforced noise

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The comparison of observed global mean surface air temperature (GMT) change to the mean change simulated by climate models has received much attention. For a given global warming signal produced by a climate model ensemble, there exists an envelope of GMT values representing the range of possible un...

  1. Analysis of warm prestress data

    SciTech Connect

    Macdonald, B.D.; Embley, G.T.; Irizarry-Quinones, H.; Smith, P.D.; Wuthrich, J.W.; McAfee, W.J.; McCabe, D.E.

    1997-12-01

    Loading a cracked structure at elevated temperature, or warm prestressing (WPS), enhances its fracture resistance at a lower temperature. Five data sets, comprising 119 unclad pressure vessel steel specimens, were combined to derive correlations for WPS-enhanced fracture toughness (K{sub Ifrac}) in the absence of ductile tearing. New WPS test results for 27 surface-flawed specimens, eight subclad-flawed specimens, and five strain-aged specimens are discussed. K{sub Ifrac} exceeded non-WPS fracture toughness, K{sub Ic}, for all experiments. The WPS data showed that no specimens failed while K was decreasing, and that at least an additional 7% additional reloading from the minimum value of applied K{sub I} took place prior to final fracture. The data included complete and partial unloading after WPS prior to final fracture. Crack tip three-dimensional elastic-plastic finite element (3DEPFE) analysis was performed to support statistical analysis of the data. Regression models were compared with the Chell WPS model. The regression model for partial unloading accurately predicted the behavior of full-scale pressure vessel WPS experiments. All but one of the 174 experiments considered lie above the lower 2{sigma} estimate of the regressions. The experiments all supported Type I WPS, i.e., there was no fracture during cooling until reloading occurred. However, the regression equations apply to the reload and are inapplicable to Type I WPS.

  2. Some economics of global warming

    SciTech Connect

    Schelling, T.C. )

    1992-03-01

    The greenhouse effect itself is simple enough to understand and is not in any real dispute. What is in dispute is its magnitude over the coming century, its translation into changes in climates around the globe, and the impacts of those climate changes on human welfare and the natural environment. These are beyond the professional understanding of any single person. The sciences involved are too numerous and diverse. Demography, economics, biology, and the technology sciences are needed to project emissions; atmospheric chemistry, oceanography, biology, and meteorology are needed to translate emissions into climates; biology, agronomy, health sciences, economics, sociology, and glaciology are needed to identify and assess impacts on human societies and natural ecosystems. And those are not all. There are expert judgments on large pieces of the subject, but no single person clothed in this panoply of disciplines has shown up or is likely to. This article makes an attempt to forecast the economic and social consequences of global warming due to anthropogenic greenhouse gases, and attempting to prevent it.

  3. Thermal pollution causes global warming

    NASA Astrophysics Data System (ADS)

    Nordell, Bo

    2003-09-01

    Over longer time-scales there is no net heat inflow to Earth since incoming solar energy is re-emitted at exactly the same rate. To maintain Earth's thermal equilibrium, however, there must be a net outflow equal to the geothermal heat flow. Performed calculations show that the net heat outflow in 1880 was equal to the geothermal heat flow, which is the only natural net heat source on Earth. Since then, heat dissipation from the global use of nonrenewable energy sources has resulted in additional net heating. In, e.g. Sweden, which is a sparsely populated country, this net heating is about three times greater than the geothermal heat flow. Such thermal pollution contributes to global warming until the global temperature has reached a level where this heat is also emitted to space. Heat dissipation from the global use of fossil fuels and nuclear power is the main source of thermal pollution. Here, it was found that one third of current thermal pollution is emitted to space and that a further global temperature increase of 1.8 C is required until Earth is again in thermal equilibrium.

  4. Intraoperative rupture of popliteal artery pseudoaneurysm secondary to distal femur osteochondroma: case report and review of the literature

    PubMed Central

    Hajji, Rita; Jiber, Hamid; Zrihni, Youssef; Zizi, Othman; Bouarroum, Abdellatif

    2013-01-01

    Vascular complications from osteochondroma are rare and include essentially stenosis, occlusion, and pseudoaneurysms. The authors report an original case of intraoperative rupture of undiagnosed popliteal artery pseudoaneurysm during resection surgery for a distal femur osteochondroma. PMID:24876908

  5. Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery

    PubMed Central

    Kim, Sung Tae; Jeong, Dong Mun; Lee, Kun Soo

    2014-01-01

    We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression. PMID:25628814

  6. An extraordinary mechanism causing intraoperative migration of the Kirschner-wire.

    PubMed

    Ero?lu, Mehmet; zcan, zal; ?entrk, ?hsan; Ycehan, Mehmet

    2016-04-01

    Migration of Kirschner wires (K-wires) postoperatively and with use of cannulated implants intraoperatively is a well-known complication. In this article, we present an extraordinary mechanism causing intraoperative migration of a K-wire. A K-wire which was used for temporary fixation of fracture fragments migrated forwardly due to its contact with the drill bit while drilling a hole for a screw. The interaction between the K-wire and the drill bit simulated a gear wheel effect and thus the rotating K-wire advanced. Although no complications occurred in this case, we believe that the mentioned mechanism may be of importance particularly in osteoporotic patients and may cause damage to vital structures. PMID:26874638

  7. Real-time Near-infrared Virtual Intraoperative Surgical Photoacoustic Microscopy.

    PubMed

    Lee, Changho; Lee, Donghyun; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

    2015-09-01

    We developed a near infrared (NIR) virtual intraoperative surgical photoacoustic microscopy (NIR-VISPAM) system that combines a conventional surgical microscope and an NIR light photoacoustic microscopy (PAM) system. NIR-VISPAM can simultaneously visualize PA B-scan images at a maximum display rate of 45Hz and display enlarged microscopic images on a surgeon's view plane through the ocular lenses of the surgical microscope as augmented reality. The use of the invisible NIR light eliminated the disturbance to the surgeon's vision caused by the visible PAM excitation laser in a previous report. Further, the maximum permissible laser pulse energy at this wavelength is approximately 5 times more than that at the visible spectral range. The use of a needle-type ultrasound transducer without any water bath for acoustic coupling can enhance convenience in an intraoperative environment. We successfully guided needle and injected carbon particles in biological tissues ex vivo and in melanoma-bearing mice in vivo. PMID:26640772

  8. Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery.

    PubMed

    Ottenhausen, Malte; Krieg, Sandro M; Meyer, Bernhard; Ringel, Florian

    2015-01-01

    Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. Therefore, functional localization of eloquent cortex or subcortical fiber tracts can enhance the EOR and functional outcome. Imaging techniques such as functional MRI and diffusion tensor imaging fiber tracking, and neurophysiological methods like navigated transcranial magnetic stimulation and magnetoencephalography, make it possible to identify eloquent areas prior to resective surgery and to tailor indication and surgical approach but also to assess the surgical risk. Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits. PMID:25552283

  9. Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm.

    PubMed

    Chowdhury, Tumul; Petropolis, Andrea; Wilkinson, Marshall; Schaller, Bernhard; Sandu, Nora; Cappellani, Ronald B

    2014-01-01

    Despite great advancements in the management of aneurysmal subarachnoid hemorrhage (SAH), outcomes following SAH rupture have remained relatively unchanged. In addition, little data exists to guide the anesthetic management of intraoperative aneurysm rupture (IAR), though intraoperative management may have a significant effect on overall neurological outcomes. This review highlights the various controversies related to different anesthetic management related to aneurysm rupture. The first controversy relates to management of preexisting factors that affect risk of IAR. The second controversy relates to diagnostic techniques, particularly neurophysiological monitoring. The third controversy pertains to hemodynamic goals. The neuroprotective effects of various factors, including hypothermia, various anesthetic/pharmacologic agents, and burst suppression, remain poorly understood and have yet to be further elucidated. Different management strategies for IAR during aneurysmal clipping versus coiling also need further attention. PMID:24723946

  10. An intraoperative device to restore femoral offset in total hip arthroplasty

    PubMed Central

    2014-01-01

    Background Leg length discrepancy (LLD) after total hip arthroplasty (THA) can lead to unsatisfactory outcome. Our objective was to design and evaluate a simple and reliable intraoperative device (Length-offset Lever) to minimize leg length discrepancy. Methods This device was used in 51 patients undergoing primary total hip replacements. The leg length discrepancy was measured pre- and postoperatively based on plain radiographs. Results Preoperative radiographic leg length discrepancy averaged 13.5??6.2 mm. Leg length discrepancy showed significant improvement, with a postoperative average of 4.1??2.3 mm (p?intraoperative tool to restore anatomic femoral offset and height of femoral head. PMID:25037492

  11. Evaluating the effect of intraoperative peritoneal lavage on bacterial culture in dogs with suspected septic peritonitis

    PubMed Central

    Swayne, Seanna L.; Brisson, Brigitte; Weese, J. Scott; Sears, William

    2012-01-01

    This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery. PMID:23450861

  12. The value of intraoperative ultrasound in the recognition of pseudo-swelling of the spinal cord

    PubMed Central

    Rao, Ganesh; Ivanov, Marcel

    2014-01-01

    We present the case of a woman who presented with weakness of both legs due to a low grade tumor of the spinal cord. Excision of the tumor was performed and confirmed with intraoperative ultrasound. Prior to dural closure the spinal cord was found to be pushed dorsally with herniation of the cord through the dural defect. Intraoperative ultrasound showed a collection of cerebrospinal fluid in an anterior pocket giving the impression of the cord being swollen. Once cerebrospinal fluid was drained, the cord settled within the thecal space and closure of the dural defect was performed. Surgery for an intramedullary spinal cord tumor can cause a significant amount of swelling and either a duroplasty is required or the dura is left open with meticulous closure of the wound. Ultrasound is helpful to identify pathology anterior to the cord and prevents the potential complications associated with duroplasty or leaving the dura open. PMID:26673157

  13. Feasibility of cervical intramedullary diffuse glioma resection using intraoperative magnetic resonance imaging.

    PubMed

    Giordano, Mario; Gerganov, Venelin M; Metwali, Hussam; Fahlbusch, Rudolf; Samii, Amir; Samii, Madjid; Bertalanffy, Helmut

    2013-11-15

    Intraoperative magnetic resonance imaging (iopMRI) actually has an important role in the surgery of brain tumors, especially gliomas and pituitary adenomas. The aim of our work was to describe the advantages and drawbacks of this tool for the surgical treatment of cervical intramedullary gliomas. We describe two explicative cases including the setup, positioning, and the complete workflow of the surgical approach with intraoperative imaging. Even if the configuration of iopMRI equipment was originally designed for cranial surgery, we have demonstrated the feasibility of cervical intramedullary glioma resection with the aid of high-field iopMRI. This tool was extremely useful to evaluate the extent of tumor removal and to obtain a higher resection rate, but still need some enhancement in the configuration of the headrest coil and surgical table to allow better patient positioning. PMID:24233260

  14. [Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway].

    PubMed

    Esquinas, A M; Jover, J L; beda, A; Belda, F J

    2015-11-01

    Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients. PMID:25702198

  15. Rat liver tolerance for partial resection and intraoperative radiation therapy: Regeneration is radiation dose dependent

    SciTech Connect

    Bossola, M.; Merrick, H.W.; Eltaki, A.; Bellantone, R.; Milligan, A.J.; Doglietto, G.B.; Conran, P.; Dobelbower, R.R. Jr.; Crucitti, F. )

    1990-11-01

    We studied the feasibility of delivering a large single dose of intraoperative radiation as an adjuvant to partial hepatic resection. Intraoperative radiation therapy (IORT) was delivered to the remaining liver of 84 rats after partial hepatectomy to determine the acute and chronic effects of treatment on blood chemistry values, histology, survival, hepatic regeneration, and cellular appearance of the normal liver. Transient elevations in SGOT, SGPT, and alkaline phosphatase were attributed both to hepatectomy and to liver parenchymal damage induced by IORT. Microscopic examination upon necropsy, performed at frequent intervals post-treatment revealed hepatic capsular thickening with some alteration of liver architecture mainly underneath the capsule, with localized inflammation and some areas of necrosis. Survival in all groups was 100% at 45 days. Liver weight increase proved to be dose-dependent and displayed a bisphasic pattern. This study demonstrated that IORT is a feasible adjunct to surgical resection of the liver in the rat model.

  16. Utility of intraoperative fetal heart rate monitoring for cerebral arteriovenous malformation surgery during pregnancy.

    PubMed

    Fukuda, Kenji; Masuoka, Jun; Takada, Shigeki; Katsuragi, Shinji; Ikeda, Tomoaki; Iihara, Koji

    2014-01-01

    We report two methods of intraoperative fetal heart rate (FHR) monitoring in cases of cerebral arteriovenous malformation surgery during pregnancy. In one case in her third trimester, cardiotocography was used. In another case in her second trimester, ultrasound sonography was used, with a transesophageal echo probe attached to her lower abdomen. Especially, the transesophageal echo probe was useful because of the advantages of being flexible and easy to attach to the mother's lower abdomen comparing with the usual doppler ultrasound probe. In both cases, the surgery was successfully performed and FHR was monitored safely and stably. The use of intraoperative FHR monitoring provides information about the influence of induced maternal hypotension and unexpected bleeding on fetus during surgery. These monitoring techniques would be especially emphasized in cerebrovascular surgery for the safe management of both mother and fetus. PMID:24759098

  17. Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

    PubMed Central

    Petropolis, Andrea; Wilkinson, Marshall; Sandu, Nora; Cappellani, Ronald B.

    2014-01-01

    Despite great advancements in the management of aneurysmal subarachnoid hemorrhage (SAH), outcomes following SAH rupture have remained relatively unchanged. In addition, little data exists to guide the anesthetic management of intraoperative aneurysm rupture (IAR), though intraoperative management may have a significant effect on overall neurological outcomes. This review highlights the various controversies related to different anesthetic management related to aneurysm rupture. The first controversy relates to management of preexisting factors that affect risk of IAR. The second controversy relates to diagnostic techniques, particularly neurophysiological monitoring. The third controversy pertains to hemodynamic goals. The neuroprotective effects of various factors, including hypothermia, various anesthetic/pharmacologic agents, and burst suppression, remain poorly understood and have yet to be further elucidated. Different management strategies for IAR during aneurysmal clipping versus coiling also need further attention. PMID:24723946

  18. Intraoperative Parathyroid Hormone Monitoring Corroborates the Success of Parathyroidectomy in Children

    PubMed Central

    elik, Ahmet; Divarc?, Emre; Dkmc, Zafer; Ergn, Orkan; zen, Samim; Gk?en, Damla; Darcan, ?kran; Ertan, Ye?im

    2014-01-01

    Objective: To assess the efficacy of intraoperative parathyroid hormone (PTH) monitoring in evaluating the outcome of parathyroidectomy in pediatric patients. Methods: Intraoperative PTH monitoring during parathyroidectomy was performed in five children (3M, 2F); three had parathyroid adenomas (single gland disease) and two had primary hyperplasia. One patient had undergone two previous surgical interventions to remove the parathyroid glands, but the PTH levels had remained high with persistence of symptoms. Immunoradiometric analysis was used for PTH measurements. Preoperative PTH values were obtained to monitor the baseline levels. Serum samples were collected 20 minutes after removal of the adenoma/parathyroid gland(s) and PTH levels were compared with preoperative values. Specimens were also confirmed by frozen sectional examination. Results: Mean age of the patients was 11 years (range: 3 months-16 years). Mean preoperative PTH values were 633.3579 pg/mL (range: 143-1300 pg/mL). Intraoperative values decreased to 18.75.5 pg/mL (range: 8-27 pg/mL) following removal of the gland(s). Normal calcium levels were achieved with adequate management following surgery. One patient (with multiple surgeries and found to have an ectopic parathyroid gland) had hungry bone syndrome after the operation and was treated successfully. There were no major complications. All patients maintained normal calcium/phosphorus levels in the follow-up period, ranging from 2 to 5 years. Conclusion: An ectopic parathyroid gland or another undetected adenoma can be overlooked during surgery. Owing to the short life of the hormone, intraoperative PTH monitoring to determine PTH clearance proved to be a feasible marker for adequacy and safety of surgery and cure. PMID:25241609

  19. The impact of feedback of intraoperative technical performance in surgery: a systematic review

    PubMed Central

    Trehan, Abhishek; Barnett-Vanes, Ashton; Carty, Matthew J; McCulloch, Peter; Maruthappu, Mahiben

    2015-01-01

    Objectives Increasing patient demands, costs and emphasis on safety, coupled with reductions in the length of time surgical trainees spend in the operating theatre, necessitate means to improve the efficiency of surgical training. In this respect, feedback based on intraoperative surgical performance may be beneficial. Our aim was to systematically review the impact of intraoperative feedback based on surgical performance. Setting MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. 32 data-points per study were extracted. Participants The search strategy yielded 1531 citations. Three studies were eligible, which comprised a total of 280 procedures by 62 surgeons. Results Overall, feedback based on intraoperative surgical performance was found to be a powerful method for improving performance. In cholecystectomy, feedback led to a reduction in procedure time (p=0.022) and an improvement in economy of movement (p<0.001). In simulated laparoscopic colectomy, feedback led to improvements in instrument path length (p=0.001) and instrument smoothness (p=0.045). Feedback also reduced error scores in cholecystectomy (p=0.003), simulated laparoscopic colectomy (p<0.001) and simulated renal artery angioplasty (p=0.004). In addition, feedback improved balloon placement accuracy (p=0.041), and resulted in a smoother learning curve and earlier plateau in performance in simulated renal artery angioplasty. Conclusions Intraoperative feedback appears to be associated with an improvement in performance, however, there is a paucity of research in this area. Further work is needed in order to establish the long-term benefits of feedback and the optimum means and circumstances of feedback delivery. PMID:26078305

  20. Acute intraoperative brain herniation during elective neurosurgery: pathophysiology and management considerations.

    PubMed Central

    Whittle, I R; Viswanathan, R

    1996-01-01

    OBJECTIVES: To describe operative procedures, pathophysiological events, management strategies, and clinical outcomes after acute intraoperative brain herniation during elective neurosurgery. METHODS: Review of clinical diagnoses, operative events, postoperative CT findings, intracranial pressure, and arterial blood pressure changes and outcomes in a series of patients in whom elective neurosurgery had to be abandoned because of severe brain herniation. RESULTS: Acute intraoperative brain herniation occurred in seven patients. In each patient subarachnoid or intraventricular haemorrhage preceded the brain herniation. The haemorrhage occurred after intraoperative aneurysm rupture either before arachnoidal dissection (three) or during clip placement (one); after resection of 70% of a recurrent hemispheric astroblastoma; after resection of a pineal tumour; and after a stereotactic biopsy of an AIDS lesion. In all patients the procedure was abandoned because of loss of access to the intracranial operating site, medical measures to control intracranial pressure undertaken (intravenous thiopentone), an intraventricular catheter or Camino intracranial pressure monitor inserted, and CT performed immediately after scalp closure. The patients were transferred to an intensive care unit for elective ventilation and multimodality physiological monitoring. Using this strategy all patients recovered from the acute ictus and no patient had intracranial pressure > 35 mm Hg. Although one patient with an aneurysm rebled and died three days later the other six patients did well considering the dramatic and apparently catastrophic nature of the open brain herniation. CONCLUSIONS: There are fundamental differences in the pathophysiological mechanisms, neuroradiological findings, and outcomes between open brain herniation occurring in post-traumatic and elective neurosurgical patients. The surprisingly good outcomes in this series may have occurred because the intraoperative brain herniation was secondary to extra-axial subarachnoid or intraventricular haemorrhage rather than intraparenchymal haemorrhage or acute brain oedema. Expeditious abandonment of the procedure and closure of the cranium may also have contributed to the often very satisfactory clinical outcome. Images PMID:8971104

  1. Surgery for traumatic facial nerve paralysis: does intraoperative monitoring have a role?

    PubMed

    Ashram, Yasmine A; Badr-El-Dine, Mohamed M K

    2014-09-01

    The use of intraoperative facial nerve (FN) monitoring during surgical decompression of the FN is underscored because surgery is indicated when the FN shows more than 90 % axonal degeneration. The present study proposes including intraoperative monitoring to facilitate decision taking and provide prognostication with more accuracy. This prospective study was conducted on ten patients presenting with complete FN paralysis due to temporal bone fracture. They were referred after variable time intervals for FN exploration and decompression. Intraoperative supramaximal electric stimulation (2-3 mA) of the FN was attempted in all patients both proximal and distal to the site of injury. Postoperative FN function was assessed using House-Brackmann (HB) scale. All patients had follow-up period ranging from 7 to 42 months. Three different patterns of neurophysiological responses were characterized. Responses were recorded proximal and distal to the lesion in five patients (pattern 1); only distal to the lesion in two patients (pattern 2); and neither proximal nor distal to the lesion in three patients (pattern 3). Sporadic, mechanically elicited EMG activity was recorded in eight out of ten patients. Patients with pattern 1 had favorable prognosis with postoperative function ranging between grade I and III. Pattern 3 patients showing no mechanically elicited activity had poor prognosis. Intraoperative monitoring affects decision taking during surgery for traumatic FN paralysis and provides prognostication with sufficient accuracy. The detection of mechanically elicited EMG activity is an additional sign predicting favorable outcome. However, absence of responses did not alter surgeon decision when the nerve was found evidently intact. PMID:24085597

  2. Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants

    PubMed Central

    Brown, Mitchell H.; Hedn, Per; Luan, Jie; Munhoz, Alexandre Mendona; Carter, Mollie

    2015-01-01

    Background: Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410. Results: Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively. Conclusions: The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeons experience, will contribute to optimal clinical outcomes with Natrelle 410.

  3. Association of intraoperative transfusion of blood products with mortality in lung transplant recipients

    PubMed Central

    2013-01-01

    Background The impact of intraoperative transfusion on postoperative mortality in lung transplant recipients is still elusive. Methods Univariate and multivariate analysis were performed to investigate the influence of red blood cells (RBCs) and fresh frozen plasma (FFP) on mortality in 134 consecutive lung transplants recipients from September 2003 until December 2008. Results Intraoperative transfusion of RBCs and FFP was associated with a significant increase in mortality with odds ratios (ORs) of 1.10 (1.03 to 1.16, P = 0.02) and 1.09 (1.02 to 1.15, P = 0.03), respectively. For more than four intraoperatively transfused RBCs multivariate analysis showed a hazard ratio for mortality of 3.8 (1.40 to 10.31, P = 0.003). Furthermore, non-survivors showed a significant increase in renal replacement therapy (RRT) (36.6% versus 6.9%, P <0.0001), primary graft dysfunction (PGD) (39.3% versus 5.9%, P <0.0001), postoperative need of extracorporeal membrane oxygenation (ECMO) (26.9% versus 3.1%, P = 0.0019), sepsis (24.2% versus 4.0%, P = 0.0004), multiple organ dysfunction syndrome (MODS) (26.9% versus 3.1%, P <0.0001), infections (18.1% versus 0.9%, P = 0.0004), retransplantation (12.1% versus 6.9%, P = 0.039) and readmission to the ICU (33.3% versus 12.8%, P = 0.024). Conclusions Intraoperative transfusion is associated with a strong negative influence on outcome in lung transplant recipients. PMID:24472535

  4. Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass

    PubMed Central

    Song, Jong Wook; Shim, Jae Kwang; Yoo, Kyung Jong; Oh, Se Young; Kwak, Young Lan

    2013-01-01

    OBJECTIVES Acute kidney injury (AKI) is one of the most frequently occurring complications after off-pump coronary artery bypass graft (OPCAB). Hyperglycaemia is a major, potentially modifiable risk factor of adverse outcome after cardiac surgery known to aggravate organ damage. The aim of this study was to address the association between intraoperative glucose concentration and postoperative AKI in patients who underwent OPCAB. METHODS The medical records of 880 consecutive patients were retrospectively reviewed. Patients were divided into three groups according to the time-weighted average of intraoperative glucose concentrations (<110, 110–150 and >150 mg/dl), and the incidence of AKI (increase of serum creatinine to >2.0 mg/dl and 2 × most recent preoperative value or a new requirement for dialysis) was compared. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative AKI. RESULTS The incidence of AKI was higher in patients with a glucose level >150 mg/dl than in patients with a glucose level = 110–150 mg/dl [8% (20 of 251) vs 3% (14 of 453), P = 0.004]. On multivariate analysis, glucose >150 mg/dl (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.12–6.86, P = 0.027), coefficient of variation of glucose (OR, 1.04; 95% CI, 1.01–1.07, P = 0.027) and preoperative serum creatinine >1.4 mg/dl (OR, 8.81; 95% CI, 3.90–19.9, P < 0.001) were identified as independent risk factors for postoperative AKI. CONCLUSIONS Intraoperative glucose concentration >150 mg/dl and increased variability of glucose were independently associated with AKI after OPCAB. Tight intraoperative glycaemic control (<110 mg/dl) does not seem to provide additional benefit in terms of AKI. PMID:23690431

  5. Negative short-term impact of intraoperative biliary lavage in patients with hepatolithiasis

    PubMed Central

    Jiang, Ou; Zhou, Rong-Xing; Yang, Ke; Cai, Chun-Xian; Liu, Yu; Cheng, Nan-Sheng

    2016-01-01

    AIM: To evaluate short-term outcomes following intraoperative biliary lavage for hepatolithiasis. METHODS: A total of 932 patients who were admitted to the West China Medical Center of Sichuan University between January 2010 and January 2014 and underwent bile duct exploration and lithotomy were retrospectively included in our study. The patients were divided into the lavage group and the control group. Related pre-, intra-, and postoperative factors were recorded, analyzed, and compared between the two groups in order to verify the effects of biliary lavage on the short-term outcome of patients with hepatolithiasis. RESULTS: Amongst the patients who were included, 678 patients with hepatolithiasis were included in the lavage group, and the other 254 patients were enrolled in the control group. Data analyses revealed that preoperative baseline and related intraoperative variables were not significantly different. However, patients who underwent intraoperative biliary lavage had prolonged postoperative hospital stays (6.67 d vs 7.82 d, P = 0.024), higher hospitalization fees (RMB 28437.1 vs RMB 32264.2, P = 0.043), higher positive rates of bacterial cultures from blood (13.3% vs 25.8%, P = 0.001) and bile (23.6% vs 40.7%, P = 0.001) samples, and increased usage of advanced antibiotics (26.3% vs 38.2%, P = 0.001). In addition, in the lavage group, more patients had fever (> 37.5 °C, 81.4% vs 91.1%, P = 0.001) and hyperthermia (> 38.5°C,39.7% vs 54.9%, P = 0.001), and higher white blood cell counts within 7 d after the operation compared to the control group. CONCLUSION: Intraoperative biliary lavage might increase the risk of postoperative infection, while not significantly increasing gallstone removal rate. PMID:27004001

  6. Clinical implementation of intraoperative cone-beam CT in head and neck surgery

    NASA Astrophysics Data System (ADS)

    Daly, M. J.; Chan, H.; Nithiananthan, S.; Qiu, J.; Barker, E.; Bachar, G.; Dixon, B. J.; Irish, J. C.; Siewerdsen, J. H.

    2011-03-01

    A prototype mobile C-arm for cone-beam CT (CBCT) has been translated to a prospective clinical trial in head and neck surgery. The flat-panel CBCT C-arm was developed in collaboration with Siemens Healthcare, and demonstrates both sub-mm spatial resolution and soft-tissue visibility at low radiation dose (e.g., <1/5th of a typical diagnostic head CT). CBCT images are available ~15 seconds after scan completion (~1 min acquisition) and reviewed at bedside using custom 3D visualization software based on the open-source Image-Guided Surgery Toolkit (IGSTK). The CBCT C-arm has been successfully deployed in 15 head and neck cases and streamlined into the surgical environment using human factors engineering methods and expert feedback from surgeons, nurses, and anesthetists. Intraoperative imaging is implemented in a manner that maintains operating field sterility, reduces image artifacts (e.g., carbon fiber OR table) and minimizes radiation exposure. Image reviews conducted with surgical staff indicate bony detail and soft-tissue visualization sufficient for intraoperative guidance, with additional artifact management (e.g., metal, scatter) promising further improvements. Clinical trial deployment suggests a role for intraoperative CBCT in guiding complex head and neck surgical tasks, including planning mandible and maxilla resection margins, guiding subcranial and endonasal approaches to skull base tumours, and verifying maxillofacial reconstruction alignment. Ongoing translational research into complimentary image-guidance subsystems include novel methods for real-time tool tracking, fusion of endoscopic video and CBCT, and deformable registration of preoperative volumes and planning contours with intraoperative CBCT.

  7. Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting

    PubMed Central

    Lim, Hyungsun; Doo, A Ram; Son, Ji-Seon; Kim, Jin-Wan; Lee, Ki-Jae; Kim, Dong-Chan

    2016-01-01

    Background Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. Methods Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 µg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. Results Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). Conclusions A single bolus administration of fentanyl 2 µg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV. PMID:26885302

  8. Pose-independent surface matching for intra-operative soft-tissue marker-less registration.

    PubMed

    dos Santos, Thiago Ramos; Seitel, Alexander; Kilgus, Thomas; Suwelack, Stefan; Wekerle, Anna-Laura; Kenngott, Hannes; Speidel, Stefanie; Schlemmer, Heinz-Peter; Meinzer, Hans-Peter; Heimann, Tobias; Maier-Hein, Lena

    2014-10-01

    One of the main challenges in computer-assisted soft tissue surgery is the registration of multi-modal patient-specific data for enhancing the surgeon's navigation capabilities by observing beyond exposed tissue surfaces. A new approach to marker-less guidance involves capturing the intra-operative patient anatomy with a range image device and doing a shape-based registration. However, as the target organ is only partially visible, typically does not provide salient features and underlies severe non-rigid deformations, surface matching in this context is extremely challenging. Furthermore, the intra-operatively acquired surface data may be subject to severe systematic errors and noise. To address these issues, we propose a new approach to establishing surface correspondences, which can be used to initialize fine surface matching algorithms in the context of intra-operative shape-based registration. Our method does not require any prior knowledge on the relative poses of the input surfaces to each other, does not rely on the detection of prominent surface features, is robust to noise and can be used for overlapping surfaces. It takes into account (1) similarity of feature descriptors, (2) compatibility of multiple correspondence pairs, as well as (3) the spatial configuration of the entire correspondence set. We evaluate the algorithm on time-of-flight (ToF) data from porcine livers in a respiratory liver motion simulator. In all our experiments the alignment computed from the established surface correspondences yields a registration error below 1cm and is thus well suited for initializing fine surface matching algorithms for intra-operative soft-tissue registration. PMID:25038492

  9. Finite Element Simulations for Sheet Warm Hydroforming

    NASA Astrophysics Data System (ADS)

    Prete, A. Del; Papadia, G.; de Vitis, A. A.; Primo, T.

    2011-05-01

    The use of lightweight alloy offers significant potential to improve product performances. However, the application of formed lightweight alloy components in critical structures is restricted due to this material's low formability at room temperature and lack of knowledge for processing lightweight alloys at elevated temperature. Warm forming is becoming of great interest in order to increase the formability of these materials and many conventional processes are adapted including the temperature as a new parameter. In addition to this option, warm hydroforming technology for the lightweight materials is currently emerging to achieve reduced number of manufacturing steps and part consolidation. The warm hydroforming process makes use of the improved formability at elevated temperature and it also utilizes the fluid to transport the forming action as well as heat. In the present work, the authors have studied the warm hydroforming process using two different numerical approaches in order to simulate it. The first software is traditionally used in metal stamping simulations (also warm and hot) unlike the second. The analyzed material is an Al 6061 alloy 2,03 mm thick. Process responses such as: bulge height, thickness reduction and strain distribution have been evaluated different temperature levels (room temperature, equal to 23° C, 100° C and 200° C). The obtained results have been used to study the accuracy of the second software in sheet warm hydroforming simulation. The authors have also defined the more reliable numerical environment in order to develop material damage models in warm forming conditions.

  10. Finite Element Simulations for Sheet Warm Hydroforming

    NASA Astrophysics Data System (ADS)

    Del Prete, A.; Papadia, G.; De Vitis, A. A.; Primo, T.

    2011-05-01

    The use of lightweight alloy offers significant potential to improve product performances. However, the application of formed lightweight alloy components in critical structures is restricted due to this material's low formability at room temperature and lack of knowledge for processing lightweight alloys at elevated temperature. Warm forming is becoming of great interest in order to increase the formability of these materials and many conventional processes are adapted including the temperature as a new parameter. In addition to this option, warm hydroforming technology for the lightweight materials is currently emerging to achieve reduced number of manufacturing steps and part consolidation. The warm hydroforming process makes use of the improved formability at elevated temperature and it also utilizes the fluid to transport the forming action as well as heat. In the present work, the authors have studied the warm hydroforming process using two different numerical approaches in order to simulate it. The first software is traditionally used in metal stamping simulations (also warm and hot) unlike the second. The analyzed material is an Al 6061 alloy 2,03 mm thick. Process responses such as: bulge height, thickness reduction and strain distribution have been evaluated different temperature levels (room temperature, equal to 23 C, 100 C and 200 C). The obtained results have been used to study the accuracy of the second software in sheet warm hydroforming simulation. The authors have also defined the more reliable numerical environment in order to develop material damage models in warm forming conditions.

  11. An Intelligent Decision System for Intraoperative Somatosensory Evoked Potential Monitoring.

    PubMed

    Fan, Bi; Li, Han-Xiong; Hu, Yong

    2016-02-01

    Somatosensory evoked potential (SEP) is a useful, noninvasive technique widely used for spinal cord monitoring during surgery. One of the main indicators of a spinal cord injury is the drop in amplitude of the SEP signal in comparison to the nominal baseline that is assumed to be constant during the surgery. However, in practice, the real-time baseline is not constant and may vary during the operation due to nonsurgical factors, such as blood pressure, anaesthesia, etc. Thus, a false warning is often generated if the nominal baseline is used for SEP monitoring. In current practice, human experts must be used to prevent this false warning. However, these well-trained human experts are expensive and may not be reliable and consistent due to various reasons like fatigue and emotion. In this paper, an intelligent decision system is proposed to improve SEP monitoring. First, the least squares support vector regression and multi-support vector regression models are trained to construct the dynamic baseline from historical data. Then a control chart is applied to detect abnormalities during surgery. The effectiveness of the intelligent decision system is evaluated by comparing its performance against the nominal baseline model by using the real experimental datasets derived from clinical conditions. PMID:26415181

  12. Mechanisms of delayed Southern Ocean warming

    NASA Astrophysics Data System (ADS)

    Armour, K.; Marshall, J.; Donohoe, A.; Scott, J. R.

    2013-12-01

    Delayed surface warming of the Southern Ocean (SO) is a robust feature of the climate response to greenhouse gas forcing. It is seen in in-situ and satellite-based observations, and is simulated within coupled atmosphere-ocean general circulation models (GCMs). The observed cooling and associated sea ice expansion around Antarctica in recent decades is in stark contrast to the rapid warming and sea ice loss seen in the Arctic, yet the processes responsible for these divergent behaviors are not well understood. The SO warming delay has been widely attributed to deep mixed layers and efficient deep ocean heat uptake processes, while the observed cooling is often attributed to changes in upper ocean stratification or surface winds. We argue here that while these mechanisms do play a role, delayed SO warming is primarily a consequence of the mean SO circulation: Ekman upwelling of unmodified water from depth acts to anchor sea surface temperatures over multi-centennial timescales; equatorward transport of surface waters acts to advect the anomalous temperature signal out of the SO, where it is subducted on the equatorward flank of the Antarctic Circumpolar Current, driving an anomalous northward ocean heat transport that largely balances the increased air-sea heat flux into the SO under global warming. We explore the relative roles of the mechanisms of delayed SO warming within a variety of GCMs and observations. The observed spatial structure of upper ocean and surface warming is found to be well represented by an ocean-only GCM forced radiatively at the surface, but with no changes in surface winds or salinity. Within this model framework, the active versus passive nature of ocean heat uptake, and its influence on SO circulation, is explored. We further consider the consequences of delayed SO warming for (i) changes in atmospheric meridional energy transport with global warming, and (ii) the global top-of-atmosphere energy budget, via the delayed activation of destabilizing SO radiative feedbacks.

  13. Intraoperative imaging-guided cancer surgery: from current fluorescence molecular imaging methods to future multi-modality imaging technology.

    PubMed

    Chi, Chongwei; Du, Yang; Ye, Jinzuo; Kou, Deqiang; Qiu, Jingdan; Wang, Jiandong; Tian, Jie; Chen, Xiaoyuan

    2014-01-01

    Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing