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Sample records for intraoperative warming comparison

  1. Preoperative forced-air warming combined with intraoperative warming versus intraoperative warming alone in the prevention of hypothermia during gynecologic surgery.

    PubMed

    Adriani, Melissa Bucci; Moriber, Nancy

    2013-12-01

    Hypothermia in the perioperative setting can have serious consequences, including increased risk of infection or adverse cardiac events. Forced-air warming units commonly are used to prevent hypothermia. This study examined the impact of adding preoperative warming (Bair Paws, 3M) to conventional intraoperative forced-air warming modalities. Thirty patients received both preoperative and intraoperative forced-air warming, and 30 patients received intraoperative warming alone. Temperature readings were recorded across 3 time periods: preoperative, intraoperative, and postoperative. Data were analyzed using descriptive statistics, analysis of variance (ANOVA), and repeated-measures ANOVA. Demographics were similar in both groups with respect to age, body mass index, total intravenous fluids, and estimated blood loss. Statistically significant differences in temperature were seen over time (df = 2, P < .001), and for each intervention across all 3 time periods (P = .042). However, no statistically significant differences in temperature were demonstrated between groups over time. ASA status and type of procedure (laparoscopic vs open) also had no impact on results. These results suggest that preoperative warming with the Bair Paws gown offers no benefit over conventional therapy in maintaining normothermia in the perioperative period. PMID:24597006

  2. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring

    PubMed Central

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery. PMID:27445969

  3. Perioperative Warming in Surgical Patients: A Comparison of Interventions.

    PubMed

    Rowley, Brenda; Kerr, Marsi; Van Poperin, Judy; Everett, Cindy; Stommel, Manfred; Lehto, Rebecca H

    2015-08-01

    The four arm study investigates how use of a preoperative forced-air warming blanket and adjustment of ambient surgical room temperature may contribute to prevention of perioperative hypothermia. Active warming interventions may prevent the drop in core temperature that occur as a result of surgical anesthesia. Core body temperatures from a convenience sample of 220 adult surgical patients were sequentially monitored in the preoperative, intraoperative, and post-anesthesia care units (PACU) while receiving: (a) routine surgical care, (b) application of preoperative forced-air warming blanket, (c) application of preoperative forced-air warming blanket with adjustment of ambient surgical room temperatures, or (d) adjustment of ambient surgical room temperature only. Sample characteristics were evenly distributed among the four groups. There were no statistical differences in PACU core body temperatures. The application of forced-air warming blankets and room temperature adjustment interventions were not more effective than current practice in preventing perioperative hypothermia. PMID:24913925

  4. 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.

  5. Characterization of mitral valve prolapse with cardiac computed tomography: comparison to echocardiographic and intraoperative findings.

    PubMed

    Ghosh, Nina; Al-Shehri, Haliah; Chan, Kwan; Mesana, Thierry; Chan, Vincent; Chen, Li; Yam, Yeung; Chow, Benjamin J W

    2012-04-01

    A single imaging modality that can accurately assess both coronary anatomy and mitral valve (MV) anatomy prior to surgery may be desirable. We sought to determine the diagnostic accuracy of cardiac computed tomography (CT) to detect and characterize mitral valve prolapse (MVP) compared to echocardiography. Consecutive patients referred for 'single-source' cardiac CT for investigation prior to non-coronary cardiac sugery were identified. MV anatomy was assessed for MVP and results were compared to echocardiography and to intra-operative visual assessment of the MV. Comparison between the three modalities was performed at the per-patient, per-leaflet and per-scallop levels. A total of 67 consecutive patients that were referred for Cardiac CT prior to non-coronary cardiac surgery and were prospectively recruited into a Cardiac CT registry. Of these, 65 patients underwent cardiac surgery. 63 patients had echocardiography and 32 patients had intra-operative visual assessment of the mitral valve. Compared to echocardiography, cardiac CT had excellent sensitivity (92.6%) and specificity (97.1%) for the detection of any MVP, but had poor sensitivity (68.5%) for the detection of individual prolapsing scallop. Compared to intra-operative visual assessment of the prolapsing scallop, both cardiac CT and echocardiography had low sensitivity (58.1 and 78.1%, respectively). Cardiac CT was able to identify patients with MVP but had difficulty identifying the prolapsed scallops compared to echocardiography. Single-source CT may not be ready for characterization of individual mitral valve scallops. PMID:21604082

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

    PubMed

    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

  7. Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy

    PubMed Central

    Karakaş, Hüseyin Buğra; Çiçekbilek, İzzet; Tok, Adem; Alışkan, Tamer; Akduman, Bülent

    2016-01-01

    Objective In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). Material and methods Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. Results The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1–8), and length of hospital stay was 4.91±1.54 (2–17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485). Conclusion A statistically

  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

  9. A comparison of warming interventions on the temperatures of inpatients undergoing colorectal surgery.

    PubMed

    Nicholson, Martha

    2013-03-01

    This study compared the effects of two different warming interventions in the preoperative setting on the preoperative, intraoperative, and postoperative temperatures of patients undergoing colorectal surgery in an inpatient setting. The study was performed to determine whether prewarming patients for at least 30 minutes would result in postoperative temperatures of 36° C (96.8° F) or higher within 15 minutes of their arrival in the postanesthesia care unit. The results indicated that prewarming devices did not result in reduced proportions of patients who subsequently experienced hypothermia. One reason may be that all the patients were warmed with a forced-air warming device before induction in the OR. Our study does not recommend a specific intervention for a prewarming strategy but indicates that prewarming may contribute to normothermia in the immediate postoperative period. PMID:23452696

  10. 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.

  11. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma

    PubMed Central

    Rogha, Mehrdad; Hashemi, Sayyed Mostafa; Mokhtarinejad, Farhad; Eshaghian, Afrooz; Dadgostar, Alireza

    2014-01-01

    Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. Conclusion: A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion. PMID:24505568

  12. 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

  13. Intraoperative electromyography.

    PubMed

    Holland, Neil R

    2002-10-01

    Intraoperative electromyography (EMG) provides useful diagnostic and prognostic information during spine and peripheral nerve surgeries. The basic techniques include free-running EMG, stimulus-triggered EMG, and intraoperative nerve conduction studies. These techniques can be used to monitor nerve roots during spine surgeries, the facial nerve during cerebellopontine angle surgeries, and peripheral nerves during brachial plexus exploration and repair. However, there are a number of technical limitations that can cause false-positive or false-negative results, and these must be recognized and avoided when possible. The author reviews these basic electrophysiologic techniques, how they are applied to specific surgical situations, and their limitations. PMID:12477989

  14. [Postoperative warming therapy in the recovery room. A comparison of radiative and convective warmers].

    PubMed

    Weyland, W; Fritz, U; Fabian, S; Jaeger, H; Crozier, T; Kietzmann, D; Braun, U

    1994-10-01

    admission were 35.2 (33.4<==>35.9), 34.7 (34.3<==>35.8), and 35.4 (34.3<==>35.9) degrees C for groups R, B, and K, respectively. No significant differences in the rate of central rewarming could be found for these groups with 0.81 (0.41<==>1.32), 0.76 (0.40<==>1.07), and 0.70 (0.37<==>1.13) degrees C/h (Fig. 1). The mean VO2 of 3.41 (3.07<==>3.73), 3.55 (2.78<==>4.06), and 3.79 (2.51<==>7.00) ml/kg/min also did not differ significantly (Fig. 3). Significant differences between groups R and B [4.39 (3.74<==>6.19) and 4.30 (3.46<==>6.67) ml/kg/min] and K [5.92 (3.79<==>10.64) ml/kg/min] were found for VO2 maxima during the course of investigation (Fig. 4). The heat balance revealed significant differences among treatment and control groups with -88 (-226<==>+30), -41 (-212<==>+12), and -191 (-265<==>-86) kJ/h for groups R, B, and K. We additionally calculated the heat balance as a quotient, which showed 0.70 (0.22<==>1.07), 0.86 (0.44<==>1.04), and 0.49 (0.31<==>0.79) for groups R, B, and K (Fig. 4). The mean rate-pressure product of all groups did not differ significantly during the period of investigation. CONCLUSIONS. Neither external heat supply by radiant heat nor by a forced warm air system significantly reduced rewarming time in extubated, awake patients. As measured by heat balance, both active treatments saved about 20% more body heat production than in the control group. Continuing peripheral vasoconstriction may be the reason for the low efficiency of heat transfer. Thermal treatment did reduce the peak load (max. VO2) on the oxygen transport systems, though shivering was treated by pethidine if it occurred. External rewarming did not reduce the average load (mean VO2). Thus, concerning the goal of accelerating rewarming, it appears more rational to prevent intraoperative heat loss. For a comparison of efficiency of different warming devices, postoperative extubated patients do not appear to be an ideal model for study. PMID:7818046

  15. Comparison of implant quality between loose and intra-operatively linked iodine-125 seeds in prostate cancer brachytherapy.

    PubMed

    Jarusevicius, Laimonas; Inciura, Arturas; Juozaityte, Elona; Vaiciunas, Kestutis; Vaitkus, Antanas; Sniureviciute, Migle

    2012-01-01

    From 2007 to 2010, 230 patients had iodine-125 seeds implanted (loose or intra-operatively linked into seed trains with variable seed-to-seed spacing). The primary aim was to evaluate differences in implant quality by comparing the intra-operative and post-implant dosimetry in patients treated with loose and intra-operatively linked seeds. The secondary aim was to evaluate the "learning curve" for the procedure. The following parameters were compared: the radiation dose to 90% of the prostate volume (D90), the radiation dose to 30% of the urethral volume (DU30), the percentage of the prostate volume receiving 100% or 200% of the prescribed dose (V100 or V200, respectively), the percentage of the rectal volume receiving 100% of the prescribed dose (VR100), and the homogeneity index (HI). We obtained the following results for loose vs. intra-operatively linked seeds: D90 (Gy), 184.7 ± 15.0 vs. 177.9 ± 12.7 (p = 0.002); V100 (%), 95.5 ± 2.4 vs. 94.9 ± 3.2 (p = 0.206); V200 (%), 35.1 ± 7.5 vs. 24.3 plusmn; 6,9 (p < 0.001); DU30 (Gy), 218.6 ± 24.1 vs. 197.4 ± 19.5 (p = 0.001); VR100 (cm³), 0.6 ± 0.47 vs. 0.3 ± 0.3 (p < 0.001); HI (%), 31.8 ± 7.3 vs. 44.0 ± 9.8 (p < 0.001). The advantages of intra-operatively linked seed implantation over loose seed implantation are a more homogeneous prostate dose and lower urethral and rectal doses. The disadvantage is a lower post-implant D90. Sufficient experience with the loose seed implantation procedure was obtained after the first 40 patients. There was essentially no learning curve when a new implantation method using intra-operatively linked seeds was subsequently initiated. PMID:22739013

  16. Comparison of electron transport calculations in warm dense matter using the Ziman formula

    DOE PAGESBeta

    Burrill, D. J.; Feinblum, D. V.; Charest, M. R. J.; Starrett, C. E.

    2016-02-10

    The Ziman formulation of electrical conductivity is tested in warm and hot dense matter using the pseudo-atom molecular dynamics method. Several implementation options that have been widely used in the literature are systematically tested through a comparison to the accurate, but expensive Kohn–Sham density functional theory molecular dynamics (KS-DFT-MD) calculations. As a result, the comparison is made for several elements and mixtures and for a wide range of temperatures and densities, and reveals a preferred method that generally gives very good agreement with the KS-DFT-MD results, but at a fraction of the computational cost.

  17. Comparison of electron transport calculations in warm dense matter using the Ziman formula

    NASA Astrophysics Data System (ADS)

    Burrill, D. J.; Feinblum, D. V.; Charest, M. R. J.; Starrett, C. E.

    2016-06-01

    The Ziman formulation of electrical conductivity is tested in warm and hot dense matter using the pseudo-atom molecular dynamics method. Several implementation options that have been widely used in the literature are systematically tested through a comparison to the accurate, but expensive Kohn-Sham density functional theory molecular dynamics (KS-DFT-MD) calculations. The comparison is made for several elements and mixtures and for a wide range of temperatures and densities, and reveals a preferred method that generally gives very good agreement with the KS-DFT-MD results, but at a fraction of the computational cost.

  18. 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 surgeon’s 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 25.9±7.52 years. The average amount of bleeding among all patients was 117.87±324.86 ml, and the average quality of the surgical site was 1.65±4.48, 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

  19. 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.

  20. Comparison of the accuracy and proximal shunt failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement.

    PubMed

    Wilson, Thomas J; McCoy, Kathleen E; Al-Holou, Wajd N; Molina, Sergio L; Smyth, Matthew D; Sullivan, Stephen E

    2016-09-01

    OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal shunt failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971-0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406-5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced shunt failure, 79 patients (30.7%) had failure involving the proximal catheter, and 53 patients (20.6%) had distal failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal shunt failure (OR 0.983, 95% CI 0.970-0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227-5.032; p = 0.011), and accurate ventricular catheter placement (OR 3

  1. Intraoperative ultrasonography (IOUS) in thoracolumbar fractures.

    PubMed

    Blumenkopf, B; Daniels, T

    1988-01-01

    The thoracolumbar levels are the second most common region for spinal trauma. A major surgical effort often entails removal of retropulsed bone fragments with decompression of the spinal contents or realignment of vertebral subluxations. The ability to determine intraoperatively the completeness of such a procedure could impact on the surgical approach and, ultimately, the operative result. The intraoperative use of ultrasonography has gained popularity and applicability. This comparison study of intraoperative ultrasonography versus postoperative computed tomography (CT) assessed the accuracy of intraoperative ultrasonography in determining the status of the spinal canal following surgical intervention in a group of 21 patients with thoracolumbar fractures. In all cases a patent ventral subarachnoid space or complete spinal canal decompression was deduced following intraoperative ultrasonography. The postoperative assessment by CT concurred in 20 of 21 (95%) situations. Intraoperative ultrasonography proved useful during the operative management of these fractures and gave good supportive evidence that the neural elements were decompressed by surgical procedure. PMID:2980067

  2. A Lagrangian analysis of a sudden stratospheric warming - Comparison of a model simulation and LIMS observations

    NASA Technical Reports Server (NTRS)

    Pierce, R. B.; Remsberg, Ellis E.; Fairlie, T. D.; Blackshear, W. T.; Grose, William L.; Turner, Richard E.

    1992-01-01

    Lagrangian area diagnostics and trajectory techniques are used to investigate the radiative and dynamical characteristics of a spontaneous sudden warming which occurred during a 2-yr Langley Research Center model simulation. The ability of the Langley Research Center GCM to simulate the major features of the stratospheric circulation during such highly disturbed periods is illustrated by comparison of the simulated warming to the observed circulation during the LIMS observation period. The apparent sink of vortex area associated with Rossby wave-breaking accounts for the majority of the reduction of the size of the vortex and also acts to offset the radiatively driven increase in the area occupied by the 'surf zone'. Trajectory analysis of selected material lines substantiates the conclusions from the area diagnostics.

  3. 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

  4. A comparison of SAGE I data during the stratospheric warming of February-March, 1979

    NASA Technical Reports Server (NTRS)

    Nagatani, R. M.; Mccormick, M. P.; Mcmaster, L. R.

    1985-01-01

    The fine scale vertical structure of SAGE I ozone and aerosol data during a stratospheric warming is investigated using meteorological and SBUV ozone data. By stratifying the ozone and aerosol data for a limited time period, a comparison of the structure of profiles becomes possible under different meteorological conditions. For example, the cold air region shows more laminated structures than the other regions. In addition, vertical motions calculated at the same locations as the SAGE profiles show that they are consistent with variances found in the ozone and aerosol data.

  5. Comparison of Real-Time Intraoperative Ultrasound-Based Dosimetry With Postoperative Computed Tomography-Based Dosimetry for Prostate Brachytherapy

    SciTech Connect

    Nag, Subir; Shi Peipei; Liu Bingren; Gupta, Nilendu; Bahnson, Robert R.; Wang, Jian Z.

    2008-01-01

    Purpose: To evaluate whether real-time intraoperative ultrasound (US)-based dosimetry can replace conventional postoperative computed tomography (CT)-based dosimetry in prostate brachytherapy. Methods and Materials: Between December 2001 and November 2002, 82 patients underwent {sup 103}Pd prostate brachytherapy. An interplant treatment planning system was used for real-time intraoperative transrectal US-guided treatment planning. The dose distribution was updated according to the estimated seed position to obtain the dose-volume histograms. Postoperative CT-based dosimetry was performed a few hours later using the Theraplan-Plus treatment planning system. The dosimetric parameters obtained from the two imaging modalities were compared. Results: The results of this study revealed correlations between the US- and CT-based dosimetry. However, large variations were found in the implant-quality parameters of the two modalities, including the doses covering 100%, 90%, and 80% of the prostate volume and prostate volumes covered by 100%, 150%, and 200% of the prescription dose. The mean relative difference was 38% and 16% for doses covering 100% and 90% of the prostate volume and 10% and 21% for prostate volumes covered by 100% and 150% of the prescription dose, respectively. The CT-based volume covered by 200% of the prescription dose was about 30% greater than the US-based one. Compared with CT-based dosimetry, US-based dosimetry significantly underestimated the dose to normal organs, especially for the rectum. The average US-based maximal dose and volume covered by 100% of the prescription dose for the rectum was 72 Gy and 0.01 cm{sup 3}, respectively, much lower than the 159 Gy and 0.65 cm{sup 3} obtained using CT-based dosimetry. Conclusion: Although dosimetry using intraoperative US-based planning provides preliminary real-time information, it does not accurately reflect the postoperative CT-based dosimetry. Until studies have determined whether US-based dosimetry

  6. Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: A randomized controlled trial

    PubMed Central

    Bilgi, Kanchan V.; Vasudevan, Arumugam; Bidkar, Prasanna Udupi

    2016-01-01

    Background: The objective of this study was to study and compare the effects of intravenous dexmedetomidine and fentanyl on intraoperative hemodynamics, opioid consumption, and recovery characteristics in hypertensive patients. Methods: Fifty-seven hypertensive patients undergoing major surgery were randomized into two groups, Group D (dexmedetomidine, n = 29) and Group F (fentanyl, n = 28). The patients received 1 μg/kg of either dexmedetomidine or fentanyl, followed by 0.5 μg/kg/h infusion of the same drug, followed by a standard induction protocol. Heart rate (HR), mean arterial pressures (MAPs), end-tidal isoflurane concentration, and use of additional fentanyl and vasopressors were recorded throughout. Results: Both dexmedetomidine and fentanyl caused significant fall in HR and MAP after induction and dexmedetomidine significantly reduced the induction dose of thiopentone (P = 0.026). After laryngoscopy and intubation, patients in Group D experienced a fall in HR and a small rise in MAP (P = 0.094) while those in Group F showed significant rise in HR (P = 0.01) and MAP (P = 0.004). The requirement of isoflurane and fentanyl boluses was significantly less in Group D. The duration of postoperative analgesia was longer in Group D (P = 0.015) with significantly lower postoperative nausea and vomiting (PONV) (P < 0.001). Conclusion: Infusion of dexmedetomidine in hypertensive patients controlled the sympathetic stress response better than fentanyl and provided stable intraoperative hemodynamics. It reduced the dose of thiopentone, requirement of isoflurane and fentanyl boluses. The postoperative analgesia was prolonged, and incidence of PONV was less in patients who received dexmedetomidine. PMID:27212770

  7. Comparison of Preoperative Topical Dexamethasone Phosphate Versus Ketorolac Tromethamine in Maintaining Intraoperative Mydriasis During Small Incision Cataract Surgery

    PubMed Central

    Sharma, Hans Raj; Sharma, Rajni; Singh, Amrita

    2016-01-01

    Introduction Intraoperative miosis is one of the many challenges which a surgeon can face during cataract surgery. It may lead to impaired view and difficulty in delivering the nucleus. Also, it increases the chances of more serious intraoperative and postoperative complications. Therefore, maintaining adequate pupillary dilatation is of utmost importance during cataract surgery. Aim To study the efficacy of topical dexamethasone phosphate (0.1%) and topical ketorolac tromethamine (0.4%) in maintaining pupillary dilatation during cataract surgery. Materials and Methods A total of 200 patients were studied. These were randomly divided into two groups of 100 each. Group1 was given topical dexamethasone phosphate (0.1%) and Group 2, topical ketorolac tromethamine (0.4%). Medications were started 1-day before surgery in the form of one drop to be instilled every 6 hours. Pupillary diameter was measured in the horizontal meridian; 4 readings were taken - before making the incision, after nucleus delivery, following cortical clean-up and after Intraocular Lens (IOL) implantation. Results The two drugs showed no statistically significant difference in pupillary diameter at the commencement of surgery (p=0.435). The difference between the two drugs was statistically significant, for the mean pupillary diameter which changed from the start of surgery to after cortical clean-up. At this stage, ketorolac group showed a tendency towards larger mean pupillary diameter than dexamethasone group (6.70 ± 0.85mm and 6.32 ± 0.84mm, respectively, p=0.002). Again, ketorolac group patients had larger pupillary diameter after IOL implantation than dexamethasone group patients (the mean was 6.16± 0.97mm and 5.75 ± 0.73mm, respectively, p=0.001). Conclusion Both ketorolac tromethamine (0.4%) and dexamethasone phosphate (0.1%) are effective in maintaining adequate mydriasis during cataract surgery, but the comparative analysis of the two drugs concludes that, ketorolac is definitely a

  8. Biomechanical comparison of two intraoperative mobilization techniques for maxillary distraction osteogenesis: Down-fracture versus non-down-fracture

    PubMed Central

    Yang, Lili; Suzuki, Eduardo Yugo; Suzuki, Boonsiva

    2014-01-01

    Purposes: The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Materials and Methods: Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann–Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Results: Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. Conclusions: In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability. PMID:25593865

  9. Intraoperative prediction of ischaemic injury of the bowel: a comparison of laser Doppler flowmetry and tissue oximetry to histological analysis.

    PubMed

    Krohg-Sørensen, K; Line, P D; Haaland, T; Horn, R S; Kvernebo, K

    1992-09-01

    Intraoperative diagnosis of inadequate colonic perfusion would contribute to prevention of ischaemic colitis after abdominal aortic reconstructions. The aim of this study was to evaluate laser Doppler flowmetry (LDF) and tissue oximetry (TpO2) as predictors of the development of bowel necrosis. Devascularised loops of colon and ileum in anaesthetised pigs were divided into 10-20 mm segments and measurements of laser Doppler flux and TpO2 were performed in each segment. After 7 h of ischaemia the segments were resected for histological and biochemical analysis. In 65 colonic and 58 ileal segments a significantly lower flux was found in segments with necrosis of greater than or equal to 30% of the mucosal thickness compared to segments with necrosis of less than or equal to 10% (p less than 0.01). The discriminant flux value was 50 perfusion units, confirming a previous clinical study. The specificity was 0.96 and the sensitivity 0.94. Flux was inversely correlated to tissue lactate concentration. Significantly lower TpO2 was found in 19 colonic segments with necrosis of greater than or equal to 30% of mucosa compared to 19 colonic segments with necrosis of less than or equal to 10% (p less than 0.01). Using a discriminant value of 5kPa, a specificity of 0.79, and a sensitivity of 0.95 were calculated. In 27 ileum segments no significant difference in TpO2 between different histological groups was found (p greater than 0.30). The results show that LDF and TpO2 can predict ischaemic injury of the colon, and LDF also of the small bowel. PMID:1397347

  10. 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.

  11. Comparison of Two Types of Warm-Up Upon Repeated-Sprint Performance in Experienced Soccer Players.

    PubMed

    van den Tillaar, Roland; von Heimburg, Erna

    2016-08-01

    van den Tillaar, R and von Heimburg, E. Comparison of two types of warm-up upon repeated-sprint performance in experienced soccer players. J Strength Cond Res 30(8): 2258-2265, 2016-The aim of the study was to compare the effects of a long warm-up and a short warm-up upon repeated-sprint performance in soccer players. Ten male soccer players (age, 21.9 ± 1.9 years; body mass, 77.7 ± 8.3 kg; body height, 1.85 ± 0.03 m) conducted 2 types of warm-ups with 1 week in between: a long warm-up (20 minutes: LWup) and a short warm-up (10 minutes: SWup). Each warm-up was followed by a repeated-sprint test consisting of 8 × 30 m sprints with a new start every 30th second. The best sprint time, total sprinting time, and % decrease in time together with heart rate, lactate, and rate of perceived exertion (RPE) were measured. No significant differences in performance were found for the repeated-sprint test parameters (total sprint time: 35.99 ± 1.32 seconds [LWup] and 36.12 ± 0.96 seconds [SWup]; best sprint time: 4.32 ± 0.13 seconds [LWup] and 4.30 ± 0.10 seconds [SWup]; and % sprint decrease: 4.16 ± 2.15% [LWup] and 5.02 ± 2.07% [SWup]). No differences in lactate concentration after the warm-up and after the repeated-sprint test were found. However, RPE and heart rate were significantly higher after the long warm-up and the repeated-sprint test compared with the short warm-up. It was concluded that a short warm-up is as effective as a long warm-up for repeated sprints in soccer. Therefore, in regular training, less warm-up time is needed; the extra time could be used for important soccer skill training. PMID:26808861

  12. 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.

  13. A Congeneric Comparison Shows That Experimental Warming Enhances the Growth of Invasive Eupatorium adenophorum

    PubMed Central

    He, Wei-Ming; Li, Jing-Ji; Peng, Pei-Hao

    2012-01-01

    Rising air temperatures may change the risks of invasive plants; however, little is known about how different warming timings affect the growth and stress-tolerance of invasive plants. We conducted an experiment with an invasive plant Eupatorium adenophorum and a native congener Eupatorium chinense, and contrasted their mortality, plant height, total biomass, and biomass allocation in ambient, day-, night-, and daily-warming treatments. The mortality of plants was significantly higher in E. chinense than E. adenophorum in four temperature regimes. Eupatorium adenophorum grew larger than E. chinense in the ambient climate, and this difference was amplified with warming. On the basis of the net effects of warming, daily-warming exhibited the strongest influence on E. adenophorum, followed by day-warming and night-warming. There was a positive correlation between total biomass and root weight ratio in E. adenophorum, but not in E. chinense. These findings suggest that climate warming may enhance E. adenophorum invasions through increasing its growth and stress-tolerance, and that day-, night- and daily-warming may play different roles in this facilitation. PMID:22536425

  14. 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

    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.

  15. Intraoperative Stem Cell Therapy

    PubMed Central

    Coelho, Mónica Beato; Cabral, Joaquim M.S.; Karp, Jeffrey M.

    2013-01-01

    Stem cells hold significant promise for regeneration of tissue defects and disease-modifying therapies. Although numerous promising stem cell approaches are advancing in clinical trials, intraoperative stem cell therapies offer more immediate hope by integrating an autologous cell source with a well-established surgical intervention in a single procedure. Herein, the major developments in intraoperative stem cell approaches, from in vivo models to clinical studies, are reviewed, and the potential regenerative mechanisms and the roles of different cell populations in the regeneration process are discussed. Although intraoperative stem cell therapies have been shown to be safe and effective for several indications, there are still critical challenges to be tackled prior to adoption into the standard surgical armamentarium. PMID:22809140

  16. A comparison of polar vortex trend response to Pacific and Indian Ocean warming

    NASA Astrophysics Data System (ADS)

    Li, S.

    2009-12-01

    During the past decades the tropical Indo-Pacific Ocean has become warmer than before. Meanwhile, both the northern and the southern hemispheric polar vortex (NPV and SPV) exhibit a deepening trend in boreal winter-half year. Although previous studies reveal that the tropical Indian Ocean Warming (IOW) favors intensifying the NPV and weakening the SPV, how the tropical Pacific Ocean Warming (POW) influences the NPV and the SPV is unclear. In this study, a comparative analysis is conducted through ensemble atmospheric general circulation model (AGCM) experiments. The results show that, for the northern hemisphere, the two warming exert an opposite impact in boreal winter, in that the IOW intensifies the NPV while the POW weakens the NPV. For the southern hemisphere, both the IOW and POW warm the southern polar atmosphere and weaken the SPV. A diagnostic analysis based on vorticity budget reveals that such an interhemispheric different influence in boreal winter between the IOW and the POW is associated with the different roles of transient eddy momentum flux convergence. Furthermore, this difference may be linked to the different strength of stationary wave activity between the hemispheres in boreal winter.

  17. A comparison of polar vortex response to Pacific and Indian Ocean warming

    NASA Astrophysics Data System (ADS)

    Li, Shuanglin

    2010-05-01

    During recent decades, the tropical Indo-Pacific Ocean has become increasingly warmer. Meanwhile, both the northern and southern hemispheric polar vortices (NPV and SPV) have exhibited a deepening trend in boreal winter. Although previous studies have revealed that the tropical Indian Ocean warming (IOW) favors an intensifying NPV and a weakening SPV, how the tropical Pacific Ocean warming (POW) influences the NPV and SPV remains unclear. In this study, a comparative analysis has been conducted through ensemble atmospheric general circulation model (AGCM) experiments. The results show that, for the Northern Hemisphere, the two warmings exerted opposite impacts in boreal winter, in that the IOW intensified the NPV while the POW weakened the NPV. For the Southern Hemisphere, both the IOW and POW warmed the southern polar atmosphere and weakened the SPV. A diagnostic analysis based on the vorticity budget revealed that such an interhemispheric difference in influences from the IOW and POW in boreal winter was associated with different roles of transient eddy momentum flux convergence between the hemispheres. Furthermore, this difference may have been linked to different strengths of stationary wave activity between the hemispheres in boreal winter.

  18. Intraoperative aortic dissection

    PubMed Central

    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

  19. 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.

  20. Prototype Hybrid Systems for Neonatal Warming: In Vitro Comparisons to Standard of Care Devices

    PubMed Central

    Hubert, Terrence L.; Lindemann, Rolf; Wu, Jichuan; Agnew, Catherine; Shaffer, Thomas H.; Wolfson, Marla R.

    2013-01-01

    Preterm infants lack necessary thermoregulation. An ideal incubator should maintain a uniform and constant thermal environment. We compared the effectiveness of a supplemental heating blanket to improve the heating characteristics of two different incubator warming devices using assessment of their respective function alone as controls. Device A and device B, with and without a heating blanket (Harvard Apparatus), were instrumented with a distribution matrix of multiple temperature (n = 11) and humidity probes. These data were serially measured during warm up to 37.5 °C and through a series of open-door perturbations. The time constant, temperature variation, and change in air temperature were calculated. Data were analyzed for significance by 2-factor ANOVA for each respective incubator either turned on or off with either the heating blanket turned on or off. Device A warms faster (33.87% ; p < 0.05) than device B, but has a greater (37.27% ; p < 0.05) temperature variation during warmup. The heating blanket enhances the thermal response of device A during warmup, but does not alter those of device B. With the side door open, device A shows a smaller (−16.5% ; p < 0.05) temperature variation than device B; the heating blanket attenuates the temperature change in both devices. These results demonstrate that the use of a supplemental heating blanket, as well as device-related differences, may impact clinical control of a thermal environment. PMID:21142524

  1. A Comparison of Variable Total and Ultraviolet Solar Irradiance Inputs to 20 th Century Global Warming

    NASA Astrophysics Data System (ADS)

    Foukal, P. V.

    2002-05-01

    Analysis of spaceborne radiometry has shown that the total solar irradiance variation over the past two activity cycles was approximately proportional to the weighted difference between areas of dark spots and bright faculae and enhanced network. Empirical models of ultraviolet irradiance variation indicate that its behavior is dominated by changes in area of the bright component alone, whose photometric contrast increases at shorter wavelength.This difference in time behavior of total and UV irradiances could help to discriminate between their relative importance in forcing of global warming. Our recent digitization of archival Ca K images from Mt Wilson and NSO provides the first direct measurement of variations in area of the bright component, extending between 1915 and 1999 (previous models have relied on the sunspot number or other proxies to estimate the bright - component contribution). We use these more direct measurements to derive the time behavior of solar total and UV irradiance variation, over this period .We find that they are significantly different;the total irradiance variation accounts for over 80 percent of the variance in global temperature during this period, while the ultraviolet irradiance variation accounts for only about 20 percent. The amplitude of total irradiance variation in our model is smaller than required to influence global warming,in current climate models.Also, the impact of sulfate aerosol variations on the extended cooling between the 1940's and 1970's must be better understood before the significance of correlations between 20 th century global warming, and any solar activity index can be properly assessed. Despite these caveats, the lower correlation we find between global temperature and UV,compared to total, irradiance requires consideration in the search for physical mechanisms linking solar activity and climate. This work was supported in part under NASA grant NAG5-7607 to CRI, Inc., and NAG5-10998 to the Applied Physics

  2. 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

  3. 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; 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.

  4. [Intraoperative pancreas puncture cytology].

    PubMed

    Eggert, A; Lattmann, E; Kopf, R; Pfeiffer, M; Klöppel, G

    1984-01-01

    In the case of 10 to 15% of surgical patients with a pancreatic disorder an intraoperative diagnosis had to be made when a preoperative diagnosis had not yielded a definite result. Fine needle aspiration biopsy ( FNAB ) of the pancreas provided the basis for intraoperative differentiation of malignant and benign pancreatic processes. 244 pancreatic biopsies were carried out in 100 patients. It was possible to make a statement in 99% of the cases, with 65 malignant and 35 benign changes. In 83% the cytological diagnosis was correct; the method yielded incorrect-negative results in 7% of the cases. In 9% the presence of tumour cells was only suspected. There were no incorrect positive cancer diagnoses. FNAB caused no postoperative complications. Intraoperative bleeding after FBAB had to be stopped with a suture in one case. Transitory, asymptomatic hyperamylasemy must be expected in 25% of the patients after FNAB . This diagnostic technique is recommended in preference to the histological tissue removal methods because of its low risk factor. At least 2 biopsies of the suspect area with 2 smears are required, as a training in this diagnostic technique. PMID:6730761

  5. 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

  6. 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] μg/mL PL group vs. 129 [105; 161] μg/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

  7. 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 < 0.0001). Mean number of stitches in G1 was statistically lower (G1, 0.10; G2, 2.07; G3, 2.29; p < 0.0001). No differences with regard to patient compliance were detected. Operator comfort was higher in G1 (p < 0.0003). Nd:YAG laser and QMR scalpel give several advantages in oral mucosal surgery: Nd:YAG laser cuts tissue slowly, but it provides a good visibility and excellent hemostasis. QMR scalpel allows a very rapid cutting with no considerable temperature increase, but there is major risk of bleeding and need for sutures with lower operator comfort. PMID:25994929

  8. Comparison of Oxidation and Microstructure of Warm-Sprayed and Cold-Sprayed Titanium Coatings

    NASA Astrophysics Data System (ADS)

    Kim, KeeHyun; Kuroda, Seiji; Watanabe, Makoto; Huang, RenZhong; Fukanuma, Hirotaka; Katanoda, Hiroshi

    2012-06-01

    Thick titanium coatings were prepared by the warm spraying (WS) and cold spraying (CS) processes to investigate the oxidation and microstructure of the coating layers. Prior to the coating formations, the temperature and velocity of in-flight titanium powder particles were numerically calculated. Significant oxidation occurred in the WS process using higher gas temperature conditions with low nitrogen flow rate, which is mixed to the flame jet of a high velocity oxy-fuel (HVOF) spray gun in order to control the temperature of the propellant gas. Oxidation, however, decreased strikingly as the nitrogen flow rate increased. In the CS process using nitrogen or helium as a propellant gas, little oxidation was observed. Even when scanning electron microscopy or an x-ray diffraction method did not detect oxides in the coating layers produced by WS using a high nitrogen flow rate or by CS using helium, the inert gas fusion method revealed minor increases of oxygen content from 0.01 to 0.2 wt.%. Most of the cross-sections of the coating layers prepared by conventional mechanical polishing looked dense. However, the cross-sections prepared by an ion-milling method revealed the actual microstructures containing small pores and unbounded interfaces between deposited particles.

  9. 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.

  10. Inadvertant hypothermia and active warming for surgical patients.

    PubMed

    Tanner, Judith

    Inadvertant hypothermia is common among surgical patients and can result in serious complications. This article describes active warming systems which can be used preoperatively and intraoperatively to prevent hypothermia and maintain normothermia (normal body temperature). PMID:22067488

  11. Intraoperative vagal nerve monitoring.

    PubMed

    Leonetti, J P; Jellish, W S; Warf, P; Hudson, E

    1996-08-01

    A variety of benign and malignant neoplasms occur in the superior cervical neck, parapharyngeal space or the infratemporal fossa. The surgical resection of these lesions may result in postoperative iatrogenic injury to the vagus nerve with associated dysfunctional swallowing and airway protection. Anatomic and functional preservation of this critical cranial nerve will contribute to a favorable surgical outcome. Fourteen patients with tumors of the cervical neck or adjacent skull base underwent intraoperative vagal nerve monitoring in an attempt to preserve neural integrity following tumor removal. Of the 11 patients with anatomically preserved vagal nerves in this group, seven patients had normal vocal cord mobility following surgery and all 11 patients demonstrated normal vocal cord movement by six months. In an earlier series of 23 patients with tumors in the same region who underwent tumor resection without vagal nerve monitoring, 18 patients had anatomically preserved vagal nerves. Within this group, five patients had normal vocal cord movement at one month and 13 patients demonstrated normal vocal cord movement at six months. This paper will outline a technique for intraoperative vagal nerve monitoring utilizing transcricothyroid membrane placement of bipolar hook-wire electrodes in the vocalis muscle. Our results with the surgical treatment of cervical neck and lateral skull base tumors for patients with unmonitored and monitored vagal nerves will be outlined. PMID:8828272

  12. 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.

  13. 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

  14. Formation and evolution of periglacial landforms in context of global warming: Comparison Earth-Mars

    NASA Astrophysics Data System (ADS)

    Séjourné, A.; Costard, F.; Gargani, J.; Marmo, C.

    2012-04-01

    potential ice-wedges and subsequent subsidence of the ground producing pits. The scalloped depressions are similar in shape and size to thermokarst lakes. They are thought to be due to degradation of ground-ice by melting or sublimation of ground-ice and subsidence of the ground. Our results show that the assemblage of landforms in Utopia Planitia indicates the presence of an ice-rich permafrost like on Earth. We suggest that this permafrost were formed during cold climatic periods and then were degraded during a relatively recent global warming. Our results show that the permafrost was degraded during a high obliquity periods of Mars. But the question is how major climate-changes could occur on Mars. Mars is thought to have undergone important variations in the orbital parameters during the last 10 Myr dramatically changing the climate. Therefore, Utopia Planitia is probably a marker of one of the last major climate change that occurred on Mars.

  15. Somatosensory evoked potential monitoring of the brachial plexus to predict nerve injury during internal mammary artery harvest: intraoperative comparisons of the Rultract and Pittman sternal retractors.

    PubMed

    Jellish, W S; Martucci, J; Blakeman, B; Hudson, E

    1994-08-01

    Brachial plexus injury after coronary artery bypass grafting (CABG) continues to be a common problem postoperatively. With the use of somatosensory evoked potential monitoring (SSEP), neurologic integrity of the brachial plexus during internal mammary artery (IMA) harvest was assessed and the Rultract and Pittman sternal retractors were compared to determine what effect they had on SSEP characteristics. Results showed that the Rultract and Pittman retractors caused large decreases in SSEP amplitudes after insertion, (1.25 +/- 0.14 versus 0.72 +/- 0.09, P < 0.05; and 1.64 +/- 0.27 versus 0.91 +/- 0.14, P < 0.05) respectively. This decrease was noted in 85% of Rultract and 68.75% of Pittman patients, respectively. Amplitudes increased after retractor removal but never returned to baseline values. Cooley retractor placement in the patients not undergoing IMA harvest (control) produced only mild decreases in amplitude. Waveform latency increased in all groups after retractor placement, but these increases were thought to be clinically insignificant. Postoperatively, three patients in each of the IMA retractor groups had brachial plexus symptoms (18%), whereas only one patient in the control group had symptoms. Somatosensory evoked potential monitoring seems to be a sensitive intraoperative monitor for assessing brachial plexus injury during CABG. The nerve plexus seems to be most at risk for pathologic injury during retraction of the sternum for IMA harvest. Though the Rultract retractor caused greater changes in SSEP characteristics than the Pittman, no clinical outcome differences between the two could be ascertained. Using SSEP monitoring may reduce brachial plexus injury during IMA harvest by allowing early detection of nerve compromise and therapeutic interventions to alleviate the insult while under general anesthesia. PMID:7948794

  16. Comparison of implant quality between intraoperatively built custom-linked seeds and loose seeds in permanent prostate brachytherapy using sector analysis

    PubMed Central

    Katayama, Norihisa; Takemoto, Mitsuhiro; Takamoto, Atsushi; Ihara, Hiroki; Katsui, Kuniaki; Ebara, Shin; Nasu, Yasutomo; Kanazawa, Susumu

    2016-01-01

    We compared the implant quality of intraoperatively built custom-linked (IBCL) seeds with loose seeds in permanent prostate brachytherapy. Between June 2012 and January 2015, 64 consecutive prostate cancer patients underwent brachytherapy with IBCL seeds (n = 32) or loose seeds (n = 32). All the patients were treated with 144 Gy of brachytherapy alone. Brachytherapy was performed using a dynamic dose calculation technique. Computed tomography/magnetic resonance imaging fusion-based dosimetry was performed 1 month after brachytherapy. Post-implant dose–volume histogram (DVH) parameters, prostate sector dosimetry, operation time, seed migration, and toxicities were compared between the IBCL seed group and the loose seed group. A sector analysis tool was used to divide the prostate into six sectors (anterior and posterior sectors at the base, mid-gland, and apex). V100 (95.3% vs 89.7%; P = 0.014) and D90 (169.7 Gy vs 152.6 Gy; P = 0.013) in the anterior base sector were significantly higher in the IBCL seed group than in the loose seed group. The seed migration rate was significantly lower in the IBCL seed group than in the loose seed group (6% vs 66%; P < 0.001). Operation time per seed was significantly longer in the IBCL seed group than in the loose seed group (1.31 min vs 1.13 min; P = 0.003). Other post-implant DVH parameters and toxicities did not differ significantly between the two groups. Our study showed more dose coverage post-operatively in the anterior base prostate sector and less seed migration in IBCL seed implantation compared with loose seed implantation. PMID:26976125

  17. 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

    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

  18. Cold to Warm and Warm to Cold: A Comparison of rates and signatures of climate change going into and out of the Younger Dryas

    NASA Astrophysics Data System (ADS)

    Popp, T.; White, J.; Sveinbjornsdottir, A.; Masson-Delmotte, V.; Johnsen, S.; Jouzel, J.

    2003-12-01

    The most recent, very large (15 degrees C change in mean annual temperature) and very abrupt (50 years or less) climate change recorded in Greenland ice cores is the end of the Younger Dryas (YD). While this cold to warm transition has been extensively studied in ice cores using tools such as stable isotopes in ice, gas concentrations, stable isotopes in gases, snow chemistry, snow accumulation, and electrical conductivity of ice, the start of the YD has received much less attention in ice core analyses. In contrast, we have better theories for how the YD began, than how it ended. We focus here on the Greenland ice core record of the beginning of the YD, with an eye to the speed and nature of this abrupt climate change, and what the ice evidence may tell us concerning the fingerprint, and thus potential processes, of climate change left by this event. The first challenge is identifying the beginning of the YD in the ice core. Warm to cold transitions in isotopes in ice cores can be muted if winter snows are lost as a result of the colder conditions. This appears to be the case in the Greenland cores. Deuterium excess, which records ocean conditions during moisture evaporation, on the other hand, retains its sharpness. At the beginning of the YD, XS changes in NorthGRIP in a matter of years, a signal similar in size and speed to that seen at the end of the YD, but opposite in sign. Other signals are not similar in size and speed, however. These differences between the beginning and end of the YD will be discussed, and can reveal clues to the nature and timing of the climate changes. For example, continental dust does not change (increase) rapidly at the beginning of the YD cold period, but rather is delayed by decades. This suggests that there may be is a lag in the production of dust as ecosystems slowly dry and transform in response to the climate change.

  19. 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

  20. 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

  1. Sea surface temperatures of the mid-Piacenzian Warm Period: A comparison of PRISM3 and HadCM3

    USGS Publications Warehouse

    Dowsett, H.J.; Haywood, A.M.; Valdes, P.J.; Robinson, M.M.; Lunt, D.J.; Hill, D.J.; Stoll, D.K.; Foley, K.M.

    2011-01-01

    It is essential to document how well the current generation of climate models performs in simulating past climates to have confidence in their ability to project future conditions. We present the first global, in-depth comparison of Pliocene sea surface temperature (SST) estimates from a coupled ocean-atmosphere climate model experiment and a SST reconstruction based on proxy data. This enables the identification of areas in which both the climate model and the proxy dataset require improvement. In general, the fit between model-produced SST anomalies and those formed from the available data is very good. We focus our discussion on three regions where the data-model anomaly exceeds 2 ??C 1) In the high latitude North Pacific, a systematic model error may result in anomalies that are too cold. Also, the deeper Pliocene thermocline may cause disagreement along the California margin; either the upwelling in the model is too strong or the modeled thermocline is not deep enough. 2) In the North Atlantic, the model predicts cooling in the center of a data-based warming trend that steadily increases with latitude from +. 1.5 ??C to >+ 6 ??C. The discrepancy may arise because the modeled North Atlantic Current is too zonal compared to reality, which is reinforced by the lowering of the altitude of the Pliocene Western Cordillera Mountains. In addition, the model's use of modern bathymetry in the higher latitudes may have led the model to underestimate the northward penetration of warmer surface water into the Arctic. 3) Finally, though the data and model show good general agreement across most of the Southern Ocean, a few locations show offsets due to the modern land-sea mask used in the model. Additional considerations could account for many of the modest data-model anomalies, such as differences between calibration climatologies, the oversimplification of the seasonal cycle, and differences between SST proxies (i.e. seasonality and water depth). New SST estimates from

  2. 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 0.16°C 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 3°C 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 Oregon’s Willamette Valley. The warmed chambers are subjected to an average increase of +3.5°C/day, with asymmetrically warmed chambers having an increase of dawn Tmin of +5°C, and an increase of midday Tmax of +2°C; and with symmetrically warmed chambers having a constant increase of +3.5°C. 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

  3. A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery

    PubMed Central

    Puthenveettil, Nitu; Rajan, Sunil; Kumar, Lakshmi; Nair, Suresh Gangadharan

    2013-01-01

    Context: Establishing a near perfect surgical field during functional endoscopic sinus surgery (FESS) is essential and even a minor bleeding can severely compromise an already restricted view. So, if controlled hypotension can be provided without compromising the safety of patient by a relatively effortless method, surgical field can be improved greatly. Aims: The aim of this study was to compare the hemodynamic changes and surgical conditions during FESS following oral premedication with clonidine and metoprolol. Settings and Design: A total of 40 patients undergoing FESS were included in this prospective, randomized controlled study. Subjects and Methods: Patients were divided into two equal groups. Group A patients were premedicated with oral clonidine 300 mcg and Group B with oral metoprolol 50 mg, 2 h before surgery. All patients received fentanyl 2 mcg/kg and induced with propofol 2 mg/kg. Intubation was done following vecuronium 1 mg/kg. Anesthesia was maintained with 66% N2O, 33% O2 and 1% isoflurane. The heart rate (HR) and blood pressure (BP) were measured before induction and thereafter every 15 min up to 2 h. The surgeons were asked to estimate the quality of the operative field using a pre-defined category scale with scores 1-5. Statistical Analysis: Difference within the groups was analyzed using analysis of variance and post-hoc test was used to test the difference between individual groups. Chi-square test was used to find out the association between categorical variables. Results: Comparison of category scale revealed a lower score in Group A up to 60 min. Group B patients showed a statistically lower HR from pre-induction up to 90 min while systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure did not show a significant difference. Conclusions: Oral premedication with 300 mcg of clonidine produced a better operative field than oral metoprolol 50 mg during FESS. PMID:25885986

  4. 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

  5. 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...

  6. 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

  7. Intraoperative cell salvage in obstetrics.

    PubMed

    Grainger, Hannah; Catling, Sue

    2011-08-01

    The use of Intraoperative Cell Salvage (ICS) in obstetrics has been slow to develop as a result of theoretical concerns relating to amniotic fluid embolism and fetal red cell contamination. In this article we examine the current UK position on the use of ICS in this clinical speciality and the recommendations for its safe and appropriate use. PMID:22029206

  8. 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.

  9. [Intraoperative ABR Monitoring in Neurosurgery].

    PubMed

    Sato, Sumito; Onozawa, Yuya; Kumabe, Toshihiro; Okamoto, Hirotsugu

    2015-05-01

    Monitoring of the intraoperative auditory brainstem response (ABR) is a less invasive, easy, and useful method for hearing preservation in patient undergoing cerebellopontine angle surgery such as microvascular decompression (MVD) and excision of an acoustic neurinoma. The ABR is tolerant of both inhalation and intravenous anesthesia. However, ABR recordings are highly susceptible to electrical noise from surgical devices. Therefore, for ABR recordings to be reliable, noise must be minimized and appropriate evaluation of waveform changes is critical. Electrode setting with low contact impedance and bilateral derivation effectively address these issues. Prolongation of the wave V latency alerts to surgical stress on the cochlear nerve due to nerve stretching from cerebellar retraction. According to Sekiya, the surgeon performing MVD or acoustic neurinoma excision should be warned as soon as latency prolongation exceeds 1.5 msec or characteristics of ABR must be understood. even less than 0.5 msec, respectively. However, hearing was preserved in some patients with false-positive results with respect to intraoperative wave V diminution. To use it as a useful intraoperative modality, the Characteristics of ABR must be understood. PMID:26422957

  10. Future perspectives for intraoperative MRI.

    PubMed

    Jolesz, Ferenc A

    2005-01-01

    MRI-guided neurosurgery not only represents a technical challenge but a transformation from conventional hand-eye coordination to interactive navigational operations. In the future, multimodality-based images will be merged into a single model, in which anatomy and pathologic changes are at once distinguished and integrated into the same intuitive framework. The long-term goals of improving surgical procedures and attendant outcomes, reducing costs, and achieving broad use can be achieved with a three-pronged approach: 1. Improving the presentation of preoperative and real-time intraoperative image information 2. Integrating imaging and treatment-related technology into therapy delivery systems 3. Testing the clinical utility of image guidance in surgery The recent focus in technology development is on improving our ability to understand and apply medical images and imaging systems. Areas of active research include image processing, model-based image analysis, model deformation, real-time registration, real-time 3D (so-called "four-dimensional") imaging, and the integration and presentation of image and sensing information in the operating room. Key elements of the technical matrix also include visualization and display platforms and related software for information and display, model-based image understanding, the use of computing clusters to speed computation (ie, algorithms with partitioned computation to optimize performance), and advanced devices and systems for 3D device tracking (navigation). Current clinical applications are successfully incorporating real-time and/or continuously up-dated image-based information for direct intra-operative visualization. In addition to using traditional imaging systems during surgery, we foresee optimized use of molecular marker technology, direct measures of tissue characterization (ie, optical measurements and/or imaging), and integration of the next generation of surgical and therapy devices (including image

  11. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña 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

  12. Comparison of false-negative/positive results of intraoperative evoked potential monitoring between no and partial neuromuscular blockade in patients receiving propofol/remifentanil-based anesthesia during cerebral aneurysm clipping surgery: A retrospective analysis of 685 patients.

    PubMed

    Kim, Sung-Hoon; Jin, Seok-Joon; Karm, Myong-Hwan; Moon, Young-Jin; Jeong, Hye-Won; Kim, Jae-Won; Ha, Seung-Il; Kim, Joung-Uk

    2016-08-01

    Although the elicited responses of motor evoked potential (MEP) monitoring are very sensitive to suppression by anesthetic agents and muscle relaxants, the use of neuromuscular blockade (NMB) during MEP monitoring is still controversial because of serious safety concerns and diagnostic accuracy. Here, we evaluated the incidence of unacceptable movement and compared false-negative MEP results between no and partial NMB during cerebral aneurysm clipping surgery. We reviewed patient medical records for demographic data, anesthesia regimen, neurophysiology event logs, MEP results, and clinical outcomes. Patients were divided into 2 groups according to the intraoperative use of NMB: no NMB group (n = 276) and partial NMB group (n = 409). We compared the diagnostic accuracy of MEP results to predict postoperative outcomes between both groups. Additionally, we evaluated unwanted patient movement during MEP monitoring in both groups. Of the 685 patients, 622 (90.8%) manifested no intraoperative changes in MEP and no postoperative motor deficits. Twenty patients showed postoperative neurologic deficits despite preserved intraoperative MEP. False-positive MEP results were 3.6% in the no NMB group and 3.9% in the partial NMB group (P = 1.00). False-negative MEP results were 1.1% in the no NMB group and 4.2% in the partial NMB group (P = 0.02). No spontaneous movement or spontaneous respiration was observed in either group. Propofol/remifentanil-based anesthesia without NMB decreases the stimulation intensity of MEPs, which may reduce the false-negative ratio of MEP monitoring during cerebral aneurysm surgery. Our anesthetic protocol enabled reliable intraoperative MEP recording and patient immobilization during cerebral aneurysm clipping surgery. PMID:27559984

  13. The effect of preoperative warming on patients' postoperative temperatures.

    PubMed

    Cooper, Shauna

    2006-05-01

    Many perioperative clinicians encounter difficulty in preventing hypothermia in surgical patients. One intervention to prevent perioperative hypothermia is the use of forced-air warming. Although forced-air warming is used most frequently in the intraoperative area, prewarming patients with forced-air warming systems before induction of anesthesia may be enough to prevent hypothermia throughout the surgical procedure, allowing patients to arrive in the postanesthesia care unit in a normothermic state. A review of the literature on preoperative forced-air warming is provided, and the effect of prewarming on postoperative patient temperatures is discussed. PMID:16722285

  14. Influence of Grape Composition on Red Wine Ester Profile: Comparison between Cabernet Sauvignon and Shiraz Cultivars from Australian Warm Climate.

    PubMed

    Antalick, Guillaume; Šuklje, Katja; Blackman, John W; Meeks, Campbell; Deloire, Alain; Schmidtke, Leigh M

    2015-05-13

    The relationship between grape composition and subsequent red wine ester profile was examined. Cabernet Sauvignon and Shiraz, from the same Australian very warm climate vineyard, were harvested at two different stages of maturity and triplicate wines were vinified. Grape analyses focused on nitrogen and lipid composition by measuring 18 amino acids by HPLC-FLD, 3 polyunsaturated fatty acids, and 6 C6-compounds derived from lipid degradation by GC-MS. Twenty esters and four higher alcohols were analyzed in wines by HS-SPME-GC-MS. Concentrations of the ethyl esters of branched acids were significantly affected by grape maturity, but the variations were inconsistent between cultivars. Small relative variations were observed between wines for ethyl esters of fatty acids, whereas higher alcohol acetates displayed the most obvious differences with concentrations ranging from 1.5- to 26-fold higher in Shiraz than in Cabernet Sauvignon wines regardless of the grape maturity. Grape analyses revealed the variations of wine ester composition might be related to specific grape juice nitrogen composition and lipid metabolism. To the authors' knowledge the present study is the first to investigate varietal differences in the ester profiles of Shiraz and Cabernet Sauvignon wines made with grapes harvested at different maturity stages. PMID:25905977

  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. Minimalism through intraoperative functional mapping.

    PubMed

    Berger, M S

    1996-01-01

    Intraoperative stimulation mapping may be used to avoid unnecessary risk to functional regions subserving language and sensori-motor pathways. Based on the data presented here, language localization is variable in the entire population, with only certainty existing for the inferior frontal region responsible for motor speech. Anatomical landmarks such as the anterior temporal tip for temporal lobe language sites and the posterior aspect of the lateral sphenoid wing for the frontal lobe language zones are unreliable in avoiding postoperative aphasias. Thus, individual mapping to identify essential language sites has the greatest likelihood of avoiding permanent deficits in naming, reading, and motor speech. In a similar approach, motor and sensory pathways from the cortex and underlying white matter may be reliably stimulated and mapped in both awake and asleep patients. Although these techniques require an additional operative time and equipment nominally priced, the result is often gratifying, as postoperative morbidity has been greatly reduced in the process of incorporating these surgical strategies. The patients quality of life is improved in terms of seizure control, with or without antiepileptic drugs. This avoids having to perform a second costly operative procedure, which is routinely done when extraoperative stimulation and recording is done via subdural grids. In addition, an aggressive tumor resection at the initial operation lengthens the time to tumor recurrence and often obviates the need for a subsequent reoperation. Thus, intraoperative functional mapping may be best alluded to as a surgical technique that results in "minimalism in the long term". PMID:9247814

  17. Comparison greenhouse gas (GHG) emissions and global warming potential (GWP) effect of energy use in different wheat agroecosystems in Iran.

    PubMed

    Yousefi, Mohammad; Mahdavi Damghani, Abdolmajid; Khoramivafa, Mahmud

    2016-04-01

    The aims of this study were to determine energy requirement and global warming potential (GWP) in low and high input wheat production systems in western of Iran. For this purpose, data were collected from 120 wheat farms applying questionnaires via face-to-face interviews. Results showed that total energy input and output were 60,000 and 180,000 MJ ha(-1) in high input systems and 14,000 and 56,000 MJ ha(-1) in low input wheat production systems, respectively. The highest share of total input energy in high input systems recorded for electricity power, N fertilizer, and diesel fuel with 36, 18, and 13 %, respectively, while the highest share of input energy in low input systems observed for N fertilizer, diesel fuel, and seed with 32, 31, and 27 %. Energy use efficiency in high input systems (3.03) was lower than of low input systems (3.94). Total CO2, N2O, and CH4 emissions in high input systems were 1981.25, 31.18, and 1.87 kg ha(-1), respectively. These amounts were 699.88, 0.02, and 0.96 kg ha(-1) in low input systems. In high input wheat production systems, total GWP was 11686.63 kg CO2eq ha(-1) wheat. This amount was 725.89 kg CO2eq ha(-1) in low input systems. The results show that 1 ha of high input system will produce greenhouse effect 17 times of low input systems. So, high input production systems need to have an efficient and sustainable management for reducing environmental crises such as change climate. PMID:26690584

  18. 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

  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. 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 0–5° 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, Tukey’s 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

  1. 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.

  2. 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

  3. The basics of intraoperative diagnosis in neuropathology.

    PubMed

    Lee, Han S; Tihan, Tarik

    2015-03-01

    Intraoperative pathologic consultation continues to be an essential tool during neurosurgical procedures, helping to ensure adequacy of material for achieving a pathologic diagnosis and to guide surgeons. For pathologists, successful consultation with central nervous system lesions involves not only a basic familiarity with the pathologic features of such lesions but also an understanding of their clinical and radiologic context. This review discusses a basic approach to intraoperative diagnosis for practicing pathologists, including preparation for, performance of, and interpretation of an intraoperative neuropathologic evaluation. The cytologic and frozen section features of select examples of common pathologic entities are described. PMID:25783820

  4. Intraoperative radiotherapy: the Japanese experience. [Betatron

    SciTech Connect

    Abe, M.; Takahashi, M.

    1981-07-01

    Clinical results of intraoperative radiotherapy (IOR) which have been obtained since 1964 in Japan were reviewed. In this radiotherapy a cancerocidal dose can be delivered safely to the lesions, since critical organs are shifted from the field so that the lesions may be exposed directly to radiation. Intraoperative radiotherapy has spread in Japan and the number of institutions in which this radiotherapy is performed has continued to increase to a total of 26 in 1979. The total number of patients treated was 717. It has been demonstrated that intraoperative radiotherapy has definite effects on locally advanced abdominal neoplasms and unresectable radioresistant tumors.

  5. 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.

  6. Comparison of the dynamical response of low latitude middle atmosphere to the major stratospheric warming events in the Northern and Southern Hemispheres

    NASA Astrophysics Data System (ADS)

    Bhagavathiammal, G. J.; Sathishkumar, S.; Sridharan, S.; Gurubaran, S.

    2016-08-01

    This study presents comparison of low-latitude dynamical responses to boreal 2008/09 and austral 2002 winter Major Stratospheric Warming (MSW) events, as both events are of vortex split type. During these winters, planetary wave (PW) variability and changes in low-latitude circulation are examined using European Center for Medium Range Weather Forecasting (ECMWF) reanalysis (ERA)-interim data sets and mesospheric wind data acquired by the MF radars at Tirunelveli (8.7°N) and Rarotonga (22°S). Eliassen-Palm diagnostic is used to provide an evidence for the lateral PW energy propagation from high to low-latitudes during both the MSW events. The PW flux reaches much lower latitudes during the boreal event than during the austral event. The low-latitude westward winds at stratospheric heights are stronger (weaker) during the boreal (austral) MSW. Weak (strong) PW wave activity at low latitude mesospheric heights during boreal (austral) MSW indicates the influence of low-latitude stratospheric westward winds on the vertical propagation of PW to low-latitude mesosphere.

  7. Intraoperative Radiotherapy in Childhood Malignant Astrocytoma

    PubMed Central

    Rana, Sohail R.; Haddy, Theresa B.; Ashayeri, Ebrahim; Goldson, Alfred L.

    1984-01-01

    A 12-year-old black male patient with glioblastoma multiforme was treated with intraoperative radiotherapy followed by conventional external beam radiation and chemotherapy. The authors' clinical experience with these therapeutic measures is discussed. PMID:6330375

  8. Value of Intraoperative Sonography in Pancreatic Surgery.

    PubMed

    Weinstein, Stefanie; Morgan, Tara; Poder, Liina; Shin, Lewis; Jeffrey, R Brooke; Aslam, Rizwan; Yee, Judy

    2015-07-01

    The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease. Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care--the surgeon's scalpel--can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures. PMID:26112636

  9. 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.

  10. Refractory intraoperative hypotension with elevated serum tryptase

    PubMed Central

    Larson, Kelly J.; Divekar, Rohit D.; Butterfield, Joseph H.; Schwartz, Lawrence B.; Weingarten, Toby N.

    2015-01-01

    Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency. PMID:25653920

  11. 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.

  12. Intraoperative radiation therapy following pancreaticoduodenectomy.

    PubMed Central

    Evans, D B; Termuhlen, P M; Byrd, D R; Ames, F C; Ochran, T G; Rich, T A

    1993-01-01

    OBJECTIVE: To determine the morbidity and mortality of pancreaticoduodenectomy followed by electron-beam intraoperative radiation therapy (EB-IORT). SUMMARY BACKGROUND DATA: Local recurrence following pancreaticoduodenectomy occurs in 50% to 90% of patients who undergo a potentially curative surgical resection for adenocarcinoma of the pancreatic head. To improve local disease control, a more aggressive retroperitoneal dissection has been combined with adjuvant EB-IORT. METHODS: Forty-one patients with malignant neoplasms of the periampullary region underwent pancreaticoduodenectomy followed by EB-IORT between January 1989 and May 1992. EB-IORT was delivered in a dedicated operative suite, eliminating the need for patient relocation. Electron-beam energies of 6 to 12 MeV were used to deliver 10 to 20 Gy to the treatment field following resection but before pancreatic, biliary, and gastrointestinal reconstruction. RESULTS: Median operative time was 9 hours, blood loss was 1 L, perioperative transfusion requirement was 2 units, and hospital stay was 20 days. One patient died of a postoperative myocardial infarction, and four patients required reoperation, one for an anastomotic leak. No patient failed to receive EB-IORT because of operative complications during the time period of this study. CONCLUSION: Adjuvant EB-IORT after pancreaticoduodenectomy can be delivered safely, with low mortality and acceptable morbidity. Images Figure 1. Figure 1. PMID:8101073

  13. 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 0.26–0.81), overweight or obesity (OR = 0.39, 95% CI 0.28–0.56), high baseline core temperature before anesthesia (OR = 0.08, 95% CI 0.04–0.13), and high ambient temperature (OR = 0.89, 95% CI 0.79–0.98) were significant protective factors for hypothermia. In contrast, major-plus operations (OR = 2.00, 95% CI 1.32–3.04), duration of anesthesia (1–2 h) (OR = 3.23, 95% CI 2.19–4.78) and >2 h (OR = 3.44, 95% CI 1.90–6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45–4.12) 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

  14. 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.

  15. Rapid Intraoperative Molecular Characterization of Glioma

    PubMed Central

    Shankar, Ganesh M.; Francis, Joshua M.; Rinne, Mikael L.; Ramkissoon, Shakti H.; Huang, Franklin W.; Venteicher, Andrew S.; Akama-Garren, Elliot H.; Kang, Yun Jee; Lelic, Nina; Kim, James C.; Brown, Loreal E.; Charbonneau, Sarah K.; Golby, Alexandra J.; Pedamallu, Chandra Sekhar; Hoang, Mai P.; Sullivan, Ryan J.; Cherniack, Andrew D.; Garraway, Levi A.; Stemmer-Rachamimov, Anat; Reardon, David A.; Wen, Patrick Y.; Brastianos, Priscilla K.; Curry, William T.; Barker, Fred G.; Hahn, William C.; Nahed, Brian V.; Ligon, Keith L.; Louis, David N.; Cahill, Daniel P.; Meyerson, Matthew

    2016-01-01

    IMPORTANCE Conclusive intraoperative pathologic confirmation of diffuse infiltrative glioma guides the decision to pursue definitive neurosurgical resection. Establishing the intraoperative diagnosis by histologic analysis can be difficult in low-cellularity infiltrative gliomas. Therefore, we developed a rapid and sensitive genotyping assay to detect somatic single-nucleotide variants in the telomerase reverse transcriptase (TERT) promoter and isocitrate dehydrogenase 1 (IDH1). OBSERVATIONS This assay was applied to tissue samples from 190 patients with diffuse gliomas, including archived fixed and frozen specimens and tissue obtained intraoperatively. Results demonstrated 96% sensitivity (95% CI, 90%–99%) and 100% specificity (95% CI, 95%–100%) for World Health Organization grades II and III gliomas. In a series of live cases, glioma-defining mutations could be identified within 60 minutes, which could facilitate the diagnosis in an intraoperative timeframe. CONCLUSIONS AND RELEVANCE The genotyping method described herein can establish the diagnosis of low-cellularity tumors like glioma and could be adapted to the point-of-care diagnosis of other lesions that are similarly defined by highly recurrent somatic mutations. PMID:26181761

  16. 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

  17. Nuclear probes and intraoperative gamma cameras.

    PubMed

    Heller, Sherman; Zanzonico, Pat

    2011-05-01

    Gamma probes are now an important, well-established technology in the management of cancer, particularly in the detection of sentinel lymph nodes. Intraoperative sentinel lymph node as well as tumor detection may be improved under some circumstances by the use of beta (negatron or positron), rather than gamma detection, because the very short range (∼ 1 mm or less) of such particulate radiations eliminates the contribution of confounding counts from activity other than in the immediate vicinity of the detector. This has led to the development of intraoperative beta probes. Gamma camera imaging also benefits from short source-to-detector distances and minimal overlying tissue, and intraoperative small field-of-view gamma cameras have therefore been developed as well. Radiation detectors for intraoperative probes can generally be characterized as either scintillation or ionization detectors. Scintillators used in scintillation-detector probes include thallium-doped sodium iodide, thallium- and sodium-doped cesium iodide, and cerium-doped lutecium orthooxysilicate. Alternatives to inorganic scintillators are plastic scintillators, solutions of organic scintillation compounds dissolved in an organic solvent that is subsequently polymerized to form a solid. Their combined high counting efficiency for beta particles and low counting efficiency for 511-keV annihilation γ-rays make plastic scintillators well-suited as intraoperative beta probes in general and positron probes in particular Semiconductors used in ionization-detector probes include cadmium telluride, cadmium zinc telluride, and mercuric iodide. Clinical studies directly comparing scintillation and semiconductor intraoperative probes have not provided a clear choice between scintillation and ionization detector-based probes. The earliest small field-of-view intraoperative gamma camera systems were hand-held devices having fields of view of only 1.5-2.5 cm in diameter that used conventional thallium

  18. Global Warming: Physics and Facts

    SciTech Connect

    Levi, B.G.; Hafemeister, D.; Scribner, R.

    1992-05-01

    This report contains papers on: A tutorial on global atmospheric energetics and the greenhouse effect; global climate models: what and how; comparison of general circulation models; climate and the earth`s radiation budget; temperature and sea level change; short-term climate variability and predictions; the great ocean conveyor; trace gases in the atmosphere: temporal and spatial trends; the geochemical carbon cycle and the uptake of fossil fuel CO{sub 2}; forestry and global warming; the physical and policy linkages; policy implications of greenhouse warming; options for lowering US carbon dioxide emissions; options for reducing carbon dioxide emissions; and science and diplomacy: a new partnership to protect the environment.

  19. Global Warming: Physics and Facts

    SciTech Connect

    Levi, B.G. ); Hafemeister, D. , Washington, DC ); Scribner, R. )

    1992-01-01

    This report contains papers on: A tutorial on global atmospheric energetics and the greenhouse effect; global climate models: what and how; comparison of general circulation models; climate and the earth's radiation budget; temperature and sea level change; short-term climate variability and predictions; the great ocean conveyor; trace gases in the atmosphere: temporal and spatial trends; the geochemical carbon cycle and the uptake of fossil fuel CO{sub 2}; forestry and global warming; the physical and policy linkages; policy implications of greenhouse warming; options for lowering US carbon dioxide emissions; options for reducing carbon dioxide emissions; and science and diplomacy: a new partnership to protect the environment.

  20. 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

  1. 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

  2. Intraoperative tracking of aortic valve plane.

    PubMed

    Nguyen, D L H; Garreau, M; Auffret, V; Le Breton, H; Verhoye, J P; Haigron, P

    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

  3. 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

  4. Intraoperative identification of adrenal-renal fusion.

    PubMed

    Boll, Griffin; Rattan, Rishi; Yilmaz, Osman; Tarnoff, Michael E

    2015-01-01

    Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection. PMID:26195881

  5. 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.

  6. Intraoperative lung ultrasound: A clinicodynamic perspective

    PubMed Central

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

    In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients.

  7. Intraoperative lung ultrasound: A clinicodynamic perspective.

    PubMed

    Mittal, Amit Kumar; Gupta, Namrata

    2016-01-01

    In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients. PMID:27625474

  8. Warm Up with Skill.

    ERIC Educational Resources Information Center

    Hoyle, R. J.; Smith, Robert F.

    1989-01-01

    Too little time is often spent on warm-up activities in the school or recreation class. Warm-ups are often perfunctory and unimaginative. Several suggestions are made for warm-up activities that incorporate both previously learned and new skills, while preparing the body for more vigorous activity. (IAH)

  9. A review of the evidence for active preoperative warming of adults undergoing general anesthesia.

    PubMed

    Roberson, Michael C; Dieckmann, Loraine S; Rodriguez, Ricardo E; Austin, Paul N

    2013-10-01

    Inadvertent perioperative hypothermia, a common occurrence in the operating suite, is associated with many adverse outcomes. It is the nurse anesthetist's goal to attenuate the incidence of this problem. Although active intraoperative warming is a widely accepted practice, active preoperative warming may be a less explored option for temperature maintenance. A search strategy to identify systematic reviews and investigations in peer-reviewed journals was undertaken to identify evidence examining the efficacy of preoperative warming. Evidence sources meeting the search criteria were randomized controlled trials and a cohort study using historical controls. Most of the studies support the implementation of active preoperative warming by demonstrating that subjects were warmer during the perioperative period. Overall, these differences were statistically significant and likely clinically significant. Future clinical trials should examine shorter warming times and lower warming unit settings, should include appropriate sample sizes, and should consistently employ trained staff using calibrated biometric instruments to measure temperature. PMID:24354070

  10. Rationale for intraoperative radiotherapy in glioblastoma.

    PubMed

    Giordano, Frank A; Wenz, Frederik; Petrecca, Kevin

    2016-09-01

    Glioblastoma is the most common and aggressive adult primary brain cancer. Despite multimodal therapy, it is associated with a survival of less than two years. Greater than 85% of recurrences occur within the original area of surgery and radiotherapy, suggesting a potential for improved local treatments. In addition to cancer cell invasion beyond surgical margins, a plethora of postinjury pro-proliferative stimuli are released from local healing brain, which both protect and nourish remaining cancer cells. This review compiles preclinical and clinical evidence for a dedicated treatment of both residual cancer cells and regional microenvironment using intraoperative radiotherapy (IORT). PMID:26824195

  11. 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

    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.

  12. Comparison between whole-body vibration, light-emitting diode, and cycling warm-up on high-intensity physical performance during sprint bicycle exercise.

    PubMed

    Teles, Maria C; Fonseca, Ivana A T; Martins, Jeanne B; de Carvalho, Marielle M; Xavier, Murilo; Costa, Sidney J; de Avelar, Núbia C P; Ribeiro, Vanessa G C; Salvador, Fabiano S; Augusto, Leonardo; Mendonça, Vanessa A; Lacerda, Ana C R

    2015-06-01

    The purpose of this study was to compare the effects of light-emitting diode (LED) irradiation and whole-body vibration (WBV) delivered either in isolation or combination (LED + WBV), warm-up (WU), and a control (C) treatment on performance during a sprint bicycle exercise. Ten cyclists performed a 30-second sprint cycle test under these conditions. The LED light was applied at 4 points bilaterally. Whole-body vibration consisted of 5 minutes of squats associated with WBV. LED + WBV consisted of WBV followed by LED therapy. Warm-up consisted of 17 minutes of moderate-intensity bicycle exercise. Control consisted of 10 minutes at rest. Blood lactate (BL) and ammonia (BA) levels and skin temperature (ST) were determined. Peak power (842 ± 117 vs. 800 ± 106 vs. 809 ± 128 W [p = 0.02 and p = 0.01]), relative power (12.1 ± 1.0 vs. 11.5 ± 0.9 vs. 11.6 ± 1.0 W·kg [p = 0.02 and p = 0.02]), and relative work (277 ± 23 vs. 263 ± 24 vs. 260 ± 23 J·kg [p = 0.02 and p = 0.003]) were higher in the WU group compared with the control and LED groups. In the LED + WBV group, peak (833 ± 115 vs. 800 ± 106 W [p = 0.02]) and relative (11.9 ± 0.9 vs. 11.5 ± 0.9 W·kg [p = 0.02]) power were higher than those in the control group, and relative work (272 ± 22 vs. 260 ± 23 J·kg [p = 0.02]) were improved compared with the LED group. There were no differences for BL, BA, and ST. The findings of this study confirmed the effectiveness of a warm-up as a preparatory activity and demonstrated that LED + WBV and WBV were as effective as WU in improving cyclist performance during a sprint bicycle exercise. PMID:25764492

  13. Self-inflicted nail-gun injury with cranial penetration and use of intraoperative computed tomography

    PubMed Central

    Carnevale, Joseph A.; Morrison, John F.; Choi, David B.; Klinge, Petra M.; Cosgrove, G. Rees; Oyelese, Adetokunbo A.

    2016-01-01

    Background: Management of penetrating cranial trauma remains a high acuity and imaging intense neurosurgical disorder. Imaging of vital structures, including angiography, is typically conducted to understand the proximity of vital structures in comparison to a foreign body and prepare for intraoperative complications such as hemorrhage. Preservation of function following initial injury in cases where minimal neurological deficit exists is essential. Case Description: Here, we present a case using intraoperative computed tomography to assist in early detection and resolution of hemorrhage in the surgical management of an intact patient with self-inflicted penetrating cranial trauma. Conclusions: This method may aid in early detection of hemorrhage and prevention of consequential neurological deterioration or emergent need for secondary surgery. PMID:27213112

  14. Neurophysiologic intraoperative monitoring: II. Facial nerve function.

    PubMed

    Niparko, J K; Kileny, P R; Kemink, J L; Lee, H M; Graham, M D

    1989-01-01

    Intraoperative facial nerve monitoring provides a potentially useful adjunct to recent surgical advances in neurotology and neurosurgery. These measures further aid the surgeon in preserving facial nerve function by enhancing visual identification with electrical monitoring of mechanically evoked facial muscle activation. Facial nerve monitoring in neurotologic surgery may achieve the following goals: (1) early recognition of surgical trauma to the facial nerve, with immediate feedback made available to the surgeon through monitoring of mechanical activation; (2) assistance in distinguishing the facial nerve from regional cranial nerves and from adjacent soft tissue and tumor with selective electrical stimulation; (3) facilitation of tumor excision by electrical mapping of portions of tumor that are remote from the facial nerve; (4) confirmation of nerve stimulability at the completion of surgery; and (5) identification of the site and degree of neural dysfunction in patients undergoing nerve exploration for suspected facial nerve neoplasm or undergoing decompression in acute facial palsy. This paper provides an overview of intraoperative facial nerve monitoring principles and methodology and reports a recent clinical investigation that demonstrates the utility of facial nerve monitoring in translabyrinthine acoustic neuroma surgery. PMID:2655465

  15. Intracardiac leiomyomatosis presenting as an intraoperative consultation.

    PubMed

    Alves, António Joaquim Teixeira; Ferreira, Marco António; Gallego-Poveda, Javier; Matos, Ana; Costa-Silva, Artur; Nobre, Ângelo; Lopez-Beltran, António

    2016-06-01

    Intravenous leiomyomatosis (IVL) is an extremely rare variant of leiomyoma in which nodular masses of tumor grow within venous channels. Rarely, the tumor can reach the vena cava and right heart. We present a case of a 45-year-old woman, admitted with rapidly evolving exertional dyspnea. Cardiac ultrasonography revealed a "mass in the right chambers". She was submitted to right atriotomy plus tumorectomy, with intraoperative consultation requested. Grossly, the tumor was polypoid, firm, with a smooth surface. The frozen section showed a lesion composed of tortuous vessels and some areas with a fibrillar eosinophil extracellular matrix and others with spindle cells, without significant atypia, mitosis or necrosis. The diagnosis was deferred for definitive paraffin sections. In the definitive H&E and immunohistochemical stains, the case was diagnosed as an IVL and confirmed in the hysterectomy specimen. This is the first case report describing an intraoperative consultation of an intracardiac leiomyomatosis. Clinical information and pathologist awareness to this entity are essential for the correct diagnosis in frozen section. PMID:27067811

  16. Intraoperative MRI in pediatric brain tumors.

    PubMed

    Choudhri, Asim F; Siddiqui, Adeel; Klimo, Paul; Boop, Frederick A

    2015-09-01

    Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children. PMID:26346145

  17. Improved Visualization of Intracranial Vessels with Intraoperative Coregistration of Rotational Digital Subtraction Angiography and Intraoperative 3D Ultrasound

    PubMed Central

    Podlesek, Dino; Meyer, Tobias; Morgenstern, Ute; Schackert, Gabriele; Kirsch, Matthias

    2015-01-01

    Introduction Ultrasound can visualize and update the vessel status in real time during cerebral vascular surgery. We studied the depiction of parent vessels and aneurysms with a high-resolution 3D intraoperative ultrasound imaging system during aneurysm clipping using rotational digital subtraction angiography as a reference. Methods We analyzed 3D intraoperative ultrasound in 39 patients with cerebral aneurysms to visualize the aneurysm intraoperatively and the nearby vascular tree before and after clipping. Simultaneous coregistration of preoperative subtraction angiography data with 3D intraoperative ultrasound was performed to verify the anatomical assignment. Results Intraoperative ultrasound detected 35 of 43 aneurysms (81%) in 39 patients. Thirty-nine intraoperative ultrasound measurements were matched with rotational digital subtraction angiography and were successfully reconstructed during the procedure. In 7 patients, the aneurysm was partially visualized by 3D-ioUS or was not in field of view. Post-clipping intraoperative ultrasound was obtained in 26 and successfully reconstructed in 18 patients (69%) despite clip related artefacts. The overlap between 3D-ioUS aneurysm volume and preoperative rDSA aneurysm volume resulted in a mean accuracy of 0.71 (Dice coefficient). Conclusions Intraoperative coregistration of 3D intraoperative ultrasound data with preoperative rotational digital subtraction angiography is possible with high accuracy. It allows the immediate visualization of vessels beyond the microscopic field, as well as parallel assessment of blood velocity, aneurysm and vascular tree configuration. Although spatial resolution is lower than for standard angiography, the method provides an excellent vascular overview, advantageous interpretation of 3D-ioUS and immediate intraoperative feedback of the vascular status. A prerequisite for understanding vascular intraoperative ultrasound is image quality and a successful match with preoperative

  18. 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

  19. 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

  20. 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

  1. Intraoperative neuromonitoring in major vascular surgery.

    PubMed

    So, V C; Poon, C C M

    2016-09-01

    There has been a growing interest in using intraoperative neuromonitoring to reduce the incidence of stroke and paralysis in major vascular interventions. Electroencephalography, various neurophysiological evoked potential measurements, transcranial Doppler, and near-infrared spectroscopy are some of the modalities currently used to detect neural injuries. A good understanding of these modalities and their interactions with anaesthesia is important to maximize their value and to allow meaningful interpretation of their results. In view of the inter-individual differences in anatomy, physiological reserves, and severity of pathological processes, neuromonitoring may be a valuable method to evaluate the well-being of the nervous system during and after surgical interventions. In this review, we summarize some of their applications, efficacies, and drawbacks in major carotid and aortic surgeries. PMID:27566804

  2. 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.

  3. 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

  4. 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

  5. Intraoperative diffusion tensor imaging predicts the recovery of motor dysfunction after insular lesions☆

    PubMed Central

    Li, Jinjiang; Chen, Xiaolei; Zhang, Jiashu; Zheng, Gang; Lv, Xueming; Li, Fangye; Hu, Shen; Zhang, Ting; Xu, Bainan

    2013-01-01

    Insular lesions remain surgically challenging because of the need to balance aggressive resection and functional protection. Motor function deficits due to corticospinal tract injury are a common complication of surgery for lesions adjacent to the internal capsule and it is therefore essential to evaluate the corticospinal tract adjacent to the lesion. We used diffusion tensor imaging to evaluate the corticospinal tract in 89 patients with insular lobe lesions who underwent surgery in Chinese PLA General Hospital from February 2009 to May 2011. Postoperative motor function evaluation revealed that 57 patients had no changes in motor function, and 32 patients suffered motor dysfunction or aggravated motor dysfunction. Of the affected patients, 20 recovered motor function during the 6–12-month follow-up, and an additional 12 patients did not recover over more than 12 months of follow-up. Following reconstruction of the corticospinal tract, fractional anisotropy comparison demonstrated that preoperative, intraoperative and follow-up normalized fractional anisotropy in the stable group was higher than in the transient deficits group or the long-term deficits group. Compared with the transient deficits group, intraoperative normalized fractional anisotropy significantly decreased in the long-term deficits group. We conclude that intraoperative fractional anisotropy values of the corticospinal tracts can be used as a prognostic indicator of motor function outcome. PMID:25206435

  6. Warm-Up Activities.

    ERIC Educational Resources Information Center

    Mingguang, Yang

    1999-01-01

    Discusses how warm-up activities can help to make the English-as-a-foreign-language classroom a lively and interesting place. Warm-up activities are games carried out at the beginning of each class to motivate students to make good use of class time. (Author/VWL)

  7. 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

  8. 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

  9. Migratory intradural disk herniation and a strategy for intraoperative localization.

    PubMed

    Daffner, Scott D; Sedney, Cara L; Rosen, Charles L

    2015-02-01

    Study Design Case report. Objective Describe a case of intradural disk herniation and a method for intraoperative localization. Methods Intradural disk herniations are uncommon but well described. The diagnosis of these lesions is often difficult, and sometimes they may be diagnosed only through an intradural exploration after an expected disk fragment cannot be located. We report the case of an intradural disk herniation with an additional diagnostic difficulty-a migrated intradural disk. Results We present the first intraoperative imaging evidence of disk migration and propose a strategy to locate intradural disk fragments prior to durotomy. Conclusion Intradural disk herniations should be suspected when intraoperative findings are not congruent with imaging findings. An intraoperative myelogram may be helpful. PMID:25648315

  10. 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.

  11. Safe thyroidectomy with intraoperative methylene blue spraying

    PubMed Central

    2012-01-01

    Background We aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area. Material and methods The intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not recurrent) thyroid surgery for a variety of thyroid diseases. Bilateral total thyroidectomy was performed in all cases. After superior but before inferior pole ligation, 0.5ml of methylene blue was sprayed over the thyroid lobe and perilober area. Tissues, especially parathyroides, the recurrent laryngeal nerve, and the inferior thyroid artery, were identified and evaluated. Results Recurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue. Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained. Thyroid tissue wash-out time was not less than 15 minutes; perithyroideal muscles, tendinous and lipoid structures took no less than 25 minutes. Conclusion The safety of intravascular methylene blue guidance on thyroid surgery is known. This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries. PMID:23148801

  12. Intraoperative imaging using intravascular contrast agent

    NASA Astrophysics Data System (ADS)

    Watson, Jeffrey R.; Martirosyan, Nikolay; Garland, Summer; Lemole, G. Michael; Romanowski, Marek

    2016-03-01

    Near-infrared (NIR) contrast agents are becoming more frequently studied in medical imaging due to their advantageous characteristics, most notably the ability to capture near-infrared signal across the tissue and the safety of the technique. This produces a need for imaging technology that can be specific for both the NIR dye and medical application. Indocyanine green (ICG) is currently the primary NIR dye used in neurosurgery. Here we report on using the augmented microscope we described previously for image guidance in a rat glioma resection. Luc-C6 cells were implanted in a rat in the left-frontal lobe and grown for 22 days. Surgical resection was performed by a neurosurgeon using augmented microscopy guidance with ICG contrast. Videos and images were acquired to evaluate image quality and resection margins. ICG accumulated in the tumor tissue due to enhanced permeation and retention from the compromised bloodbrain- barrier. The augmented microscope was capable of guiding the rat glioma resection and intraoperatively highlighted tumor tissue regions via ICG fluorescence under normal illumination of the surgical field.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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)

  18. 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.

  19. 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.

  20. Analytic models of warm plasma dispersion relations

    SciTech Connect

    Seough, J. J.; Yoon, P. H.

    2009-09-15

    The present paper is concerned with analytic models of warm plasma dispersion relations for electromagnetic waves propagating parallel to the ambient magnetic field. Specifically, effects of finite betas on two slow modes, namely, the left-hand circularly polarized ion-cyclotron mode and the right-hand circularly polarized whistler mode, are investigated. Analytic models of the warm plasma dispersion relations are constructed on the basis of conjecture and upon comparisons with numerically found roots. It is shown that the model solutions are good substitutes for actual roots. The significance of the present work in the context of nonlinear plasma research is discussed.

  1. The role of intraoperative frozen sections in revision total joint arthroplasty.

    PubMed

    Feldman, D S; Lonner, J H; Desai, P; Zuckerman, J D

    1995-12-01

    We performed a retrospective analysis of thirty-three consecutive total hip and knee (twenty-three hip and ten knee) revision arthroplasties during which intraoperative frozen sections were analyzed. Data for the study were collected by means of a review of the charts, radiographic analysis, and evaluation of both frozen and permanent histological sections. The frozen sections, of periprosthetic tissue at the bone-cement interface or the pseudocapsule, were considered positive for active infection if there were more than five polymorphonuclear leukocytes per high-power field in at least five distinct microscopic fields. All patients were available for follow-up, at an average of thirty-six months (range, seventeen to seventy-nine months) after the initial revision operation. The frozen sections from ten patients were positive for infection, and those from twenty-three patients were negative. Comparison of the results of the analyses of the frozen sections (both positive and negative) with those of the analyses of the permanent histological sections of similar tissue showed a correlation of 100 per cent (sensitivity, 1.00; specificity, 1.00; and accuracy, 1.00). Nine patients had positive intraoperative cultures, and all of them had positive frozen sections (sensitivity, 1.00). Of the twenty-four patients who had negative intraoperative cultures, twenty-three had negative frozen sections (specificity, 0.96). Of the nine patients who had positive intraoperative cultures, only two were found to have infection on intraoperative gram-staining. The surgeon's operative assessment regarding the presence of infection, compared with the final pathological diagnosis, demonstrated a sensitivity of 0.70, a specificity of 0.87, and an accuracy of 0.82. All ten patients who had positive frozen sections were managed with excision arthroplasty; six of them subsequently had reimplantation, and the excision was the definitive procedure in the remaining four. One patient who had had a

  2. 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.

  3. A light blanket for intraoperative photodynamic therapy

    NASA Astrophysics Data System (ADS)

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

    2009-06-01

    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 fingerlike 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.

  4. Warm up to the idea: Global warming is here

    SciTech Connect

    Lynch, C.F.

    1996-07-01

    This article summarizes recent information about global warming as well as the history of greenhouse gas emissions which have lead to more and more evidence of global warming. The primary source detailed is the second major study report on global warming by the Intergovernmental Panel on climate change. Along with comments about the environmental effects of global warming such as coastline submersion, the economic, social and political aspects of alleviating greenhouse emissions and the threat of global warming are discussed.

  5. 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.; Brattström, 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

  6. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  7. Use of intraoperative ultrasonography in canine spinal cord lesions.

    PubMed

    Nanai, Beatrix; Lyman, Ronald; Bichsel, Pierre S

    2007-01-01

    The purpose of this retrospective study was to describe the intraoperative appearance of various spinal cord conditions, and to investigate how intraoperative ultrasonography assisted in modification of surgical and postoperative treatment plans. Intraoperative ultrasonography (B-mode, and power Doppler mode) was used in 25 dogs undergoing spinal surgery. The neurologic conditions included cervical spondylomyelopathy, intervertebral disc (IVD) protrusion, IVD extrusion, spinal tumors, nerve sheath mass, granulomatous myelitis, and discospondylitis. All of these diagnoses were supported by histopathologic and/or cytologic evaluation. It was possible to visualize the spinal cord and the abnormal spinal tissue in all of the patients. Power Doppler imaging allowed assessment of the spinal cord microcirculation, and assisted in judgment of the degree of decompression. Ultrasound imaging directly impacted the surgical and the medical treatment plans in four patients. Owing to the intraoperative imaging, two hemilaminectomies were extended cranially and caudally, and additional disc spaces were fenestrated, one hemilaminectomy site was extended dorsally to retrieve the disc material from the opposite side, and one intramedullary cervical spinal cord lesion was discovered, aspirated, and consequently diagnosed as granulomatous inflammation, which altered the long-term medication protocol in that dog. This study suggests that intraoperative sonographic spinal cord imaging is a useful and viable technique. PMID:17508514

  8. 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

  9. Rate of intraoperative complications during cataract surgery following intravitreal injections.

    PubMed

    Hahn, P; Jiramongkolchai, K; Stinnett, S; Daluvoy, M; Kim, T

    2016-08-01

    PurposeTo investigate the effect of prior intravitreal injections on intraoperative and postoperative complication rates associated with cataract surgery.MethodsA retrospective cohort analysis reviewed 10 105 cataract surgery procedures performed by experienced surgeons at the Duke Eye Center from 1 January 2005 to 10 December 2012. A group of 197 eyes with prior intravitreal injections was compared with an equal number of matched control eyes without prior injection using the Fisher's exact test of difference in proportions and the Wilcoxon rank-sum test of difference in means. Outcomes analyzed included baseline demographic information, preoperative clinical characteristics, prevalence of intraoperative complications, and postoperative intraocular pressure, glaucoma surgery, and glaucoma medication requirement through 1 year following cataract surgery.ResultsAn increased rate of intraoperative complications was identified during cataract surgery in eyes with prior intravitreal injections compared with control eyes (3 vs 0%, P=0.030). Injection eyes required more glaucoma medications at 1 year, but no difference was identified if steroid injections were excluded. No difference in postoperative IOP or glaucoma surgery was identified. No cases of endophthalmitis were reported.ConclusionsA history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications. We hypothesize this may be due to unidentified iatrogenic lens trauma during intravitreal injections. Particular attention to the posterior capsule during preoperative assessment and intraoperatively is recommended in eyes undergoing cataract surgery with a prior history of intravitreal injections. PMID:27229705

  10. Intraoperative Contrast Enhanced Ultrasound Evaluates the Grade of Glioma

    PubMed Central

    Cheng, Ling-Gang; He, Wen; Zhang, Hong-Xia; Song, Qian; Ning, Bin; Li, Hui-Zhan; He, Yan; Lin, Song

    2016-01-01

    Objective. The aim of our study was to investigate the value of intraoperative contrast enhanced ultrasound (CEUS) for evaluating the grade of glioma and the correlation between microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods. We performed intraoperative conventional ultrasound (CUS) and CEUS on 88 patients with gliomas. All of the patients have undergone surgery and obtained the results of pathology. All patients have undergone intraoperative CUS and CEUS to compare the characteristics of different grade gliomas and the results of CUS and CEUS were compared with pathological results. Results. The time to start (TTS) and time to peak (TTP) of low grade glioma (LGG) were similar to those of edema and normal brain surrounding glioma. The enhanced extent of LGG was higher than that of the normal brain and edema. The TTS and TTP of high grade glioma were earlier than those of the edema and normal brain surrounding glioma. The enhancement of HGG was higher than that of LGG. The absolute peak intensity (API) was correlated with MVD and VEGF. Conclusion. Intraoperative CEUS could help in determining boundary of peritumoral brain edema of glioma. Intraoperative CEUS parameters in cerebral gliomas could indirectly reflect the information of MVD and VEGF. PMID:27069921

  11. Indocyanine green for intraoperative localization of ureter.

    PubMed

    Siddighi, Sam; Yune, Junchan Joshua; Hardesty, Jeffrey

    2014-10-01

    Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG

  12. 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

  13. Intraoperative fluorescent imaging of intracranial tumors: a review.

    PubMed

    Behbahaninia, Milad; Martirosyan, Nikolay L; Georges, Joseph; Udovich, Joshua A; Kalani, M Yashar S; Feuerstein, Burt G; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

    2013-05-01

    A review of fluorescent imaging for intracranial neoplasms is presented. Complete resection of brain cancer is seldom possible because of the goal to preserve brain tissue and the inability to visualize individual infiltrative tumor cells. Verification of histology and identification of tumor invasion in macroscopically normal-appearing brain tissue determine prognosis after resection of malignant gliomas. Therefore, imaging modalities aim to facilitate intraoperative decision-making. Intraoperative fluorescent imaging techniques have the potential to enable precise histopathologic diagnosis and to detect tumor remnants in the operative field. Macroscopic fluorescence imaging is effective for gross tumor detection. Microscopic imaging techniques enhance the sensitivity of the macroscopic observations and provide real-time histological information. Further development of clinical grade fluorescent agents specifically targeting tumor cells could improve the diagnostic and prognostic yield of intraoperative imaging. PMID:23523009

  14. Robust endoscopic pose estimation for intraoperative organ-mosaicking

    NASA Astrophysics Data System (ADS)

    Reichard, Daniel; Bodenstedt, Sebastian; Suwelack, Stefan; Wagner, Martin; Kenngott, Hannes; Müller-Stich, Beat Peter; Dillmann, Rüdiger; Speidel, Stefanie

    2016-03-01

    The number of minimally invasive procedures is growing every year. These procedures are highly complex and very demanding for the surgeons. It is therefore important to provide intraoperative assistance to alleviate these difficulties. For most computer-assistance systems, like visualizing target structures with augmented reality, a registration step is required to map preoperative data (e.g. CT images) to the ongoing intraoperative scene. Without additional hardware, the (stereo-) endoscope is the prime intraoperative data source and with it, stereo reconstruction methods can be used to obtain 3D models from target structures. To link reconstructed parts from different frames (mosaicking), the endoscope movement has to be known. In this paper, we present a camera tracking method that uses dense depth and feature registration which are combined with a Kalman Filter scheme. It provides a robust position estimation that shows promising results in ex vivo and in silico experiments.

  15. Navigation, robotics, and intraoperative imaging in spinal surgery.

    PubMed

    Ringel, Florian; Villard, Jimmy; Ryang, Yu-Mi; Meyer, Bernhard

    2014-01-01

    Spinal navigation is a technique gaining increasing popularity. Different approaches as CT-based or intraoperative imaging-based navigation are available, requiring different methods of patient registration, bearing certain advantages and disadvantages. So far, a large number of studies assessed the accuracy of pedicle screw implantation in the cervical, thoracic, and lumbar spine, elucidating the advantages of image guidance. However, a clear proof of patient benefit is missing, so far. Spinal navigation is closely related to intraoperative 3D imaging providing an imaging dataset for navigational use and the opportunity for immediate intraoperative assessment of final screw position giving the option of immediate screw revision if necessary. Thus, postoperative imaging and a potential revision surgery for screw correction become dispensable.Different concept of spinal robotics as the DaVinci system and SpineAssist are under investigation. PMID:24309918

  16. [Intraoperative monitoring of oxygen tissue pressure: Applications in vascular neurosurgery].

    PubMed

    Arikan, Fuat; Vilalta, Jordi; Torne, Ramon; Chocron, Ivette; Rodriguez-Tesouro, Ana; Sahuquillo, Juan

    2014-01-01

    Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction. PMID:24934513

  17. 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,…

  18. Intraoperative Ultrasound-Fluoroscopy Fusion can Enhance Prostate Brachytherapy Quality

    SciTech Connect

    Orio, Peter F.; Tutar, Ismail B.; Narayanan, Sreeram; Arthurs, Sandra; Cho, Paul S.; Kim, Yongmin; Merrick, Gregory; Wallner, Kent E.

    2007-09-01

    Purpose: To evaluate a transrectal ultrasound (TRUS)-fluoroscopy fusion-based intraoperative dosimetry system. Method and Materials: Twenty-five patients were treated for prostate cancer with Pd-103 implantation. After the execution of the treatment plan, two sets of TRUS images were collected using the longitudinal and axial transducers of a biplanar probe. Then, three fluoroscopic images were acquired at 0, -15 and +15{sup o}. The three-dimensional locations of all implanted seeds were reconstructed from fluoroscopic images. A subset of the implanted seeds was manually identified in TRUS images and used as fiducial markers to perform TRUS-fluoroscopy fusion. To improve the implant quality, additional seeds were placed if adverse isodose patterns were identified during visual inspection. If additional seeds were placed, intraoperative dosimetry was repeated. Day 0 computed tomography-based dosimetry was compared with final intraoperative dosimetry to validate dosimetry achieved in the implant suite. Results: An average of additional 4.0 seeds was implanted in 16 patients after initial intraoperative dose evaluation. Based on TRUS-fluoroscopy fusion-based dosimetry, the V100 improved from 86% to 93% (p = 0.005), whereas D90 increased from 94% to 109% (p = 0.011) with the guided additional seed implantation. No statistical difference was observed in V200 and V300 values. V100 and D90 values were 95 {+-} 4% and 120 {+-} 24%, respectively, based on the final intraoperative dosimetry evaluation, compared with 95 {+-} 4% and 122 {+-} 24%, respectively, based on Day 0 computed tomography-based dosimetry. Conclusions: Implantation of extra seeds based on TRUS-fluoroscopy fusion-based intraoperative dosimetry can improve the final V100 and D90 values with minimal increase in V200 and V300 values.

  19. Comparative study of dacryocystorhinostomy with and without intraoperative application of Mitomycin C

    PubMed Central

    Qadir, Maniah; Ahangar, Andleeb; Dar, Mohamed Ahsan; Hamid, Sumaya; Keng, Manzoor Qadir

    2013-01-01

    Aims and objectives To compare the outcome of dacryocystorhinostomy surgery with and without the intraoperative use of Mitomycin C. Methods Our study is a prospective comparative case study in which 50 patients of primary acquired nasolacrimal duct obstruction were divided on the basis of random sampling into the conventional dacryocystorhinostomy group and the Mitomycin C group in which Mitomycin C 0.2 mg/ml was used intraoperatively. Patients were followed on 1st postoperative day, 1st, 3rd, 6th weeks, 3rd and 6th months. Patient symptoms and satisfaction were noted. Patency of lacrimal passage was assessed by lacrimal syringing and tear meniscus height was recorded on each follow-up. Results At the end of 6 months of follow-up, 96% of patients were asymptomatic in the Mitomycin C group whereas 80% patients in the conventional group were asymptomatic. On lacrimal syringing 24 (96%) eyes had patent passage in the Mitomycin C group where as only 1 (4%) patient had complete block with regurgitation of mucopurulent fluid. In the conventional group 20 (80%) eyes had patent passage, 4 (16%) eyes had complete block with regurgitation of mucopurulent fluid and 1 (4%) eye had partially patent passage on lacrimal syringing. Out of 25 eyes, 24 had normal tear meniscus height, and 1 had high tear meniscus height in the Mitomycin C group in comparison to the conventional group in which out of 25 eyes 20 eyes had normal, 1 had moderate and 4 eyes had high tear meniscus height. Intraoperative and postoperative complications in both the groups were identical. Conclusion Although the difference between the two groups was not statistically significant, a distinctly higher success was achieved in patients undergoing dacryocystorhinostomy with intra operative Mitomycin C as compared to conventional dacryocystorhinostomy. PMID:24526858

  20. 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

  1. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    PubMed

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury. PMID:26008880

  2. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    PubMed Central

    Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  3. Intraoperative Fluorescence Imaging and Multimodal Surgical Navigation Using Goggle System.

    PubMed

    Mela, Christopher A; Papay, Francis A; Liu, Yang

    2016-01-01

    Intraoperative imaging is an invaluable tool in many surgical procedures. We have developed a wearable stereoscopic imaging and display system entitled Integrated Imaging Goggle, which can provide real-time multimodal image guidance. With the Integrated Imaging Goggle, wide field-of-view fluorescence imaging is tracked and registered with intraoperative ultrasound imaging and preoperative tomography-based surgical navigation, to provide integrated multimodal imaging capabilities in real-time. Herein we describe the system instrumentation and the methods of using the Integrated Imaging Goggle to guide surgeries. PMID:27283420

  4. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation.

    PubMed

    Kim, Terrence T; Johnson, J Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  5. 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

  6. -induced continental warming

    NASA Astrophysics Data System (ADS)

    Kamae, Youichi; Watanabe, Masahiro; Kimoto, Masahide; Shiogama, Hideo

    2014-11-01

    In this the second of a two-part study, we examine the physical mechanisms responsible for the increasing contrast of the land-sea surface air temperature (SAT) in summertime over the Far East, as observed in recent decades and revealed in future climate projections obtained from a series of transient warming and sensitivity experiments conducted under the umbrella of the Coupled Model Intercomparison Project phase 5. On a global perspective, a strengthening of land-sea SAT contrast in the transient warming simulations of coupled atmosphere-ocean general circulation models is attributed to an increase in sea surface temperature (SST). However, in boreal summer, the strengthened contrast over the Far East is reproduced only by increasing atmospheric CO2 concentration. In response to SST increase alone, the tropospheric warming over the interior of the mid- to high-latitude continents including Eurasia are weaker than those over the surrounding oceans, leading to a weakening of the land-sea SAT contrast over the Far East. Thus, the increasing contrast and associated change in atmospheric circulation over East Asia is explained by CO2-induced continental warming. The degree of strengthening of the land-sea SAT contrast varies in different transient warming scenarios, but is reproduced through a combination of the CO2-induced positive and SST-induced negative contributions to the land-sea contrast. These results imply that changes of climate patterns over the land-ocean boundary regions are sensitive to future scenarios of CO2 concentration pathways including extreme cases.

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

    PubMed

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

    2007-11-01

    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

  8. Teaching Global Warming

    NASA Astrophysics Data System (ADS)

    Hobson, Art

    2004-05-01

    Every citizen's education should include socially relevant science courses because, as the American Association for the Advancement of Science puts it, "Without a scientifically literate population, the outlook for a better world is not promising." I have developed a conceptual liberal-arts physics course that covers the major principles of classical physics, emphasizes modern/contemporary physics, and includes societal topics such as global warming, ozone depletion, transportation, exponential growth, scientific methodology, risk assessment, nuclear weapons, nuclear power, and the energy future. The societal topics, occupying only about 15% of the class time, appear to be the main cause of the surprising popularity of this course among non-scientists. I will outline some ideas for incorporating global warming into such a course or into any other introductory physics course. For further details, see my textbook Physics: Concepts and Connections (Prentice Hall, 3rd edition 2003).

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

    NASA Astrophysics Data System (ADS)

    Röhl, S.; Bodenstedt, S.; Küderle, C.; Suwelack, S.; Kenngott, H.; Müller-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.

  10. Integration of 3D intraoperative ultrasound for enhanced neuronavigation

    NASA Astrophysics Data System (ADS)

    Paulsen, Keith D.; Ji, Songbai; Hartov, Alex; Fan, Xiaoyao; Roberts, David W.

    2012-03-01

    True three-dimensional (3D) volumetric ultrasound (US) acquisitions stand to benefit intraoperative neuronavigation on multiple fronts. While traditional two-dimensional (2D) US and its tracked, hand-swept version have been recognized for many years to advantage significantly image-guided neurosurgery, especially when coregistered with preoperative MR scans, its unregulated and incomplete sampling of the surgical volume of interest have limited certain intraoperative uses of the information that are overcome through direct volume acquisition (i.e., through 2D scan-head transducer arrays). In this paper, we illustrate several of these advantages, including image-based intraoperative registration (and reregistration) and automated, volumetric displacement mapping for intraoperative image updating. These applications of 3D US are enabled by algorithmic advances in US image calibration, and volume rasterization and interpolation for multi-acquisition synthesis that will also be highlighted. We expect to demonstrate that coregistered 3D US is well worth incorporating into the standard neurosurgical navigational environment relative to traditional tracked, hand-swept 2D US.

  11. 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.

  12. Laser Doppler imaging for intraoperative human brain mapping.

    PubMed

    Raabe, A; Van De Ville, D; Leutenegger, M; Szelényi, A; Hattingen, E; Gerlach, R; Seifert, V; Hauger, C; Lopez, A; Leitgeb, R; Unser, M; Martin-Williams, E J; Lasser, T

    2009-02-15

    The identification and accurate location of centers of brain activity are vital both in neuro-surgery and brain research. This study aimed to provide a non-invasive, non-contact, accurate, rapid and user-friendly means of producing functional images intraoperatively. To this end a full field Laser Doppler imager was developed and integrated within the surgical microscope and perfusion images of the cortical surface were acquired during awake surgery whilst the patient performed a predetermined task. The regions of brain activity showed a clear signal (10-20% with respect to the baseline) related to the stimulation protocol which lead to intraoperative functional brain maps of strong statistical significance and which correlate well with the preoperative fMRI and intraoperative cortical electro-stimulation. These initial results achieved with a prototype device and wavelet based regressor analysis (the hemodynamic response function being derived from MRI applications) demonstrate the feasibility of LDI as an appropriate technique for intraoperative functional brain imaging. PMID:19049824

  13. PERENNIAL WARM-SEASON GRASSES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Warm-season grasses and can be used to augment the forage supply for grazing livestock operations in the northeastern U.S. Much of what is known about warm season grass production and management in the northeastern US was obtained from a soil conservation or wildlife habitat perspective. Warm-seas...

  14. 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

  15. 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 (38°C), patients in combined warming group received pre-warmed Ringer serum (38°C) 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

  16. 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

  17. Intraoperative tissue expansion in the surgical correction of craniosynostosis

    PubMed Central

    Doshier, Laura J; Fowler, Daniel; McEwan, Thomas; Baker, C Lynette; Muzaffar, Arshad R

    2015-01-01

    BACKGROUND: Wound healing complications can occur after calvarial vault expansion due to tension on the scalp flaps. OBJECTIVES: To compare wound healing outcomes in patients with craniosynostosis undergoing calvarial vault expansion with and without intraoperative tissue expansion of the scalp. METHODS: The present analysis was an institutional review board-approved, retrospective cohort study involving 40 consecutive patients at the University of Missouri Hospitals and Clinics (Columbia, Missouri, USA) who underwent calvarial vault expansion for nonsyndromic craniosynostosis between June 1, 2009 and June 30, 2012. Patients were divided into two sequential cohorts: the first 20 underwent calvarial vault expansion without intraoperative tissue expansion; the second 20 underwent calvarial vault expansion with intraoperative tissue expansion. The main outcome measures included presence or absence of wound healing complications (persistent scabbing or slow-healing wounds, hardware exposure, need for operative wound revision or healed but widened scars), with documented postoperative follow-up of at least three months. The primary end point was the presence of a well-healed scar; the secondary end point was the need for an operative revision. RESULTS: Patients in the intraoperative tissue expansion group had a higher percentage of well-healed scars (73.6%) than those in the nonexpansion group (42.1%) (P=0.0487). This difference was primarily due to scar widening in the nonexpansion group. CONCLUSIONS: The present study demonstrated that the use of intraoperative tissue expansion in patients with nonsyndromic craniosynostosis who underwent calvarial vault expansion resulted in a greater likelihood of a well-healed incision with a lower rate of poor scarring. PMID:25821768

  18. 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

  19. 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

  20. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia

    PubMed Central

    Lee, Kyu Chang; Lee, Myeong Jong; Kim, Mi-Na; Kim, Ji-Sub; Lee, Won Sang; Lee, Jung Hwa

    2014-01-01

    Background In the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress. Methods Forty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed. Results Core temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group. Conclusions The circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering. PMID:24910726

  1. 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.

  2. 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.

  3. FLATs: Warming Up

    NASA Astrophysics Data System (ADS)

    Calzetti, Daniela

    1997-07-01

    The purpose of this proposal is to monitor the flat fields during the interval between the end of science observations and the exhaustion of cryogen and subsequent warming of the dewar to > 100K. These flats will provide a monitor for particulate comtamination {GROT} and detector lateral position {from the coronagraphic spot and FDA vignetting}. They will provide some measure of relative {flat field} and absolute QE variation as a function of temperature. When stars are visible they might provide a limited degree of focus determination.

  4. FLATs: Warming Up - continuation

    NASA Astrophysics Data System (ADS)

    Calzetti, Daniela

    1997-07-01

    The purpose of this proposal is to monitor the flat fields during the interval between the end of science observations and the exhaustion of cryogen and subsequent warming of the dewar to > 100K. These flats will provide a monitor for particulate comtamination {GROT} and detector lateral position {from the coronagraphic spot and FDA vignetting}. They will provide some measure of relative {flat field} and absolute QE variation as a function of temperature. When stars are visible they might provide a limited degree of focus determination.

  5. 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.

  6. Warm Inflation Model Building

    NASA Astrophysics Data System (ADS)

    Bastero-Gil, Mar; Berera, Arjun

    We review the main aspects of the warm inflation scenario, focusing on the inflationary dynamics and the predictions related to the primordial spectrum of perturbations, to be compared with the recent cosmological observations. We study in detail three different classes of inflationary models, chaotic, hybrid models and hilltop models, and discuss their embedding into supersymmetric models and the consequences for model building of the warm inflationary dynamics based on first principles calculations. Due to the extra friction term introduced in the inflaton background evolution generated by the dissipative dynamics, inflation can take place generically for smaller values of the field, and larger values of couplings and masses. When the dissipative dynamics dominates over the expansion, in the so-called strong dissipative regime, inflation proceeds with sub-Planckian inflaton values. Models can be naturally embedded into a supergravity framework, with SUGRA corrections suppressed by the Planck mass now under control, for a larger class of Kähler potentials. In particular, this provides a simpler solution to the "eta" problem in supersymmetric hybrid inflation, without restricting the Kähler potentials compatible with inflation. For chaotic models dissipation leads to a smaller prediction for the tensor-to-scalar ratio and a less tilted spectrum when compared to the cold inflation scenario. We find in particular that a small component of dissipation renders the quartic model now consistent with the current CMB data.

  7. Intraoperative fluorescence vascular angiography: during tibial bypass.

    PubMed

    Perry, Diana; Bharara, Manish; Armstrong, David G; Mills, Joseph

    2012-01-01

    Preventing amputations in persons with lower extremity complications of diabetes is a complex endeavor, particularly in those with concomitant ischemia and tissue loss. Fluorescence angiography (Novadaq SPY system) may provide a tool for objective evaluations of tissue viability in the diabetic foot, which is an important indicator of the ability of the diabetic ulcer to heal adequately. The SPY system uses a low-power laser coupled with a charge-coupled device camera and indocyanine green (ICG) to sequence perfusion at the surface of the skin. We present an illustrated example of the potential utility of ICG fluorescence angiography (ICGFA) before and after vascular intervention in a high-risk limb. ICGFA appeared to reveal demarcation between viable and nonviable tissue and real-time perfusion, specifically capillary fill. ICGFA clarified the extent of necessary debridement and provided an immediate indication of improvement in regional perfusion status following revascularization. Future studies involving ICGFA may include pre- and postdebridement and closure perfusion, comparison of tissue perfusion pre- and post-endovascular therapy, and lower extremity flap viability. Future works will also address the consistency of results with ICGFA by analyzing a larger cohort of patients being treated by our unit. PMID:22401340

  8. [Intraoperative ultrasound diagnosis in the removal of intraocular foreign bodies].

    PubMed

    Andreev, A A; Gundarova, R A; Kodzov, M B

    2008-01-01

    The paper provides a rationale and indications for diascleral removal of foreign bodies from the anterior chamber of the eyeball, by intraoperatively using ultrasound study. The clinical material presents 148 cases of diascleral removal of foreign (49 magnetic and 49 amagnetic) bodes impacted into the tunics of the anterior eye without evident opacities of optical media and without signs of endophthalmitis. The paper provides a pathogenetic rationale for the method that is lowly traumatic and highly effective (foreign bodies being removed in 99.9% of cases) due to the high precision of location of a scleral cut in the projection of foreign body bedding owing to intraoperative sound usage. A model clinical case of fragment removal is also shown in the paper. The specific features of criteria for using the method are described, by taking into account the anatomic characteristics of orbital eyeball location. PMID:18756799

  9. Trajectory optimization for intra-operative nuclear tomographic imaging.

    PubMed

    Vogel, Jakob; Lasser, Tobias; Gardiazabal, José; Navab, Nassir

    2013-10-01

    Diagnostic nuclear imaging modalities like SPECT typically employ gantries to ensure a densely sampled geometry of detectors in order to keep the inverse problem of tomographic reconstruction as well-posed as possible. In an intra-operative setting with mobile freehand detectors the situation changes significantly, and having an optimal detector trajectory during acquisition becomes critical. In this paper we propose an incremental optimization method based on the numerical condition of the system matrix of the underlying iterative reconstruction method to calculate optimal detector positions during acquisition in real-time. The performance of this approach is evaluated using simulations. A first experiment on a phantom using a robot-controlled intra-operative SPECT-like setup demonstrates the feasibility of the approach. PMID:23706624

  10. Toward Intraoperative Image-Guided Transoral Robotic Surgery.

    PubMed

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

    2013-09-01

    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

  11. 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.

  12. 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

  13. 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

  14. 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

  15. Intraoperative findings in revision chronic otitis media surgery.

    PubMed

    Faramarzi, Abolhassan; Motasaddi-Zarandy, Masoud; Khorsandi, Mohammad-Taghi

    2008-03-01

    In this study, we reviewed the surgical findings in a series of revision tympanomastoidectomy to determine the most common causes of failure in chronic otitis media surgery. The intraoperative findings at revision mastoidectomy with tympanoplasty of 116 patients were analyzed. The most common sites of pathologic tissue at revision surgery (with cholesteatoma and/ or granulation tissue) were unexenterated cells of the sinodural angle. The most common mechanical cause of retention of debris in canal wall down procedures was facial ridge. PMID:18298298

  16. 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. PMID:26730318

  17. Intraoperative MRI in pediatric neurosurgery—an update

    PubMed Central

    2014-01-01

    Since the advent of intraoperative magnetic resonance imaging (ioMRI) at the Brigham and Women’s 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 it’s effectiveness in pediatric neurosurgery. While of considerable expense, current trends in healthcare essentially mandate the use of ioMRI in a growing number of cases. PMID:26835341

  18. Intraoperative diagnostics and elimination of residual microtumours with plasmonic nanobubbles

    NASA Astrophysics Data System (ADS)

    Lukianova-Hleb, Ekaterina Y.; Kim, Yoo-Shin; Belatsarkouski, Ihor; Gillenwater, Ann M.; O'Neill, Brian E.; Lapotko, Dmitri O.

    2016-06-01

    Failure of cancer surgery to intraoperatively detect and eliminate microscopic residual disease (MRD) causes lethal recurrence and metastases, and the removal of important normal tissues causes excessive morbidity. Here, we show that a plasmonic nanobubble (PNB), a non-stationary laser pulse-activated nanoevent, intraoperatively detects and eliminates MRD in the surgical bed. PNBs were generated in vivo in head and neck cancer cells by systemically targeting tumours with gold colloids and locally applying near-infrared, low-energy short laser pulses, and were simultaneously detected with an acoustic probe. In mouse models, between 3 and 30 residual cancer cells and MRD (undetectable with current methods) were non-invasively detected up to 4 mm deep in the surgical bed within 1 ms. In resectable MRD, PNB-guided surgery prevented local recurrence and delivered 100% tumour-free survival. In unresectable MRD, PNB nanosurgery improved survival twofold compared with standard surgery. Our results show that PNB-guided surgery and nanosurgery can rapidly and precisely detect and remove MRD in simple intraoperative procedures.

  19. A geometric analysis of mastectomy incisions: Optimizing intraoperative breast volume

    PubMed Central

    Chopp, David; Rawlani, Vinay; Ellis, Marco; Johnson, Sarah A; Buck, Donald W; Khan, Seema; Bethke, Kevin; Hansen, Nora; Kim, John YS

    2011-01-01

    INTRODUCTION: The advent of acellular dermis-based tissue expander breast reconstruction has placed an increased emphasis on optimizing intraoperative volume. Because skin preservation is a critical determinant of intraoperative volume expansion, a mathematical model was developed to capture the influence of incision dimension on subsequent tissue expander volumes. METHODS: A mathematical equation was developed to calculate breast volume via integration of a geometrically modelled breast cross-section. The equation calculates volume changes associated with excised skin during the mastectomy incision by reducing the arc length of the cross-section. The degree of volume loss is subsequently calculated based on excision dimensions ranging from 35 mm to 60 mm. RESULTS: A quadratic relationship between breast volume and the vertical dimension of the mastectomy incision exists, such that incrementally larger incisions lead to a disproportionally greater amount of volume loss. The vertical dimension of the mastectomy incision – more so than the horizontal dimension – is of critical importance to maintain breast volume. Moreover, the predicted volume loss is more profound in smaller breasts and primarily occurs in areas that affect breast projection on ptosis. CONCLUSIONS: The present study is the first to model the relationship between the vertical dimensions of the mastectomy incision and subsequent volume loss. These geometric principles will aid in optimizing intra-operative volume expansion during expander-based breast reconstruction. PMID:22654531

  20. Intraoperative brain tumor resection cavity characterization with conoscopic holography

    NASA Astrophysics Data System (ADS)

    Simpson, Amber L.; Burgner, Jessica; Chen, Ishita; Pheiffer, Thomas S.; Sun, Kay; Thompson, Reid C.; Webster, Robert J., III; Miga, Michael I.

    2012-02-01

    Brain shift compromises the accuracy of neurosurgical image-guided interventions if not corrected by either intraoperative imaging or computational modeling. The latter requires intraoperative sparse measurements for constraining and driving model-based compensation strategies. Conoscopic holography, an interferometric technique that measures the distance of a laser light illuminated surface point from a fixed laser source, was recently proposed for non-contact surface data acquisition in image-guided surgery and is used here for validation of our modeling strategies. In this contribution, we use this inexpensive, hand-held conoscopic holography device for intraoperative validation of our computational modeling approach to correcting for brain shift. Laser range scan, instrument swabbing, and conoscopic holography data sets were collected from two patients undergoing brain tumor resection therapy at Vanderbilt University Medical Center. The results of our study indicate that conoscopic holography is a promising method for surface acquisition since it requires no contact with delicate tissues and can characterize the extents of structures within confined spaces. We demonstrate that for two clinical cases, the acquired conoprobe points align with our model-updated images better than the uncorrected images lending further evidence that computational modeling approaches improve the accuracy of image-guided surgical interventions in the presence of soft tissue deformations.

  1. 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.

  2. Intraoperative diagnostics and elimination of residual microtumours with plasmonic nanobubbles.

    PubMed

    Lukianova-Hleb, Ekaterina Y; Kim, Yoo-Shin; Belatsarkouski, Ihor; Gillenwater, Ann M; O'Neill, Brian E; Lapotko, Dmitri O

    2016-06-01

    Failure of cancer surgery to intraoperatively detect and eliminate microscopic residual disease (MRD) causes lethal recurrence and metastases, and the removal of important normal tissues causes excessive morbidity. Here, we show that a plasmonic nanobubble (PNB), a non-stationary laser pulse-activated nanoevent, intraoperatively detects and eliminates MRD in the surgical bed. PNBs were generated in vivo in head and neck cancer cells by systemically targeting tumours with gold colloids and locally applying near-infrared, low-energy short laser pulses, and were simultaneously detected with an acoustic probe. In mouse models, between 3 and 30 residual cancer cells and MRD (undetectable with current methods) were non-invasively detected up to 4 mm deep in the surgical bed within 1 ms. In resectable MRD, PNB-guided surgery prevented local recurrence and delivered 100% tumour-free survival. In unresectable MRD, PNB nanosurgery improved survival twofold compared with standard surgery. Our results show that PNB-guided surgery and nanosurgery can rapidly and precisely detect and remove MRD in simple intraoperative procedures. PMID:26878142

  3. Intraoperative nerve monitoring during total shoulder arthroplasty surgery

    PubMed Central

    Aresti, Nick; Plumb, Karen; Cowan, Joseph; Higgs, Deborah; Lambert, Simon; Falworth, Mark

    2014-01-01

    Background Nerve injury is an acknowledged complication of total shoulder arthroplasty (TSA). Although the incidence of postoperative neurological deficit has been reported to be between 1% and 16%, the true incidence of nerve damage is considered to be higher. The present study aimed to identify the rate of intraoperative nerve injury during total shoulder arthroplasty and to determine potential risk factors. Methods A prospective study of nerve conduction in 21 patients who underwent primary or revision TSA was carried out over a 12-month period. Nerve conduction was monitored by measuring intraoperative sensory evoked potentials (SEP). A significant neurophysiological signal change was defined as either a unilateral or bilateral decrease in SEP signal of ≥50%, a latency increase of ≥10% or a change in waveform morphology, not caused by operative or anaesthetic technique. Results Seven (33%) patients had a SEP signal change. The only significant risk factor identified for signal change was male sex (odds ratio 15.00, 95% confidence interval). The median nerve was the most affected nerve in the operated arm. All but one signal change returned to normal before completion of the operation and no patient had a persisting postoperative clinical neurological deficit. Conclusions The incidence of intraoperative nerve damage may be more common than previously reported. However, the loss of SEP signal is reversible and does not correlate with persisting clinical neurological deficits. The median nerve appears to be most at risk. Monitoring SEPs in the operated limb during TSA may be a valuable tool during TSA.

  4. [Intraoperative navigation, with focus on the skull base].

    PubMed

    Wirtz, C R

    2016-09-01

    Intraoperative navigation systems are widely used in ENT, oral and maxillofacial, and neurosurgery. The benefits of such systems have been demonstrated in various applications, including intracranial and skull base surgery. Intraoperative shift, "brain shift" and changes in anatomy caused by the surgical procedure itself impair the accuracy of navigation and represent factors limiting its application, particularly in glioma and metastatic brain surgery. For this reason, intraoperative imaging was incorporated into neurosurgery. A specific application of navigation is thus skull base surgery, where shifts are often negligible due to the bony structures in which pathologies are embedded. Development of new systems with seamless integration into the operative workflow propagated routine use of navigation in neuro- and ENT surgery. Navigation proved especially helpful in interdisciplinary surgery with pathologies located in anatomic regions where competences of different surgical disciplines overlap, as in the skull base. While this increased radicality in tumour resection, there was a high risk of morbidity. The integration of electrophysiological function monitoring served to preserve function and reduce morbidity, and has led to less invasive and radical strategies in skull base surgery. New radiosurgical methods to adjuvantly treat possible tumour remnants have also supported this development. Systems allowing resection borders to be marked in the navigational coordinates would enable direct linking of these data to radiotherapy planning and better interpretation of follow-up imaging. Navigation is thus a valuable tool supporting interdisciplinary cooperation in skull base surgery for the benefit of patients. PMID:27566369

  5. The role of intraoperative scrape cytology in vertebroplasty

    PubMed Central

    Inuganti, Renuka Venkata; Mettu, Rami Reddy; Surath, Harsha Vardhan; Surath, Amarnath

    2016-01-01

    Aims: To assess the adequacy of intraoperative scrape cytology during percutaneous vertebroplasty by correlating results with corresponding histopathology. Settings and Design: Vertebroplasty is a procedure increasingly used to treat painful vertebral compression fractures. The history and presentation of osteoporotic fractures are straightforward, but difficulty arises in differentiating infective from neoplastic lesions, especially in cases where the magnetic resonance imaging is equivocal. The procedure involves injection of polymethyl methacrylate (bone cement) into the pathological vertebral body and gives dramatic pain relief. It is indicated in osteoporotic and neoplastic lesions but contraindicated in infections. Hence, intraoperative evaluation of a specimen is essential to aid in the decision of performing vertebroplasty. Subjects and Methods: A total of 128 patients with vertebral lesions underwent core biopsy and scrape cytology from June 2006 to June 2015. Based on the findings of cytological examination, malignant lesions were subjected to vertebroplasty. In lesions with infective etiology, vertebroplasty was abandoned and antibiotic or antituberculous therapy started. Results: The overall diagnostic accuracy of scrape cytology was excellent with 97.58% cases correlating with the final histopathological diagnosis. Specificity was 100%, positive predictive value was 100% and negative predictive value was 33.33%. Conclusion: Scrape cytology is a simple, rapid, accurate cytodiagnostic technique and should be routinely utilized in vertebral lesions for intraoperative consultation and decision making during vertebroplasty. PMID:27298628

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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 λρ{sub m}{sup α}ρ{sub e}{sup β} form, where ρ{sub m} and ρ{sub e} are the energy densities of the dark matter and dark energy, respectively. The parameters α and β 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 (λ,α,β) 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 ΛCDM model. We find also a large dispersion on the best estimated values of the (λ,α,β) 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.

  11. Policy implications of greenhouse warming

    NASA Astrophysics Data System (ADS)

    Coppock, Rob

    1992-03-01

    A study panel of the National Academy of Sciences, National Academy of Engineering, and Institute of Medicine recently issued the report Policy Implications of Greenhouse Warming. That report examined relevant scientific knowldeg and evidence about the potential of greenhouse warming, and assayed actions that could slow the onset of warming (mitigation policies) or help human and natural systems of plants and animals adapt to climatic changes (adaptation policies). The panel found that, even given the considerable uncertainties knowledge of the relevant phenomena, greenhouse warming poses a threat sufficient to merit prompt action. People in this country could probably adapt to the changes likely to accompany greenhouse warming. The costs, however, could be substantial. Investment in mitigation acts as insurance protection against the great uncertainties and the possibility of dramatic surprises. The panel found mitigation options that could reduce U.S. emissions by an estimated 10 to 40 percent at modest cost.

  12. Validation of a novel robotic telepathology platform for neuropathology intraoperative touch preparations

    PubMed Central

    Thrall, Michael J.; Rivera, Andreana L.; Takei, Hidehiro; Powell, Suzanne Z.

    2014-01-01

    Background: Robotic telepathology (RT) allows a remote pathologist to control and view a glass slide over the internet. This technology has been demonstrated to be effective on several platforms, but we present the first report on the validation of RT using the iScan Coreo Au whole slide imaging scanner. Methods: One intraoperative touch preparation slide from each of 100 cases were examined twice (200 total cases) using glass slides and RT, with a 3 week washout period between viewings, on two different scanners at two remote sites. This included 75 consecutive neuropathology cases and 25 consecutive general surgical pathology cases. Interpretations were compared using intraobserver variability. Results: Of the 200 total cases, one failed on RT. There were 47 total interpretive variances. Most of these were the result of less specific interpretations or an inability to identify scant diagnostic material on RT. Nine interpretive variances had potentially significant clinical implications (4.5%). Using the final diagnosis as a basis for comparison to evaluate these nine cases, three RT interpretations and three glass slide interpretations were considered to be discrepant. In the other three cases, both modalities were discrepant. This distribution of discrepancies indicates that underlying case difficulty, not the RT technology, probably accounts for these major variances. For the subset of 68 neoplastic neuropathology cases, the unweighted kappa of agreement between glass slides and RT was 0.68 (good agreement). RT took 225 s on average versus only 71 s per glass slide. Conclusions: This validation demonstrates that RT using the iScan Coreo Au system is a reasonable method for supplying remote neuropathology expertise for the intraoperative interpretation of touch preparations, but is limited by the slowness of the robotics, crude focusing, and the challenge of determining where to examine the slide using small thumbnail images. PMID:25191620

  13. 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

  14. Warming up for Planck

    NASA Astrophysics Data System (ADS)

    Bartrum, Sam; Berera, Arjun; Rosa, João G.

    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|nt|, where nt 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.

  15. Warm dense crystallography

    NASA Astrophysics Data System (ADS)

    Valenza, Ryan A.; Seidler, Gerald T.

    2016-03-01

    The intense femtosecond-scale pulses from x-ray free electron lasers (XFELs) are able to create and interrogate interesting states of matter characterized by long-lived nonequilibrium semicore or core electron occupancies or by the heating of dense phases via the relaxation cascade initiated by the photoelectric effect. We address here the latter case of "warm dense matter" (WDM) and investigate the observable consequences of x-ray heating of the electronic degrees of freedom in crystalline systems. We report temperature-dependent density functional theory calculations for the x-ray diffraction from crystalline LiF, graphite, diamond, and Be. We find testable, strong signatures of condensed-phase effects that emphasize the importance of wide-angle scattering to study nonequilibrium states. These results also suggest that the reorganization of the valence electron density at eV-scale temperatures presents a confounding factor to achieving atomic resolution in macromolecular serial femtosecond crystallography (SFX) studies at XFELs, as performed under the "diffract before destroy" paradigm.

  16. 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.

  17. Warming up for Planck

    SciTech Connect

    Bartrum, Sam; Berera, Arjun; Rosa, João 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.

  18. Intraoperative heart rate reduction--alinidine versus metoprolol.

    PubMed

    Gombotz, H; Metzler, H; Winkler, G; Rehak, P

    1988-11-01

    In a double-blind randomized protocol the effectiveness of the specific bradycardic agent alinidine (0.6 mg.kg-1 i.v.) was compared to that of the betablocker metoprolol (0.035 mg.kg-1 i.v.). Twenty-four coronary artery disease patients undergoing a bypass procedure with an intraoperative heart rate increase of more than 20% were included. Patients with a concomitant intraoperative mean arterial pressure increase of more than 30% or with an intraoperative wedge pressure higher than 15 mmHg (2.0 kPa) were excluded. After application of alinidine and metoprolol, heart rate decreased significantly (P less than 0.01) in the alinidine group from 88 +/- 19 beats per min to 72 +/- 13 and in the metoprolol group from 82 +/- 16 to 72 +/- 12. Baseline values were not obtained. Compared to the hemodynamic changes in the metoprolol group, the alterations of pulmonary capillary wedge pressure (PCWP) (P less than 0.05), stroke volume index (SVI) (P less than 0.05), left ventricular stroke work index (LVSWI) (P less than 0.01) and right ventricular stroke work index (RVSWI) (P less than 0.05) in the alinidine group were statistically significantly different. PCWP remained unchanged after alinidine and increased in the metoprolol group (1.4 +/- 0.4 to 1.6 +/- 0.4 kPa). In the alinidine group LVSWI (43.1 +/- 15 to 49.2 +/- 18 g-m.m-2), RVSWI (5.1 +/- 4 to 6.6 +/- 3 g-m.m-2) and SVI (37.2 +/- 12.2 to 42.5 +/- 12.8 ml.m-2) increased.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3063047

  19. 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…

  20. Delayed flowering and global warming

    NASA Astrophysics Data System (ADS)

    Cook, B. I.; Wolkovich, E. M.; Parmesan, C.

    2011-12-01

    Within general trends toward earlier spring, observed cases of species and ecosystems that have not advanced their phenology, or have even delayed it, appear paradoxical, especially when made in temperate regions experiencing significant warming. The typical interpretation of this pattern has been that non-responders are insensitive to relatively small levels of warming over the past 40 years, while species showing delays are often viewed as statistical noise or evidence for unknown confounding factors at play. However, plant physiology studies suggest that when winter chilling (vernalization) is required to initiate spring development, winter warming may retard spring events, masking expected advances caused by spring warming. Here, we analyzed long-term data on phenology and seasonal temperatures from 490 species on two continents and demonstrate that 1) apparent non-responders are indeed responding to warming, but their responses to winter and spring warming are opposite in sign, 2) observed trends in first flowering date depend strongly on the magnitude of a given species' response to autumn/winter versus spring warming, and 3) inclusion of these effects strongly improves hindcast predictions of long-term flowering trends. With a few notable exceptions, climate change research has focused on the overall mean trend towards phenological advance, minimizing discussion of apparently non-responding species. Our results illuminate an under-studied source of complexity in wild species responses and support the need for models incorporating diverse environmental cues in order to improve predictability of species responses to anthropogenic climate change.

  1. 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 0.12°C 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

  2. Dermographism: A Rare Cause of Intraoperative Hypotension and Urticaria.

    PubMed

    Burbridge, Mark

    2016-07-15

    A 54-year-old man with dermographism presented for spine surgery, and shortly after induction of anesthesia, he experienced severe hypotension and urticaria, resulting in cancellation of the case on suspicion of allergic reaction. For subsequent ventral hernia repair, a perioperative management strategy was devised, which resulted in an uneventful perioperative course. This case report is the first to demonstrate severe intraoperative hypotension and urticaria from dermographism. We discuss the strategy that made the subsequent surgery a success and provide guidance for practitioners who face a patient with a severe form of this chronic disease. PMID:27434310

  3. 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.

  4. 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. PMID:26973803

  5. [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

  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 Score—based on intraoperative blood loss, heart rate, and blood pressure—that 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 7–8) were equivalent to preoperative predictions (likelihood ratio (LR) 1.05, 95%CI 0.78–1.41), significantly decreased for those who achieved the best scores of 9–10 (LR 0.52, 95%CI 0.35–0.78), and were significantly poorer for those with low scores—LRs 1.60 (1.12–2.28) for scores 5–6, and 2.80 (1.50–5.21) for scores 0–4. Conclusions Even after accounting for fixed preoperative risk—due to patients’ acute condition, comorbidities and/or operative complexity—the 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. Intraoperative radiation therapy-induced sarcomas in dogs.

    PubMed

    Hoekstra, H J; Sindelar, W F; Kinsella, T J; Mehta, D M

    1989-12-01

    In a canine model the tolerance of normal and surgically manipulated tissue to intraoperative radiotherapy (IORT) was investigated to provide guidelines for the clinical use of IORT in human cancer patients. A dose of 20 Gy IORT, with or without external beam radiotherapy, was generally well tolerated without significant increased treatment morbidity. Higher doses of IORT (over 30 Gy) have produced radiation-induced sarcomas in some animals followed over a long period. Therefore IORT should be used only in human cancer patients in well controlled studies, in which complications are well documented, and the possibility of radiation-induced malignancies in long-term survival should be considered. PMID:2594971

  8. Intraoperative Neurophysiologic Monitoring: Basic Principles and Recent Update

    PubMed Central

    Kim, Sung-Min; Kim, Seung Hyun; Seo, Dae-Won

    2013-01-01

    The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperative neurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditory evoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated. In this review, we also discuss the optimal stimulation/recording method for each of these modalities during individual surgeries as well as the diverse criteria for alarm signs. PMID:24015028

  9. A case of refractory intraoperative hypotension treated with vasopressin infusion.

    PubMed

    Wheeler, Adam D; Turchiano, John; Tobias, Joseph D

    2008-03-01

    A 56-year-old man, treated with an angiotensin II receptor antagonist for hypertension, presented for placement of a cochlear implant during general anesthesia. Intraoperatively, there was profound hypotension that was resistant to decreasing the anesthetic depth, fluid administration, as well as bolus doses of phenylephrine, ephedrine, and epinephrine. Hypotension was eventually successfully treated with a vasopressin infusion (0.06 U/min). Vasopressin may be a useful agent in such scenarios because its effect is not dependent on either adrenergic or angiotensin receptors, both of which may be affected by angiotensin II receptor antagonists. PMID:18410871

  10. Minimally invasive radioguided parathyroidectomy using intraoperative sestamibi localization.

    PubMed

    Lee, Wha-Joon; Ruda, James; Stack, Brendan C

    2004-08-01

    This article presents the authors' technique of minimally invasive radio guided parathyroidectomy (MIRP) with intra-operative use of the hand-held gamma probe for primary HPT caused by a solitary adenoma. It points out how this approach varies from that of others who perform MIRP. It also illustrates ways to troubleshoot common problems with the technique in inexperienced hands. The goal is to present an understandable and systematic approach to MIRP for surgeons who do not currently use this technique. This article is not intended to replace formalized training, which is essential to master the technique. PMID:15262516

  11. 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

  12. 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

  13. Modeling permafrost thaw and ecosystem carbon cycle under annual and seasonal warming at an Arctic tundra site in Alaska

    NASA Astrophysics Data System (ADS)

    Li, Jianwei; Luo, Yiqi; Natali, Susan; Schuur, Edward A. G.; Xia, Jianyang; Kowalczyk, Eva; Wang, Yingping

    2014-06-01

    Permafrost thaw and its impacts on ecosystem carbon (C) dynamics are critical for predicting global climate change. It remains unclear whether annual and seasonal warming (winter or summer) affect permafrost thaw and ecosystem C balance differently. It is also required to compare the short-term stepwise warming and long-term gradual warming effects. This study validated a land surface model, the Community Atmosphere Biosphere Land Exchange model, at an Alaskan tundra site, and then used it to simulate permafrost thaw and ecosystem C flux under annual warming, winter warming, and summer warming. The simulations were conducted under stepwise air warming (2°C yr-1) during 2007-2011, and gradual air warming (0.04°C yr-1) during 2007-2056. We hypothesized that all warming treatments induced greater permafrost thaw, and larger ecosystem respiration than plant growth thus shifting the ecosystem C sink to C source. Results only partially supported our hypothesis. Climate warming further enhanced C sink under stepwise (6-15%) and gradual (1-8%) warming scenarios as followed by annual warming, winter warming, and summer warming. This is attributed to disproportionally low temperature increase in soil (0.1°C) in comparison to air warming (2°C). In a separate simulation, a greater soil warming (1.5°C under winter warming) led to a net ecosystem C source (i.e., 18 g C m-2 yr-1). This suggests that warming tundra can potentially provide positive feedbacks to global climate change. As a key variable, soil temperature and its dynamics, especially during wintertime, need to be carefully studied under global warming using both modeling and experimental approaches.

  14. 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 μm). These preliminary results suggest that EIT is possible in a probe designed to fit within a 12-mm laparoscopic access port. PMID:24951675

  15. Intra-operative nuclear medicine in surgical practice.

    PubMed

    Perkins, A C; Hardy, J G

    1996-12-01

    The use of radionuclides for the intra-operative localization of tumours has increased steadily over the past 15 years. We reviewed more than 15 years experience of a peripatetic service using a sterilizable probe system in operating theatres throughout the UK for localizing bone and soft tissue lesions. The technique requires the positive concentration of an appropriate radiopharmaceutical, together with a suitably designed detector system which can be sterilized for use during surgery. All surgical procedures were undertaken following initial positive imaging studies. A well-collimated nuclear probe with a 5 mm diameter CdTe detector was sterilized with ethylene oxide gas and coupled to a digital counter and ratemeter for use in the operating theatre. A total of 68 surgical procedures have been undertaken at 35 hospitals. Fifty-eight patients underwent excision of osteoid osteoma subsequently proven by histology. The other lesions successfully resected included osteoblastoma, hamartoma, Brodie's abscess, chronic bone infection, ectopic parathyroid adenoma and metastatic neuroblastoma. The technique can now be regarded as the method of choice for the surgical localization of osteoid osteoma. The successful detection of lesions at surgery can be assured providing that clear localization of the radiopharmaceutical occurs on the pre-operative images. The intra-operative use of conventional and new tumour-specific radiopharmaceuticals is reviewed and we confirm an increasing role for the surgical-probe-guided localization of primary and metastatic tumours. PMID:9004295

  16. Simulated microsurgery monitoring using intraoperative multimodal surgical microscopy

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

    We have developed an intraoperative multimodal surgical microscopy system that provides simultaneous real-time enlarged surface views and subsurface anatomic information during surgeries by integrating spectral domain optical coherence tomography (SD-OCT), optical-resolution photoacoustic microscopy (OR-PAM), and conventional surgical microscopy. By sharing the same optical path, both OCT and PAM images were simultaneously acquired. Additionally, the custom-made needle-type transducer received the generated PA signals enabling convenient surgical operation without using a water bath. Using a simple augmented device, the OCT and PAM images were projected on the view plane of the surgical microscope. To quantify the performance of our system, we measured spatial resolutions of our system. Then, three microsurgery simulation and analysis were processed: (1) ex vivo needle tracking and monitoring injection of carbon particles in biological tissues, (2) in vivo needle tracking and monitoring injection of carbon particles in tumor-bearing mice, and (3) in vivo guiding of melanoma removal in melanoma-bearing mice. The results indicate that this triple modal system is useful for intraoperative purposes, and can potentially be a vital tool in microsurgeries.

  17. Stereoscopic Integrated Imaging Goggles for Multimodal Intraoperative Image Guidance.

    PubMed

    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, PMID:26529249

  18. Risk factors for intraoperative floppy iris syndrome: a prospective study.

    PubMed

    Chatziralli, I P; Peponis, V; Parikakis, E; Maniatea, A; Patsea, E; Mitropoulos, P

    2016-08-01

    PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis. PMID:27367744

  19. 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

  20. Intraoperative Indocyanine Green Laser Angiography in Pediatric Autologous Ear Reconstruction.

    PubMed

    Martins, Deborah B; Farias-Eisner, Gina; Mandelbaum, Rachel S; Hoang, Han; Bradley, James P; Lee, Justine C

    2016-05-01

    Skin flap vascularity is a critical determinant of aesthetic results in autologous ear reconstruction. In this study, we investigate the use of intraoperative laser-assisted indocyanine green angiography (ICGA) as an adjunctive measure of skin flap vascularity in pediatric autologous ear reconstruction. Twenty-one consecutive pediatric patients undergoing first-stage autologous total ear reconstruction were retrospectively evaluated. The first 10 patients were treated traditionally (non-ICGA), and the latter 11 patients were evaluated with ICGA intraoperatively after implantation of the cartilage construct and administration of suction. Relative and absolute perfusion units in the form of contour maps were generated. Statistical analyses were performed using independent sample Student t test. Statistically significant differences in exposure and infection were not found between the 2 groups. However, decreased numbers of surgical revisions were required in cases with ICGA versus without ICGA (P = 0.03), suggesting that greater certainty in skin flap perfusion correlated with a reduction in revision surgeries. In cases of exposure, we found an average lowest absolute perfusion unit of 14.3, whereas cases without exposure had an average of 26.1 (P = 0.02), thereby defining objective parameters for utilizing ICGA data in tailoring surgical decision making for this special population of patients. Defined quantitative parameters for utilizing ICGA in evaluating skin flap vascularity may be a useful adjunctive technique in pediatric autologous ear reconstruction. PMID:27579233

  1. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas.

    PubMed

    Oh, Taemin; Nagasawa, Daniel T; Fong, Brendan M; Trang, Andy; Gopen, Quinton; Parsa, Andrew T; Yang, Isaac

    2012-09-01

    Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection. PMID:22937857

  2. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub.

    PubMed

    Garibaldi, R A

    1988-04-01

    In a prospective, controlled, clinical trial, we found that preoperative showering and scrubbing with 4% chlorhexidine gluconate was more effective than povidone-iodine or triclocarban medicated soap in reducing skin colonization at the site of surgical incision. Mean log colony counts of the incision site were one half to one log lower for patients who showered with chlorhexidine compared to those who showered with the other regimens. No growth was observed on 43% of the post shower skin cultures from patients in the chlorhexidine group compared with 16% of the cultures from patients who had povidone-iodine showers and 5% of those from patients who used medicated soap and water. The frequency of positive intraoperative wound cultures was 4% with chlorhexidine, 9% with povidone-iodine and 14% with medicated soap and water. This study demonstrates that chlorhexidine gluconate is a more effective skin disinfectant than either povidone-iodine or triclocarban soap and water and that its use is associated with lower rates of intraoperative wound contamination. PMID:2898503

  3. Trends in electrocardiographic R-wave amplitude during intraoperative pneumothorax.

    PubMed

    Tomiyama, Yoshinobu; Higashijima, Sachiyo; Kadota, Takako; Kume, Katsuyoshi; Kawahara, Tomiya; Ohshita, Naohiro

    2014-01-01

    Tension pneumothorax is a rare but potentially life-threating complication of laparoscopic fundoplication. Electrocardiogram (ECG) changes may be used in the diagnosis of intraoperative tension pneumothorax. This case study examines a pediatric patient who underwent laparoscopic fundoplication. Sudden decreases in oxygen saturation were observed during dissection, although the patient's decrease in blood pressure was less marked. Manual ventilation with high inspiratory pressure and inspiratory pause improved oxygenation. The amplitude of the R-wave decreased from 0.8 mV to 0.3 mV in 5 seconds. Twenty minutes later, oxygen saturation decreased again, the R-wave amplitude decreased from 0.3 mV to 0.1 mV in 1 second, and the decrease in blood pressure was marked. Manual ventilation with high inspiratory pressure improved oxygenation, blood pressure, and R-wave amplitude within two minutes. After conversion to open surgery, the cardiorespiratory condition gradually improved, but the R-wave amplitude did not fully recover, even at the end of surgery. Right-side pneumothorax was subsequently confirmed by postoperative chest X-ray. Chest drains were inserted after surgery. This case suggests that trends in R-wave amplitude are potential indicators of intraoperative tension pneumothorax. PMID:25264070

  4. 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

  5. Intraoperative Indocyanine Green Laser Angiography in Pediatric Autologous Ear Reconstruction

    PubMed Central

    Martins, Deborah B.; Farias-Eisner, Gina; Mandelbaum, Rachel S.; Hoang, Han; Bradley, James P.

    2016-01-01

    Summary: Skin flap vascularity is a critical determinant of aesthetic results in autologous ear reconstruction. In this study, we investigate the use of intraoperative laser-assisted indocyanine green angiography (ICGA) as an adjunctive measure of skin flap vascularity in pediatric autologous ear reconstruction. Twenty-one consecutive pediatric patients undergoing first-stage autologous total ear reconstruction were retrospectively evaluated. The first 10 patients were treated traditionally (non-ICGA), and the latter 11 patients were evaluated with ICGA intraoperatively after implantation of the cartilage construct and administration of suction. Relative and absolute perfusion units in the form of contour maps were generated. Statistical analyses were performed using independent sample Student t test. Statistically significant differences in exposure and infection were not found between the 2 groups. However, decreased numbers of surgical revisions were required in cases with ICGA versus without ICGA (P = 0.03), suggesting that greater certainty in skin flap perfusion correlated with a reduction in revision surgeries. In cases of exposure, we found an average lowest absolute perfusion unit of 14.3, whereas cases without exposure had an average of 26.1 (P = 0.02), thereby defining objective parameters for utilizing ICGA data in tailoring surgical decision making for this special population of patients. Defined quantitative parameters for utilizing ICGA in evaluating skin flap vascularity may be a useful adjunctive technique in pediatric autologous ear reconstruction. PMID:27579233

  6. Weird Warm Spot on Exoplanet

    NASA Video Gallery

    This animation illustrates an unexpected warm spot on the surface of a gaseous exoplanet. NASA's Spitzer Space Telescope discovered that the hottest part of the planet, shown here as bright, orange...

  7. 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

  8. Use of Intraoperative Computed Tomography for Revisional Procedures in Patients with Complex Maxillofacial Trauma

    PubMed Central

    Singh, Mansher; Ricci, Joseph A.

    2015-01-01

    Background: In patients with panfacial fractures and distorted anatomic landmarks of zygomatic and orbital complex, there is a risk of zygomaticomaxillary complex (ZMC) malpositioning even with the best efforts for surgical repair. This results in increased number of additional procedures to achieve accurate positioning. Methods: We describe the usage of intraoperative C-arm cone-beam computed tomographic (CT) scan for ZMC malpositioning in a representative patient with panfacial fractures. Results: We have successfully used intraoperative CT scan for ZMC malpositioning in 3 patients. The representative patient had ZMC malposition after the initial attempt of surgical repair without any intraoperative imaging. On using intraoperative CT scan during the next attempt, we were able to reposition the ZMC accurately. Conclusions: Intraoperative CT scan might improve the accuracy of ZMC positioning and decrease the chances of potential additional surgeries. In patients with distorted anatomical landmarks and panfacial fractures, it can be especially helpful toward correcting ZMC malposition. PMID:26301152

  9. 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

  10. 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.

  11. 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.

  12. Distinguishing warming-induced drought from drought-induced warming

    NASA Astrophysics Data System (ADS)

    Roderick, M. L.; Yin, D.

    2015-12-01

    It is usually observed that temperatures, especially maximum temperatures are higher during drought. A very widely held public perception is that the increase in temperature is a cause of drought. This represents the warming-induced drought scenario. However, the agricultural and hydrologic scientific communities have a very different interpretation with drought being the cause of increasing temperature. In essence, those communities assume the warming is a surface feedback and their interpretation is for drought-induced warming. This is a classic cause-effect problem that has resisted definitive explanation due to the lack of radiative observations at suitable spatial and temporal scales. In this presentation we first summarise the observations and then use theory to untangle the cause-effect relationships that underlie the competing interpretations. We then show how satellite data (CERES, NASA) can be used to disentangle the cause-effect relations.

  13. 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

  14. 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…

  15. Warm Up to a Good Sound

    ERIC Educational Resources Information Center

    Tovey, David C.

    1977-01-01

    Most choral directors in schools today have been exposed to a variety of warm-up procedures. Yet, many do not use the warm-up time effectively as possible. Considers the factors appropriate to a warm-up exercise and three basic warm-up categories. (Author/RK)

  16. Effects of comfort warming on preoperative patients.

    PubMed

    Wagner, Doreen; Byrne, Michelle; Kolcaba, Katharine

    2006-09-01

    THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety. PMID:17004666

  17. 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.

  18. Ion-ion dynamic structure factor of warm dense mixtures.

    PubMed

    Gill, N M; Heinonen, R A; Starrett, C E; Saumon, D

    2015-06-01

    The ion-ion dynamic structure factor of warm dense matter is determined using the recently developed pseudoatom molecular dynamics method [Starrett et al., Phys. Rev. E 91, 013104 (2015)]. The method uses density functional theory to determine ion-ion pair interaction potentials that have no free parameters. These potentials are used in classical molecular dynamics simulations. This constitutes a computationally efficient and realistic model of dense plasmas. Comparison with recently published simulations of the ion-ion dynamic structure factor and sound speed of warm dense aluminum finds good to reasonable agreement. Using this method, we make predictions of the ion-ion dynamical structure factor and sound speed of a warm dense mixture-equimolar carbon-hydrogen. This material is commonly used as an ablator in inertial confinement fusion capsules, and our results are amenable to direct experimental measurement. PMID:26172810

  19. Ion-ion dynamic structure factor of warm dense mixtures

    SciTech Connect

    Gill, N. M.; Heinonen, R. A.; Starrett, C. E.; Saumon, D.

    2015-06-25

    In this study, the ion-ion dynamic structure factor of warm dense matter is determined using the recently developed pseudoatom molecular dynamics method [Starrett et al., Phys. Rev. E 91, 013104 (2015)]. The method uses density functional theory to determine ion-ion pair interaction potentials that have no free parameters. These potentials are used in classical molecular dynamics simulations. This constitutes a computationally efficient and realistic model of dense plasmas. Comparison with recently published simulations of the ion-ion dynamic structure factor and sound speed of warm dense aluminum finds good to reasonable agreement. Using this method, we make predictions of the ion-ion dynamical structure factor and sound speed of a warm dense mixture—equimolar carbon-hydrogen. This material is commonly used as an ablator in inertial confinement fusion capsules, and our results are amenable to direct experimental measurement.

  20. Warm air sensation for assessment of block after spinal anaesthesia.

    PubMed

    Shah, J; Ayorinde, B T; Rowbotham, D J; Buggy, D J

    2000-03-01

    We have evaluated a new method of assessing dermatomal sensory levels after regional anaesthesia based on warm sensation. Sensory levels were assessed in 30 patients after spinal anaesthesia using a respiratory gas humidifier, adapted to deliver a constant flow of warm air at 40 +/- 0.2 degrees C. This was compared with the cold sensation from ethyl chloride spray. The frequency distribution of the dermatomal differences showed 96.6% of the comparisons were between +1 and -1 dermatomes. The median difference in dermatomal levels between the two methods of assessment was 0 (interquartile range 0-1) (P = 0.65). We conclude that the warm air method compares favourably with ethyl chloride spray and both can be used interchangeably. PMID:10793604

  1. Ion-ion dynamic structure factor of warm dense mixtures

    DOE PAGESBeta

    Gill, N. M.; Heinonen, R. A.; Starrett, C. E.; Saumon, D.

    2015-06-25

    In this study, the ion-ion dynamic structure factor of warm dense matter is determined using the recently developed pseudoatom molecular dynamics method [Starrett et al., Phys. Rev. E 91, 013104 (2015)]. The method uses density functional theory to determine ion-ion pair interaction potentials that have no free parameters. These potentials are used in classical molecular dynamics simulations. This constitutes a computationally efficient and realistic model of dense plasmas. Comparison with recently published simulations of the ion-ion dynamic structure factor and sound speed of warm dense aluminum finds good to reasonable agreement. Using this method, we make predictions of the ion-ionmore » dynamical structure factor and sound speed of a warm dense mixture—equimolar carbon-hydrogen. This material is commonly used as an ablator in inertial confinement fusion capsules, and our results are amenable to direct experimental measurement.« less

  2. 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.

  3. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    PubMed

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow. PMID:25962306

  4. 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

  5. Intraoperative Cranial Nerve Monitoring During Posterior Skull Base Surgery

    PubMed Central

    Kartush, Jack M.; LaRouere, Michael J.; Graham, Malcolm D.; Bouchard, Kenneth R.; Audet, Blaise V.

    1991-01-01

    Intraoperative monitoring of neurophysiologic function is rapidly evolving as an important adjunct during skull base surgery to reduce the incidence of neurologic deficit. Facial nerve monitoring is an excellent model, since electrical and mechanical evoked potentials can be directly presented to the surgeon in real-time through an acoustic loudspeaker display. The lower cranial nerves may also be monitored using similar electromyographic techniques. Auditory system monitoring is more difficult due to the low amplitude response that requires averaging and filtering to extract the evoked potential. In conjunction with auditory monitoring, improved hearing preservation may be further enhanced by concomitant facial nerve monitoring, since the surgeon is alerted to traumatic manipulations that may affect both facial and cochlear nerves. Techniques and interpretative issues are presented to maximize the efficacy and safety of cranial nerve monitoring. ImagesFigure 1Figure 2Figure 3Figure 5 PMID:17170827

  6. 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.

  7. Is current clinical practice modified about intraoperative breast irradiation?

    PubMed

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-04-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences. PMID:27199511

  8. Is current clinical practice modified about intraoperative breast irradiation?

    PubMed Central

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-01-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences. PMID:27199511

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

    PubMed

    Escallon, A; 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. PMID:3888131

  10. 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 (12–26) 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

  11. 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 1 year 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 5 days. Results The mean age of patients was 41 years (range, 4–61 years). 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

  12. 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

  13. 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

  14. 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

  15. [The role of intraoperative flowmetry in surgery of cerebral aneurysms].

    PubMed

    Shekhtman, O D; Éliava, Sh Sh; Shakhnovich, V A; Pilipenko, Iu V

    2011-01-01

    Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping. PMID:22066255

  16. Intraoperative Radiation Exposure During Revision Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Iceman, Kelli; Elliott, Andrew D

    2016-01-01

    Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure. PMID:27320191

  17. 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.

  18. 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

  19. 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.

  20. [Passive nighttime warming (PNW) system, its design and warming effect].

    PubMed

    Chen, Jin; Yang, Fei; Zhang, Bin; Tian, Yun-lu; Dong, Wen-jun; Zhang, Wei-jian

    2010-09-01

    Based on the technique of passive nighttime warming (PNW), a convenient and energy-saving PNW facility was designed for a rice-wheat cropping system in Danyang, Jiangsu Province. The facility could guarantee 15.75 m2 effective sampling area, with a homogeneous amplitude of increased temperature, and making the nighttime canopy temperature during whole rice growth season increased averagely by 1.1 degrees C and the nighttime canopy temperature and 5 cm soil temperature during whole winter wheat growth period increased averagely by 1.3 degrees C and 0.8 degrees C, respectively. During the operation period of the facility, the variation trends of the canopy temperature and 5 cm soil temperature during the whole growth periods of rice and winter wheat in the warming plots were similar to those of the control. Though the facility slightly decreased the soil moisture content during winter wheat growth period, wheat growth was less impacted. The application of this facility in our main production areas of rice and winter wheat showed that the facility could advance the initial blossoming stages of rice and winter wheat averagely by 3 d and 5 d, respectively. In despite of the discrepancy in the warming effect among different regions and seasons, this energy-saving facility was reliable for the field research on crop responses to climate warming, when the homogeneity of increased temperature, the effective area, and the effects on crop growth period were taken into comprehensive consideration. PMID:21265150

  1. 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.

  2. 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.

  3. 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

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

    PubMed

    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

  5. Role of preoperative localization and intraoperative localization maneuvers including intraoperative PTH assay determination for patients with persistent or recurrent hyperparathyroidism.

    PubMed

    Alexander, H Richard; Chen, Clara C; Shawker, Thomas; Choyke, Peter; Chan, Teresa J; Chang, Richard; Marx, Stephen J

    2002-11-01

    Patients with recurrent or persistent primary hyperparathyroidism have increased operative risk because of scarring in the operative field and the frequent presence of an ectopic gland. Preoperative imaging studies will identify the hyperfunctioning parathyroid gland in the majority of circumstances. The best types or combination of imaging tests has not been definitely established. However, because of their wide availability and demonstrated sensitivity, US and sestamibi scans are most commonly obtained. Based on the clinical setting, additional tests including CT or MRI may be useful. In circumstances when the noninvasive imaging modalities are inconclusive, invasive imaging tests including selective angiography venous sampling and/or direct fine needle aspiration should be used. IOUS, MIRP, and intraoperative PTH determination are useful adjuncts to the safe and successful conduct of reoperative parathyroid surgery: however, the benefit of the routine use of these modalities in reoperative parathyroid surgery has yet to be critically determined. PMID:12412790

  6. 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.

  7. The effect of specific versus combined warm-up strategies on the voice.

    PubMed

    McHenry, Monica; Johnson, Jim; Foshea, Brianne

    2009-09-01

    Although actors and singers typically warm-up the voice before performing, little is known about the effects of vocal warm-up on the voice. This study was designed to determine the relative effectiveness of specific versus combined warm-up strategies on the voice by group comparison. Twenty participants, 10 male and 10 female actors, completed two warm-up protocols, at least 1 week apart, in a counter-balanced order. Measures of phonation threshold pressure (PTP), jitter, noise-to-harmonics-ratio (NHR), and self-perceived vocal effort were obtained. For the males, there was no significant difference in PTP difference values between vocal warm-up only (specific) and vocal plus aerobic warm-up (combined) conditions. For the females, however, a significant difference was found, with a greater reduction in PTP in the combined warm-up condition. A significant difference was also found in male jitter percent values, with significantly lower values in the specific condition than in the combined condition. There were no significant differences in the remaining comparisons. Females appeared to respond more to the vocal warm-up when it had an aerobic exercise component. It is possible that the males' greater level of physical fitness impacted this finding. PMID:18411037

  8. 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.

  9. 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.

  10. 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

  11. Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report.

    PubMed

    Iturri Clavero, F; Tamayo Medel, G; de Orte Sancho, K; González Uriarte, A; Iglesias Martínez, A; Martínez Ruíz, A

    2015-12-01

    Changes in BIS (bispectral index) VISTA bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described. PMID:25944463

  12. 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; Mariën, 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

  13. A method of intraoperative right ventricular assistance following the Fontan procedure for tricuspid atresia

    PubMed Central

    Livesay, James J.; Cooley, Denton A.; Norman, John C.

    1980-01-01

    A method of temporary intraoperative right ventricular assistance following the Fontan procedure is described in this case report. The multiple etiologic factors and avenues of treatment for postoperative right ventricular failure are discussed. PMID:15216242

  14. Relationship of Intraoperative Transit Time Flowmetry Findings to Angiographic Graft Patency at Follow-Up.

    PubMed

    Amin, Sanaz; Pinho-Gomes, Ana-Catarina; Taggart, David P

    2016-05-01

    Early and late graft occlusion remains a significant complication of coronary artery bypass grafting. Transit time flowmetry is the most commonly used imaging technique to assess graft patency intraoperatively. Although the value of transit time flowmetry for intraoperative quality control of coronary anastomosis is well established, its standard variables for predicting eventual graft failure remain controversial. This review readdresses the issue of intraoperative transit time flowmetry, with a particular emphasis on defining cutoff values for standard variables and correlating them with the ability to predict midterm and long-term graft patency for arterial and venous conduits. Further research is warranted to support clinically useful recommendations on the intraoperative application and interpretation of transit time flowmetry. PMID:26876343

  15. Prospective trial of intraoperative mitomycin C in the treatment of primary pterygium.

    PubMed Central

    Cano-Parra, J; Diaz-Llopis, M; Maldonado, M J; Vila, E; Menezo, J L

    1995-01-01

    AIMS--A prospective, randomised, double blind, placebo controlled study of intraoperative mitomycin C as adjunctive treatment of primary pterygium was conducted. METHODS--A total of 66 eyes of 54 patients with primary pterygium were treated with excision, with or without a single intraoperative application of mitomycin C (0.1 mg/ml for 5 minutes) to evaluate the efficacy and toxicity of this adjunctive treatment. The mean follow up was 14.1 months (range 12-23 months). RESULTS--Of the 36 eyes that underwent simple excision, 14 (38.8%) exhibited recurrences whereas only one of 30 eyes (3.33%) treated with excision and intraoperative application of mitomycin C had recurrence (p = 0.0006). Neither serious ocular complications nor systemic toxicity were noted in the mitomycin C treated group. CONCLUSION--Intraoperative mitomycin C appears to be an effective and safe adjunctive treatment of primary pterygium. PMID:7612555

  16. 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.

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

    PubMed Central

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

    2016-01-01

    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

  18. 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

  19. 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.

  20. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date

    PubMed Central

    Kirby, A M

    2015-01-01

    Following early results of recent studies of intraoperative radiotherapy (IORT) in the adjuvant treatment of patients with early breast cancer, the clinical utility of IORT is a subject of much recent debate within the breast oncology community. This review describes the intraoperative techniques available, the potential indications and the evidence to date pertaining to local control and toxicity. We also discuss any implications for current practice and future research. PMID:25734489

  1. Warming trends: Adapting to nonlinear change

    DOE PAGESBeta

    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.

  2. Arctic climate change: Greenhouse warming unleashed

    NASA Astrophysics Data System (ADS)

    Mauritsen, Thorsten

    2016-04-01

    Human activity alters the atmospheric composition, which leads to global warming. Model simulations suggest that reductions in emission of sulfur dioxide from Europe since the 1970s could have unveiled rapid Arctic greenhouse gas warming.

  3. Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.

    PubMed

    Handa, Takemi; Katare, Rajesh G; Sasaguri, Shiro; Sato, Takayuki

    2009-08-01

    We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. We routinely performed both transit-time flowmetry (TFM) and color images for intraoperative assessment, thallium-scintigraphy for the early postoperative assessment, and then angiography after 1-year surgery. We also obtained intraoperative graft flows and images in 116 grafts. Although TFM indicated a graft patency, the CCD camera suspected perfusion failures in four grafts. Also the analysis of the ICG fluorescence intensity showed the significant hypoperfusion at the perfusion territory distal to the anastomosis (graft vs. perfusion territory; 230+/-26 vs. 156+/-13 a.u, P=0.02). When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG). PMID:19423513

  4. 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.

  5. Novel Balloon Surface Scanning Device for Intraoperative Breast Endomicroscopy.

    PubMed

    Zuo, Siyang; Hughes, Michael; Yang, Guang-Zhong

    2016-07-01

    Recent advances in fluorescence confocal endomicroscopy have allowed real-time identification of residual tumour cells on the walls of the cavity left by breast conserving surgery. However, it is difficult to systematically survey the surgical site because of the small imaging field-of-view of these probes, compounded by tissue deformation and inconsistent probe-tissue contact when operated manually. Therefore, a new robotized scanning device is required for controlled, large area scanning and mosaicing. This paper presents a robotic scanning probe with an inflatable balloon, providing stable cavity scanning over undulating surfaces. It has a compact design, with an outer diameter of 4 mm and a working channel of 2.2 mm, suitable for a leached flexible fibre bundle endomicroscope probe. With the probe inserted, the tip positioning accuracy measured to be 0.26 mm for bending and 0.17 mm for rotational motions. Large area scanning was achieved (25-35 mm(2)) and the experimental results demonstrate the potential clinical value of the device for intraoperative cavity tumour margin evaluation. PMID:26508330

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

    PubMed Central

    Gunderson, L L; Martin, J K; Bèart, 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

  7. Intraoperative Squash Cytologic Features of Subependymal Giant Cell Astrocytoma.

    PubMed

    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

  8. 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

  9. Intraoperative Floppy Iris Syndrome: Pathophysiology, Prevention, and Treatment

    PubMed Central

    Flach, Allan J.

    2009-01-01

    Purpose: To extend upon previous reports, observations, and discussions of intraoperative floppy iris syndrome (IFIS) with the goal of providing new insight into the syndrome’s pathophysiology, prevention, and treatment. Methods: Following a review of IFIS and its relationship to autonomic pharmacology, evidence for anatomic changes following exposure of humans and other animals to autonomic drugs is described. The clinical implications for these findings are discussed as they relate to the treatment and prevention of this syndrome. Results: IFIS has been associated with the use of adrenergic antagonists even after they have been discontinued years prior to surgery. Some investigators believe that this persistence of IFIS reflects anatomic structural change. Evidence from laboratory experiments and human clinical studies using topically applied and systemic autonomic drugs supports the possibility of anatomic changes coexisting with IFIS observed during cataract surgery. Conclusions: IFIS is a relatively rare syndrome, often associated with the use of systemic α-blockers and conditions that influence dilator muscle tone. Laboratory and clinical evidence supports the possibility of anatomic changes following the use of autonomic drugs. The persistence of IFIS years after cessation of treatment with α-blockers suggests that the potential risks of discontinuing these drugs prior to cataract surgery outweigh potential benefits. PMID:20126500

  10. Intraoperative management of patients with heparin-induced thrombocytopenia.

    PubMed

    Kappa, J R; Fisher, C A; Todd, B; Stenach, N; Bell, P; Campbell, F; Ellison, N; Addonizio, V P

    1990-05-01

    For 11 patients with confirmed heparin-induced thrombocytopenia, we used reversible platelet inhibition with iloprost, a stable prostacyclin analogue, to permit safe heparin administration for cardiac (n = 9) or vascular (n = 2) operations. In vitro, iloprost (0.01 mumol/L) prevented both heparin-induced platelet aggregation and 14C-serotonin release in all patients. Therefore, intraoperatively, a continuous infusion of iloprost was started before administration of heparin and was continued until 15 minutes after administration of protamine. For cardiac patients, after heparin administration, the whole blood platelet count did not change (171,000 +/- 29,000/microL versus 174,000 +/- 29,000/microL, mean +/- standard error of the mean); no spontaneous platelet aggregation was observed, and plasma levels of the alpha-granule constituents platelet factor 4 and beta-thromboglobulin increased from 38 +/- 14 and 140 +/- 18 ng/mL to 591 +/- 135 and 235 +/- 48 ng/mL, respectively. Fibrinopeptide A levels actually decreased from 287 +/- 150 to 27 +/- 6 ng/mL. Furthermore, adenosine diphosphate-induced platelet activation was preserved, postoperative bleeding times were unchanged, and no heparin-related deaths occurred. Similar results were obtained in both vascular patients. We conclude that temporary platelet inhibition with iloprost now permits safe heparin administration in all patients with heparin-induced thrombocytopenia who require a cardiac or vascular operation. PMID:1692679

  11. Pedicle versus free flap reconstruction in patients receiving intraoperative brachytherapy.

    PubMed

    Geiger, Erik J; Basques, Bryce A; Chang, Christopher C; Son, Yung; Sasaki, Clarence T; McGregor, Andrew; Ariyan, Stephan; Narayan, Deepak

    2016-08-01

    Introduction This study compared complication rates between pedicle flaps and free flaps used for resurfacing of intraoperative brachytherapy (IOBT) implants placed following head and neck tumour extirpation to help clarify the ideal reconstructive procedure for this scenario. Patients and methods A retrospective review of reconstructions with IOBT at our institution was conducted. Patient and treatment details were recorded, as were the number and type of flap complications, including re-operations. Logistic regressions compared complications between flap groups. Results Fifty free flaps and 55 pedicle flaps were included. On multivariate analysis, free flap reconstruction with IOBT was significantly associated with both an increased risk of having any flap complication (OR = 2.9, p = 0.037) and with need for operative revision (OR = 3.5, p = 0.048) compared to pedicle flap reconstruction. Conclusions In the setting of IOBT, free flaps are associated with an increased risk of having complications and requiring operative revisions. PMID:26983038

  12. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma.

    PubMed

    Willett, C G; Suit, H D; Tepper, J E; Mankin, H J; Convery, K; Rosenberg, A L; Wood, W C

    1991-07-15

    From December 1981 to December 1989, 20 patients with primary or recurrent retroperitoneal sarcoma received 4000 to 5000 cGy of external beam radiation therapy (EBRT) in conjunction with surgical resection and intraoperative radiation therapy (IORT). Seventeen of 20 patients underwent complete (14 patients) or partial (3 patients) resection. Three patients had shown evidence of metastases after EBRT by the time of surgery. The 4-year actuarial local control and disease-free survival rates of the 17 patients undergoing resection were 81% and 64%, respectively. Twelve patients received IORT at the time of resection for microscopic disease (10 patients) or gross residual sarcoma (2 patients). Of the ten patients receiving IORT for microscopic tumor, one patient has died of local failure and peritoneal sarcomatosis and two patients have died of distant metastases only. The remaining seven patients are disease-free. One patient treated for gross residual sarcoma has experienced a local failure 1 year after IORT and is without disease 7 years after salvage chemotherapy. The other patient treated for gross residual sarcoma has died of local failure. Five patients did not receive IORT at the time of resection because of the extensive size of the tumor bed. Three of these patients are disease-free with one patient alive with lung metastases and one patient dying of hepatic metastases. Aggressive radiation and surgical procedures appear to provide satisfactory resectability and local control with acceptable tolerance. PMID:1906369

  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. 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.

  15. 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

  16. An orthopedic tissue adhesive for targeted delivery of intraoperative biologics.

    PubMed

    Simson, Jacob; Crist, Joshua; Strehin, Iossif; Lu, Qiaozhi; Elisseeff, Jennifer H

    2013-03-01

    Tissue adhesives can bind together damaged tissues and serve as tools to deliver and localize therapeutics to facilitate regeneration. One emerging therapeutic trend in orthopedics is the use of intraoperative biologics (IOB), such as bone marrow (BM) and platelet-rich plasma (PRP), to stimulate healing. Here, we introduce the application of the biomaterial chondroitin sulfate succinimidyl succinate (CS-NHS) to deliver IOB in a hydrogel adhesive. We demonstrate the biomaterial's ability to bind various tissue types and its cellular biocompatibility with encapsulated human mesenchymal stem cells (hMSCs). Further, we examine in detail the CS-NHS adhesive combined with BM aspirate for use in bone applications. hMSCs were encapsulated in CS-BM and cultured for 5 weeks in osteogenic medium. Quantitative RT-PCR demonstrated osteogenesis via upregulation of the osteogenic transcription factor Runx2 and bone markers alkaline phosphatase and osteocalcin. Significant deposition of calcium and osteocalcin was detected using biochemical, histological, and immunohistochemical techniques. Shear testing demonstrated that the CS-BM adhesive exhibited an adhesive strength approximately an order of magnitude stronger than fibrin glue and approaching that of a cyanoacrylate adhesive. These results indicate that CS-NHS is a promising delivery tool for IOB in orthopedic applications requiring a strong, degradable, and biocompatible adhesive that supports bone growth. PMID:23097279

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

    PubMed

    Oldhafer, F; Ringe, K I; Timrott, K; Kleine, M; Ramackers, W; Cammann, S; Jäger, 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

  18. The use of intraoperative grid pattern markings in lipoplasty.

    PubMed

    Chang, K Ning

    2004-10-01

    Intraoperative grid pattern markings have been used in the performance of liposuction. Grid pattern markings include series of longitudinal and transverse lines to delineate various anatomical boundaries and landmarks, including the midline, lateral line, and medial line. The markings are superimposed on the customary preoperative markings and divide broad or circumferential body surfaces into smaller subunits for liposuction. Grid pattern markings are applied to areas such as the anterior thighs, medial thighs, entire abdomen, flanks, back, arms, buttocks, calves, and ankles; they are not applied to smaller, less curved areas. Eighty-two consecutive patients underwent lipoplasty in 562 areas of the body. The revision rate for postliposuction contour irregularities was 4.0 percent (nine of 224 areas) where grid pattern markings were used; one area had an indentation type of contour irregularity and required autologous fat grafting. The revision rate was 1.5 percent (five of 328 areas) where grid pattern markings were not used; two areas in one patient had indentation-type contour irregularities and required autologous fat grafting. All remaining areas requiring revision had protuberant-type contour irregularities and responded to additional liposuction only. The use of grid pattern markings is associated with a low incidence of serious contour-related complications. PMID:15457052

  19. Revision stapedectomy: intraoperative findings, results, and review of the literature.

    PubMed

    Han, W W; Incesulu, A; McKenna, M J; Rauch, S D; Nadol, J B; Glynn, R J

    1997-09-01

    Seventy-four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology--Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air-bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss (large residual air-bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure-tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air-bone gaps. These results were compared with previously published data. PMID:9292601

  20. Contralateral ulnar neuropathy following total hip replacement and intraoperative positioning.

    PubMed

    O'Brien, S; Bennett, D; Spence, D J; Mawhinney, I; Beverland, D E

    2016-05-01

    Peripheral neuropathy is a rare but important complication of total hip arthroplasty (THA) and has previously been reported in the ipsilateral arm and associated with inflammatory arthritis. The results of 7004 primary hip arthroplasties performed between January 1993 and February 2009 were retrospectively reviewed to identify patients who reported ulnar neuropathy symptoms, with ten patients identified at mean follow-up of 57 months (range = 3-195 months). Eight patients experienced unilateral ulnar nerve symptoms in the contralateral upper limb post-surgery, one patient experienced symptoms in the ipsilateral upper limb and one patient experienced symptoms in both upper limbs. The incidence of post-THA ulnar neuropathy was 0.14%. All patients had a pre-operative diagnosis of osteoarthritis and none had diabetes, a previous history of neuropathy or inflammatory arthritis. All operations were primary arthroplasties and were performed under the care of a single surgeon in a single centre. Two of the ten patients (20%) had a general anaesthetic. The pattern of symptoms reported, i.e. mainly unilateral affecting the contralateral side with variable resolution, contrasts with previous studies and suggests that intraoperative patient positioning may be an important factor influencing ulnar neuropathy following THA. Attention to support and positioning of the contralateral arm may help reduce the incidence of this complication. PMID:26589446

  1. Response of canine esophagus to intraoperative electron beam radiotherapy

    SciTech Connect

    Sindelar, W.F.; Hoekstra, H.J.; Kinsella, T.J.; Barnes, M.; DeLuca, A.M.; Tochner, Z.; Pass, H.I.; Kranda, K.C.; Terrill, R.E.

    1988-09-01

    Tolerance of esophagus to intraoperative radiotherapy (IORT) was investigated in dogs. Thirteen adult foxhounds were subjected to right thoractomy, mobilization of the intrathoracic esophagus, and IORT to a 6 cm full-thickness esophageal segment using 9 MeV electrons at doses of 0, 2,000, or 3,000 cGy. Dogs were followed clinically and were evaluated at regular intervals after treatment with fiberoptic esophagoscopy, barium swallows, and postmortem histologic evaluations. One sham-irradiated control dog showed no abnormalities during follow-up of 24 months. Seven dogs receiving 2,000 cGy IORT showed transient mild dysphagia and mild esophagitis, but no clinically or pathologically significant complications. Five dogs receiving 3,000 cGy demonstrated severe ulcerative esophagitis within 6 weeks of treatment which progressed to chronic ulcerative esophagitis with stricture formation by 9 months following IORT. One 3,000 cGy dog died at 13 months from an esophageal perforation. On the basis of a pilot experience using 13 experimental animals, it was concluded that intact canine esophagus tolerates IORT well to doses of 2,000 cGy, but doses of 3,000 cGy pose serious and potentially lethal risks. The clinical application of IORT to the treatment of human intrathoracic neoplasms requiring esophageal irradiation should be approached with caution, particularly at doses exceeding 2,000 cGy.

  2. 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.; Jäger, 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

  3. Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

    PubMed Central

    Subedi, Asish

    2013-01-01

    As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.25% bupivacaine (30 mL) was administered 30 min prior to spinal block. Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively. PMID:23936683

  4. 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.

  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. Hematological Findings in Medical Professionals Involved at Intraoperative Fluoroscopy.

    PubMed

    Shafiee, Mohsen; Hoseinnezhad, Elham; Vafapour, Hassan; Borzoueisileh, Sajad; Ghorbani, Mohammad; Rashidfar, Razieh

    2016-01-01

    Medical professionals involved at intraoperative fluoroscopy are exposed to low doses of the occupational radiation exposures. The biological effects of chronic low-dose radiation on human health are complex and have not been well established. The aim of the present study is to follow up hematological parameter changes during 2 years in medical professionals exposed to ionization radiation in operating rooms.22 medical professionals (medical specialists and technicians), chronically exposed to ionizing radiation of mobile C-Arm X ray machine, were selected. The seven hematological parameters were examined each time. The statistical analyses were done by Student's t test and one way ONOVA test.The data analysis led to the following observations: (1) the present study incorporated that the basic hematological parameters including the mean value of red blood cells (P=0.90), white blood cells (P=0.68), and platelets count (P=0.45) did not show a significant difference between two years. (2) The mean values corpuscular hemoglobin concentration, corpuscular hemoglobin, and hematocrit parameters were found disturbed low or high in some of medical professionals but their means were not significantly different between two measurements. (3)A statistically significant relation in mean value of RBCs with the duration of exposure and sex were observed.It seems that, hematological parameters survey could not be a reliable test as the biological indicator of long term exposure to very low dose of radiation exposure in medical professionals which their physical dosimetry values are lower than dose limits. PMID:27357897

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

    PubMed

    Park, Chul Soo

    2015-06-14

    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

  8. 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

  9. Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.

    PubMed

    Chaudhry, Nauman S; Ambekar, Sudheer; Elhammady, Mohamed Samy; Riley, Jonathan P; Pradilla, Gustavo; Nogueira, Raul G; Ahmad, Faiz U

    2016-08-01

    Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography. PMID:27041076

  10. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

    PubMed

    Yang, Lin; Sun, De-Feng; Han, Jun; Liu, Ruochuan; Wang, Li-Jie; Zhang, Zhen-Zhen

    2016-01-01

    BACKGROUND Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. MATERIAL AND METHODS Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. RESULTS At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. CONCLUSIONS Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  11. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study

    PubMed Central

    Yang, Lin; Sun, De-feng; Han, Jun; Liu, Ruochuan; Wang, Li-jie; Zhang, Zhen-zhen

    2016-01-01

    Background Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. Material/Methods Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. Results At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. Conclusions Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

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

    PubMed

    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

  13. 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.

  14. 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

  15. Warm Debris Disks from WISE

    NASA Technical Reports Server (NTRS)

    Padgett, Deborah L.

    2011-01-01

    "The Wide Field Infrared Survey Explorer (WISE) has just completed a sensitive all-sky survey in photometric bands at 3.4, 4.6, 12, and 22 microns. We report on a preliminary investigation of main sequence Hipparcos and Tycho catalog stars with 22 micron emission in excess of photospheric levels. This warm excess emission traces material in the circumstellar region likely to host terrestrial planets and is preferentially found in young systems with ages < 1 Gyr. Nearly a hundred new warm debris disk candidates are detected among FGK stars and a similar number of A stars within 120 pc. We are in the process of obtaining spectra to determine spectral types and activity level of these stars and are using HST, Herschel and Keck to characterize the dust, multiplicity, and substellar companions of these systems. In this contribution, we will discuss source selection methods and individual examples from among the WISE debris disk candidates. "

  16. The Sudden Stratospheric Warming Atlas

    NASA Astrophysics Data System (ADS)

    Sjoberg, J. P.; Butler, A. H.; Seidel, D. J.

    2015-12-01

    Sudden stratospheric warmings (SSWs) are large and rapid temperature increases in the polar stratosphere associated with a complete reversal of the climatological westerly winds in wintertime. These extreme events can have substantial impacts on wintertime surface climate, such as cold air outbreaks over North America and Eurasia, or anomalous warming over Greenland. Here we promote our progress towards a new atlas of historical SSW events and their impacts on the surface. The SSW atlas contains a variety of metrics, time series, maps, and animations for individual SSW events. The atlas will allow users to examine the structure and development of individual SSWs, the variability between events, the surface impacts in temperature and precipitation, and the impacts of SSWs during years with certain tropospheric signatures, like El Niño or La Niña winters.

  17. Warm Climates in Earth History

    NASA Astrophysics Data System (ADS)

    Huber, Brian T.; MacLeod, Kenneth G.; Wing, Scott L.

    1999-12-01

    The study of greenhouse climates in the earth's past leads to a greater understanding of the factors that influence today's climate. In this fully integrated volume, leading experts in paleoclimatology present cutting edge paleontological, geological, and theoretical research to assess intervals of global warmth. Coverage examines warm climate intervals during the Paleozoic, Mesozoic and Cenozoic from the same perspectives: oceanic and terrestrial, theoretical and observational. This approach illuminates the differences and, more importantly, the commonalities of warm climate intervals. The book also provides a comprehensive overview of the advantages and limitations of different types of climate models that are currently used, and it discusses major factors that have caused global climatic change across geologic time scales. Central problems that remain unresolved are clearly identified. The book will be of great interest to researchers in paleoclimatology, and it will also be useful as a supplementary text in advanced undergraduate or graduate level courses in paleoclimatology and earth science.

  18. 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.

  19. MCCB warm adjustment testing concept

    NASA Astrophysics Data System (ADS)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  20. 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.

  1. 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.

  2. 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.

  3. Comparative effect of intraoperative propacetamol versus placebo on morphine consumption after elective reduction mammoplasty under remifentanil-based anesthesia: a randomized control trial [ISRCTN71723173].

    PubMed

    Binhas, Michèle; Decailliot, François; Rezaiguia-Delclaux, Saïda; Suen, Powen; Dumerat, Marc; François, Véronique; Combes, Xavier; Duvaldestin, Philippe

    2004-09-14

    BACKGROUND: Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. METHODS: We were interested in determining the postoperative effect of propacetamol administered intraoperatively after intraoperative remifentanil. Thirty-six adult women undergoing mammoplasty with remifentanil-based anesthesia were randomly assigned to receive propacetamol 2 g or placebo one hour before the end of surgery. After remifentanil interruption and tracheal extubation in recovery room, pain was assessed and intravenous titrated morphine was given. The primary end-point was the cumulative dose of morphine administered in the recovery room. The secondary end-points were the pain score after tracheal extubation and one hour after, the delay for obtaining a Simplified Numerical Pain Scale (SNPS) less than 4, and the incidence of morphine side effects in the recovery room.For intergroup comparisons, categorical variables were compared using the chi-squared test and continuous variables were compared using the Student t test or Mann-Whitney U test, as appropriate. A p value less than 0.05 was considered as significant. RESULTS: In recovery room, morphine consumption was lower in the propacetamol group than in the placebo group (p = 0.01). Pain scores were similar in both groups after tracheal extubation and lower in the propacetamol group (p = 0.003) one hour after tracheal

  4. Warm Dense Matter: An Overview

    SciTech Connect

    Kalantar, D H; Lee, R W; Molitoris, J D

    2004-04-21

    This document provides a summary of the ''LLNL Workshop on Extreme States of Materials: Warm Dense Matter to NIF'' which was held on 20, 21, and 22 February 2002 at the Wente Conference Center in Livermore, CA. The warm dense matter regime, the transitional phase space region between cold material and hot plasma, is presently poorly understood. The drive to understand the nature of matter in this regime is sparking scientific activity worldwide. In addition to pure scientific interest, finite temperature dense matter occurs in the regimes of interest to the SSMP (Stockpile Stewardship Materials Program). So that obtaining a better understanding of WDM is important to performing effective experiments at, e.g., NIF, a primary mission of LLNL. At this workshop we examined current experimental and theoretical work performed at, and in conjunction with, LLNL to focus future activities and define our role in this rapidly emerging research area. On the experimental front LLNL plays a leading role in three of the five relevant areas and has the opportunity to become a major player in the other two. Discussion at the workshop indicated that the path forward for the experimental efforts at LLNL were two fold: First, we are doing reasonable baseline work at SPLs, HE, and High Energy Lasers with more effort encouraged. Second, we need to plan effectively for the next evolution in large scale facilities, both laser (NIF) and Light/Beam sources (LCLS/TESLA and GSI) Theoretically, LLNL has major research advantages in areas as diverse as the thermochemical approach to warm dense matter equations of state to first principles molecular dynamics simulations. However, it was clear that there is much work to be done theoretically to understand warm dense matter. Further, there is a need for a close collaboration between the generation of verifiable experimental data that can provide benchmarks of both the experimental techniques and the theoretical capabilities. The conclusion of this

  5. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery.

    PubMed Central

    Charlson, M E; MacKenzie, C R; Gold, J P; Ales, K L; Topkins, M; Shires, G T

    1990-01-01

    We prospectively studied patients with hypertension and diabetes undergoing elective noncardiac surgery with general anesthesia to test the hypothesis that patients at high risk for prognostically significant intraoperative hemodynamic instability could be identified by their preoperative characteristics. Specifically we hypothesized that patients with a low functional capacity, decreased plasma volume, or significant cardiac comorbidity would be at high risk for intraoperative hypotension and those with a history of severe hypertension would be at risk for intraoperative hypertension. Patients who had a preoperative mean arterial pressure (MAP) greater than or equal to 110, a walking distance of less than 400 m, or a plasma volume less than 3000 cc were at increased risk of intraoperative hypotension (i.e., more than 1 hour of greater than or equal to 20 mmHg decreases in the MAP). Hypotension was also more common among patients having intra-abdominal or vascular surgery, and among those who had operations longer than 2 hours. Patients older than 70 years or with a decreased plasma volume were at increased risk of having more than 15 minutes of intraoperative elevations of greater than or equal to 20 mmHg over the preoperative MAP in combination with intraoperative hypotension; this was also more common when surgery lasted more than 2 hours. Patients who had intraoperative hypotension tended to have an immediate decrease in MAP at the onset of anesthesia and were often purposefully maintained at MAPs less than their usual level during surgery with fentanyl and neuromuscular blocking agents. Patients who had intraoperative hyper/hypotension tended to have repeated elevations in MAP above their preoperative levels during the course of surgery, and such elevations precipitated interventions with neuromuscular blocking agents and/or fentanyl. Neither pattern was more common among patients who developed net intraoperative negative fluid balances. Both hypotension and

  6. Warm Spray Forming of Ti-6Al-4V

    NASA Astrophysics Data System (ADS)

    Molak, R. M.; Araki, H.; Watanabe, M.; Katanoda, H.; Ohno, N.; Kuroda, S.

    2014-01-01

    Warm spray (WS) is a modification of high-velocity oxy-fuel spraying, in which the temperature of the supersonic gas flow generated by the combustion of kerosene and oxygen is controlled by diluting the combustion flame with an inert gas such as nitrogen. The inert gas is injected into the mixing chamber placed between the combustion chamber and the powder feed ports, thus the temperature of the propellant gas can be controlled from ~700 to 2,000 K. Since WS allows for higher particle temperatures in comparison to cold spray, warm sprayed particles are more softened upon impact, thus resulting in greater deformation facilitating the formation of shear instability for bonding. Recently, the combustion pressure of WS has been increased from 1 (low-pressure warm spray) to 4 MPa (high-pressure warm spray) in order to increase the velocity of sprayed particles. Effects of spray parameters on microstructure, mechanical properties, and splats formation of Ti-6Al-4V were systematically studied. Obtained coatings were examined by analyzing the coating cross-section images, microhardness as well as oxygen content. In addition, flattening ratio of splats was calculated as a function of nitrogen flow rate. It was found that the increased particle velocity caused by the increased combustion pressure had significant beneficial effects in terms of improving density and controlling the oxygen level in the sprayed Ti-6Al-4V coatings.

  7. 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

  8. 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.

  9. 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.

  10. Intraoperative monitoring of motor function by magnetic motor evoked potentials.

    PubMed

    Lee, W Y; Hou, W Y; Yang, L H; Lin, S M

    1995-03-01

    Under etomidate anesthesia, motor evoked potentials produced by magnetic stimulation were successfully recorded from 10 thenar muscles and 10 anterior tibial muscles of eight patients who had undergone surgery on the medulla oblongata and the cervical and thoracic spinal cords. Recordings taken before placing the neural tissue at risk were assessed for variability in amplitude and latency. The lower limit in amplitude was approximately one-third (25-43%) of the baseline. The latencies were more difficult to monitor than were the amplitudes. The latency variations were 2.56 +/- 0.50 milliseconds for the hand and 6.84 +/- 1.37 milliseconds for the leg. During surgery, the unilateral recordings of two patients were transiently lost but partially recovered after a pause in the operation. No obvious postoperative weaknesses in the corresponding limbs occurred. One patient, who showed a permanent loss of unilateral recording, had transient monoplegia with a complete recovery. None of the remaining five patients who had amplitudes larger than one-third of the baseline at the end of the operation had additional motor deficits. Our conclusions are that under etomidate anesthesia, the magnetic motor evoked potentials can be convenient and reliable monitors of motor function, that changes in the amplitude may be superior to those in the latency for intraoperative warning, that the criterion for potential neural damage under magnetic motor evoked potential monitoring might be an amplitude reduction of two-thirds of the control value, and that the magnetic stimulation seems to be more sensitive than the electrical stimulation in the monitoring of motor function and also allows more time and opportunities for the motor function to recover. PMID:7753349

  11. 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.

  12. Quantification of tumor fluorescence during intraoperative optical cancer imaging.

    PubMed

    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

  13. 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

  14. 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.

  15. Intraoperative monitoring of torsion to prevent vertical deviations during augmented vertical rectus transposition surgery

    PubMed Central

    Holmes, Jonathan M.; Hatt, Sarah R.; Leske, David A.

    2012-01-01

    Background Total transposition of the superior and inferior rectus muscle laterally, with augmentation sutures, may be complicated by induction of an undesirable vertical deviation. Induced vertical misalignment may be associated with changes in torsion. We have developed a simple method to monitor intraoperative torsion that may reduce the incidence of vertical deviations. Methods We reviewed consecutive cases of total abducens palsy or esotropic Duane syndrome treated with augmented lateral transposition of the superior and inferior rectus muscles, where the 12 o’clock and 6 o’clock intraoperative positions were initially marked with a dot at the limbus using a surgical pen. The location of the marks was monitored during tying of the augmentation sutures; changes in torsion were monitored intraoperatively. Results Records of 9 cases of augmented vertical rectus transposition were reviewed. Based on intraoperative assessment of torsion by observing the position of the preplaced limbal dots, the inferior rectus augmentation suture was tied less tightly than the superior rectus suture, leaving a gap of 1–3 mm between the inferior and lateral rectus muscles in 8 of 9 cases. The augmentation suture was totally removed in 1 case. Following these intraoperative adjustments, there was no induced intraoperative torsion, whereas further tightening of the inferior suture induced extorsion. Six weeks postoperatively, 8 of 9 patients did not experience a symptomatic vertical deviation. Conclusions When performing augmented transposition procedures, intraoperative monitoring of torsion may reduce the incidence of inadvertent vertical deviations and torsion. This technique may also be useful in other cases where correction or avoidance of torsion is needed. PMID:22525168

  16. The role of intraoperative ultrasound in establishing the surgical strategy regarding hepato-bilio-pancreatic pathology.

    PubMed

    Cirimbei, S; Puşcu, C; Lucenco, L; Brătucu, E

    2013-01-01

    Intraoperative ultrasound examination plays a more and more important role in open or laparoscopic abdominal surgery,satisfying the surgeon's need to correctly characterize lesions,bringing various benefits regarding topography and local regional extension, relations between neighbouring structures and, finally, disease staging. Intraoperative ultrasound is used especially in hepato-bilio-pancreatic tract interventions, given its diagnostic and therapeutic values. Between 2009-2012 in the IOB First Surgery Clinic 57 intraoperative echo graphies were performed, in patients with hepato-bilio-pancreatic pathologies, leading to intraoperative guided punctures with diagnostic or therapeutic purpose (in case of hepatic abscesses),detection of new hepatic metastases, their ablation under ultrasound guidance, exploration of the local-regional topography with the aim of an optimal hepatic resection. Intraoperative ultrasound allowed radioablation under echographic guidance in 43 patients, the majority presenting multiple hepatic metastases in different areas, this method also enabling control over complete lesional destruction. Also, in 11 cases (22.915), a number of hepatic 20 metastases which had not been visible on preoperative imaging scans were detected, and afterwards treated through RFA; also, in 14 cases intraoperative echography revealed the presence and nature of the hepatic tumours, leading to a correct histopathological diagnostic and an adequate therapy. The method was useful in pancreatic pathologies as well, in complicated forms of acute or chronic pancreatitis, tracking the Wirsung duct within the scleral and calcified mass of pancreatic tissue, through an ultrasound guided puncture, as well as in locating pancreatic cystic masses,determining the optimal puncture or pericystic-digestive drainage areas. Intraoperative ultrasound is an inexpensive, easy method, which allows real time exploration throughout the entire surgical process of hepato

  17. 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.

  18. 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.

  19. 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.

  20. Cutaneous warming promotes sleep onset.

    PubMed

    Raymann, Roy J E M; Swaab, Dick F; Van Someren, Eus J W

    2005-06-01

    Sleep occurs in close relation to changes in body temperature. Both the monophasic sleep period in humans and the polyphasic sleep periods in rodents tend to be initiated when core body temperature is declining. This decline is mainly due to an increase in skin blood flow and consequently skin warming and heat loss. We have proposed that these intrinsically occurring changes in core and skin temperatures could modulate neuronal activity in sleep-regulating brain areas (Van Someren EJW, Chronobiol Int 17: 313-54, 2000). We here provide results compatible with this hypothesis. We obtained 144 sleep-onset latencies while directly manipulating core and skin temperatures within the comfortable range in eight healthy subjects under controlled conditions. The induction of a proximal skin temperature difference of only 0.78 +/- 0.03 degrees C (mean +/- SE) around a mean of 35.13 +/- 0.11 degrees C changed sleep-onset latency by 26%, i.e., by 3.09 minutes [95% confidence interval (CI), 1.91 to 4.28] around a mean of 11.85 min (CI, 9.74 to 14.41), with faster sleep onsets when the proximal skin was warmed. The reduction in sleep-onset latency occurred despite a small but significant decrease in subjective comfort during proximal skin warming. The induction of changes in core temperature (delta = 0.20 +/- 0.02 degrees C) and distal skin temperature (delta = 0.74 +/- 0.05 degrees C) were ineffective. Previous studies have demonstrated correlations between skin temperature and sleep-onset latency. Also, sleep disruption by ambient temperatures that activate thermoregulatory defense mechanisms has been shown. The present study is the first to experimentally demonstrate a causal contribution to sleep-onset latency of skin temperature manipulations within the normal nocturnal fluctuation range. Circadian and sleep-appetitive behavior-induced variations in skin temperature might act as an input signal to sleep-regulating systems. PMID:15677527

  1. High dissipative nonminimal warm inflation

    NASA Astrophysics Data System (ADS)

    Nozari, Kourosh; Shoukrani, Masoomeh

    2016-09-01

    We study a model of warm inflation in which both inflaton field and its derivatives are coupled nonminimally to curvature. We survey the spectrum of the primordial perturbations in high dissipative regime. By expanding the action up to the third order, the amplitude of the non-Gaussianity is studied both in the equilateral and orthogonal configurations. Finally, by adopting four sort of potentials, we compare our model with the Planck 2015 released observational data and obtain some constraints on the model's parameters space in the high dissipation regime.

  2. 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.

  3. 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

  4. Intraoperative augmented reality for laparoscopic colorectal surgery by intraoperative near-infrared fluorescence imaging and optical coherence tomography.

    PubMed

    Cahill, R A; Mortensen, N J

    2010-08-01

    Advances in imaging quality and capability have been the major driver of the laparoscopic revolution that has dramatically impacted upon operative strategies and surgical patient care in recent years. Increasingly now the technological capacity is becoming available to supraselect or extend the useful clinical range of the electromagnetic spectrum beyond visible or white light. This has markedly broadened the intraprocedural optical information available at intraluminal endoscopy and there is likely to be considerable similar benefit for laparoscopy. Rather than narrow band or ultraviolet imaging however, it is the near infrared (NIR) spectrum that seems of most potential to exploit during intra-abdominal endoscopy in particular as this energy range is capable of penetrating relatively deeply into tissues such as the mesentery and bowel wall without inducing thermal damage due to heat dissipation or indeed the intracellular effects associated with higher energy, shorter wavelength energies. By incorporating the NIR spectrum alongside more conventional laparoscopic imaging, a greater appreciation of tissue architecture, character and quality is possible in particular with respect to lymphatic and vascular channel anatomy and flow dynamics and also real-time optical histology (by NIR optical coherence tomography). Such a facility may significantly aid critical intraoperative decision making during colorectal operations by informing the surgeon regarding the most biologically relevant lymphatic basin and lymph nodes for any target area of interest (especially important if considering tailored operative extent for colorectal neoplasia), the sufficiency and quality of arterial supply (and hence inform re the perfusion of stapled intestinal ends prior to reanastomosis) and perhaps even in situ pathological assessment. This article provides a state of art overview of the fascinating potential of this emergent technological capability. PMID:20802433

  5. Simulated sudden stratospheric warming - Synoptic evolution

    NASA Technical Reports Server (NTRS)

    Blackshear, W. T.; Grose, W. L.; Turner, R. E.

    1987-01-01

    An analysis is presented of a sudden stratospheric warming event which occurred spontaneously during a general circulation model simulation of the global atmospheric circulation. Two separate warming pulses exhibit the same dynamical evolution with a 'cycle' of about two weeks. Two distinct phases of the warming cycle are apparent: (1) the generation of an intense localized warm cell in conjunction with significant adiabatic heating associated with cross-isobar flow which has been induced by vertically propagating long wave disturbances; and (2) the northward transport of that warm cell via advection by the essentially geostrophic windfield corresponding to an intense, offset polar cyclone, in conjunction with a strong Aleutian anticyclone. During the first warming pulse in January, a moderate Aleutian anticyclone was in place prior to the warming cycle and was intensified by interaction with an eastward traveling anticyclone induced by the differential advection of the warm cell. The second warming pulse occurred in early February with a strong Aleutian anticyclone already established. In contrast to the January event, the warming in February culminated with reversal of the zonal westerlies to easterlies over a significant depth of the stratosphere.

  6. Line shape modeling in warm and dense hydrogen plasmas

    NASA Astrophysics Data System (ADS)

    Ferri, S.; Calisti, A.; Mossé, C.; Talin, B.; Gigosos, M. A.; González, M. A.

    2007-05-01

    A study of hydrogen lines emitted in warm ( T˜1eV) 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 Hα line, for which a few experiments in the warm and dense plasma regimes are available.

  7. 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.

  8. The use of intra-operative fluoroscopy for tibial tunnel placement in anterior cruciate ligament reconstruction

    PubMed Central

    Hughes, A. W.; Dwyer, A. J.; Govindaswamy, R.; Lankester, B.

    2012-01-01

    Objectives Our aim was to assess the use of intra-operative fluoroscopy in the assessment of the position of the tibial tunnel during reconstruction of the anterior cruciate ligament (ACL). Methods Between January and June 2009 a total of 31 arthroscopic hamstring ACL reconstructions were performed. Intra-operative fluoroscopy was introduced (when available) to verify the position of the guidewire before tunnel reaming. It was only available for use in 20 cases, due to other demands on the radiology department. The tourniquet times were compared between the two groups and all cases where radiological images lead to re-positioning of the guide wire were recorded. The secondary outcome involved assessing the tibial interference screw position measured on post-operative radiographs and comparing with the known tunnel position as shown on intra-operative fluoroscopic images. Results Of the 20 patients treated with fluoroscopy, the imaging led to repositioning of the tibial guide wire before reaming in three (15%). The mean tourniquet time with intra-operative fluoroscopy was 56 minutes (44 to 70) compared with 51 minutes (42 to 67) for the operations performed without. Six patients (30%) had post-operative screw positions that were > 5% more posterior than the known position of the tibial tunnel. Conclusion Intra-operative fluoroscopy can be effectively used to improve the accuracy of tibial tunnel positions with minimal increase in tourniquet time. This study also demonstrates the potential inaccuracy associated with plain radiological assessment of tunnel position. PMID:23610653

  9. Intraoperative portal vein insulin assay combined with occlusion of the pancreas for complex pancreatogenous hypoglycemia

    PubMed Central

    Yang, Zhiying; Tan, Haidong; Sun, Yongliang; Si, Shuang; Xu, Li; Liu, Xiaolei; Liu, Liguo; Zhou, Wenying; Huang, Jia

    2016-01-01

    Abstract Intraoperative localization and confirmation of complete resection of the hypersecreting tissue are the 2 main challenges in the management of pancreatogenous hypoglycemia. Here, we report our experience with intraoperative portal vein insulin assay combined with occlusion of the pancreas in the management of pancreatogenous hypoglycemia. Clinical courses of 2 patients with biochemical evidence of a pancreatogenous hypoglycemia were studied. The preoperative diagnosis was multiple endocrine neoplasia 1 (MEN-1) and nesidioblastosis, respectively. Rapid intraoperative portal vein insulin assay combined with occlusion of the pancreas was used to localize and confirm complete excision of the hypersecreting tissue. Hypoglycemia was successfully treated in both the patients. In the MEN-1 patient, 2 small tumors in the head of pancreas were not resected, as they were deemed noninsulin secreting by intraoperative portal vein insulin assay, thus avoiding a total pancreatectomy. In the patient with nesidioblastosis, using intraoperative portal vein insulin assay combined with occlusion of the pancreas, an appropriate amount of pancreatic tissue was resected thereby avoiding recurrence and diabetes. This technique may be of particular value in patients with complex conditions such as MEN-1 and nesidioblastosis, to localize and achieve complete resection of hypersecreting pancreatic tissue. PMID:27367988

  10. Intraoperative implant rod three-dimensional geometry measured by dual camera system during scoliosis surgery.

    PubMed

    Salmingo, Remel Alingalan; Tadano, Shigeru; Abe, Yuichiro; Ito, Manabu

    2016-05-12

    Treatment for severe scoliosis is usually attained when the scoliotic spine is deformed and fixed by implant rods. Investigation of the intraoperative changes of implant rod shape in three-dimensions is necessary to understand the biomechanics of scoliosis correction, establish consensus of the treatment, and achieve the optimal outcome. The objective of this study was to measure the intraoperative three-dimensional geometry and deformation of implant rod during scoliosis corrective surgery.A pair of images was obtained intraoperatively by the dual camera system before rotation and after rotation of rods during scoliosis surgery. The three-dimensional implant rod geometry before implantation was measured directly by the surgeon and after surgery using a CT scanner. The images of rods were reconstructed in three-dimensions using quintic polynomial functions. The implant rod deformation was evaluated using the angle between the two three-dimensional tangent vectors measured at the ends of the implant rod.The implant rods at the concave side were significantly deformed during surgery. The highest rod deformation was found after the rotation of rods. The implant curvature regained after the surgical treatment.Careful intraoperative rod maneuver is important to achieve a safe clinical outcome because the intraoperative forces could be higher than the postoperative forces. Continuous scoliosis correction was observed as indicated by the regain of the implant rod curvature after surgery. PMID:27175467

  11. 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

  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. 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.

  14. 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.

  15. 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

  16. 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

  17. A cost comparison of allogeneic and preoperatively or intraoperatively donated autologous blood.

    PubMed

    Roberts, W A; Kirkley, S A; Newby, M

    1996-07-01

    We determined the cost of allogeneic packed red blood cells and autologous whole blood donated either preoperatively or in the operating room during hemodilution. Direct and indirect cost estimates were based on patients requiring simple transfusion and included procurement and preparation of the blood including testing performed, materials and time used, waste, and materials for administration. Data were derived from prospective blood bank time studies, material invoice records, and retrospective review of anesthesia times. Viral infection and transfusion reaction costs were accepted from previously published sources. Direct cost of purchasing and indirect costs of preparation resulted in an overall cost of $107.26 for the first unit of allogeneic packed red blood cells transfused. A second unit was slightly less costly ($100.89), as no type and screen was required and the same delivery set and filter can be used. The total cost of acquisition, processing, and transfusion of 1 U of preoperatively donated autologous blood was $97.83. The total cost of a 2-U transfusion of autologous whole blood donated in the operating room during acute normovolemic hemodilution was $83.10. These data suggest that autologous predonation of whole blood is somewhat less expensive than allogeneic packed red blood cells, and that hemodilution may be a cost effective alternative to autologous predonation in selected patients. PMID:8659723

  18. [Lipoemulsification versus lipoaspiration. Comparison of intraoperative blood loss and surgery time].

    PubMed

    Palmieri, B; Bosio, P; Catania, N; Gozzi, G

    1997-06-01

    Blood loss due to liposuction is one of the main problems in this kind of surgery, blood volume being up to 30%-35% of the whole liposucked volume. We studied the possible lower impact of ultrasound lipolysis in order to obviate this non negligible problem. For this purpose we treated 10 patients, females, aged between 28 and 55, such obese to overweight between 50% and 200%. These patients underwent ultrasound lipolysis surgery after any dietetic or any other treatment against obesity. No patient dropped out of the study. Each patient was treated, under general anesthesia, in a region included between an imaginary horizontal line passing through the umbilicus and another one through the middle of the femur. Thirty minutes after a bilateral infiltration with an epinephrine solution (1:500000 diluted, 28 C) 2 1 volume each side, the right side was treated with the liposucking cannula (0.4 cm diameter), the left one underwent ultrasound lipolysis with a titanium probe (0.5 cm diameter, SMEI Casale Monferrato, Italy). A liposucking probe every 10 minutes into the left side was inserted. Haemoglobin was detected (according to the method of Goodpasture) in the liposucked material. The result showed a statistically significant difference between the blood rate in the lipoaspirate and that one in the ultrasound lysed material. Ultrasound lipolysis is slower than lipoaspiration, but it also shows less risk of hemorrhage and fat embolism. PMID:9324665

  19. The use of bilateral blink reflexes in intraoperative monitoring of facial-trigeminal nerves in cerebello-pontine angle operations

    PubMed Central

    Jamshidi Fard, Alireza; Dalvandi, Mohsen; Mohammadi, Alireza

    2012-01-01

    Abstract: Background: Intraoperative monitoring (IOM) of facial nerve is routinely recommended in Cerebello-Pontine Angle (CP Angle) operations. Middle cranial nerves: V, VII, VIII are mainly involved since these nerves are sometimes separated by the tumor mass causing an inadvertent section of the facial nerve. Blink reflex could be elicited by stimulation of supraorbital branch of Trigeminal nerve which elicits EMG responses in facial muscles. Threshold, amplitude, latencies, pre-post surgery are strong predictors of postoperative facial function. Methods: In 17 cases of CP angle tumors (24-43 mm, by MRI) approached suboccipitally, we performed bilateral blink reflexes pre/intra/post surgery. The setup consisted of a Nicolet Endeavor IOM system( VIASYS Healthcare, 2005, USA) with the ability to perform several voltage/current stimulations and recordingsup to 20 Evoked Potentials and Electromyography (EMG) simultaneously. Bilateral blink reflexes were evoked by stimulation of bilateral supraorbital nerves. Stimulating pulses of 0.1 ms duration and 5-20 mA intensity were applied percutaneously at the intervals of 10-20 s. The orbicularis oculi muscle responses were recorded using surface electrodes. Early EMG responses (R1) and later reflex activities (R2) were elicited ipsi/contra laterally (R1/2-i/c). Every five successive trials were superimposed and the lowest latencies were used for comparison. Blink reflexes of each subject considered pathologic if: 1- Loss of R1-i,c to the operation side, latencies are more than 15 ms or side differences are 3 ms or more; 2- Loss of R2-i, latencies are more than 50 ms or side differences are 10 ms or more. 3- Loss of R2-c, latencies are more than 55 ms or side differences are 10 ms or more. Recordings were performed 2-3 days before operaration, intraoperative and 21 days after operation. Results: Before surgery, in 15 subjects, the amplitudes of R1-i responses were significantly lower than the R1-c. However, in 2 cases with

  20. Atlantic Warm Pool Trigger for the Younger Dryas Climate Event

    NASA Astrophysics Data System (ADS)

    Abdul, N. A.; Mortlock, R. A.; Wright, J. D.; Fairbanks, R. G.; Teneva, L. T.

    2011-12-01

    There is growing evidence that variability in the size and heat content of the tropical Atlantic Warm Pool impacts circum-North Atlantic climate via the Atlantic Multi-decadal Oscillation mode (Wang et al., 2008). The Atlantic Warm Pool spans the Gulf of Mexico, Caribbean Sea and the western tropical North Atlantic. Barbados is located near the center of the tropical Atlantic Warm Pool and coupled ocean models suggest that Barbados remains near the center of the tropical Atlantic Warm Pool under varying wind stress simulations. Measurements of the oxygen isotope paleothermometer in Acropora palmata coral species recovered from cores offshore Barbados, show a 3oC monotonic decrease in sea surface temperature from 13106 ± 83 to 12744 ± 61 years before present (errors given as 2 sigma). This interval corresponds to a sea level rise from 71.4 meters to 67.1 meters below present levels at Barbados. The 3oC temperature decrease is captured in eight A. palmata specimens that are in stratigraphic sequence, 230Th/234U dated, and analyzed for oxygen isotopes. All measurements are replicated. We are confident that this is the warm pool equivalent of the Younger Dryas climate event. The initiation of this temperature drop in the Atlantic Warm Pool predates the Younger Dryas start in Greenland ice cores, reported to start at 12896 ± 138 years (relative to AD 2000) (Rasmussen et al., 2006), while few other Younger Dryas climate records are dated with similar accuracy to make the comparison. Rasmussen, S.O., Andersen, K.K., Svensson, A.M., Steffensen, J.P., Vinther, B.M., Clausen, H.B., Siggaard-Andersen, M.L., Johnsen, S.J., Larsen, L.B., Dahl-Jensen, D., Bigler, M., Röthlisberger, R., Fischer, H., Goto-Azuma, K., Hansson, M.E., and Ruth, U., 2006, A new Greenland ice core chronology for the last glacial termination: J. Geophys. Res., v. 111, p. D06102. Wang, C., Lee, S.-K., and Enfield, D.B., 2008, Atlantic Warm Pool acting as a link between Atlantic Multidecadal

  1. [Thoracoscopy and intraoperative upper gastrointestinal endoscopy was effective for Boerhaave syndrome; report of a case].

    PubMed

    Hayashi, Hiroyuki; Iwasaki, A; Kato, F; Makihata, S; Yamamoto, S; Shiraishi, T; Yamazaki, S; Shirakusa, T

    2005-05-01

    Boerhaave syndrome is a rare disease and needs an exact diagnosis and a proper treatment plan because of its terrible clinical course. We experienced a case of Boerhaave syndrome that thoracoscopy and intraoperative upper gastrointestinal (GI) endoscopy was very effective. Sixty-four-year-old man realized chest and back pain after vomitting. Esophageal perforation was suspected, but 64 hours had passed already when we started a surgical treatment. By the thoracoscopy and intraoperative endoscopy, lower esophageal perforation and infectious pleural effusion were found. Therefore, we selected a surgical treatment under the assistance of thoracoscopy. Secondly, a simple closure and intracostal muscle overlapping was performed with small incisional thoracotomy. Postoperative complication, such as mediastinal abscess, has not occurred. Thoracoscopy and intraoperative upper GI endoscopy was effective for an appropriate diagnosis and treatment of Boerhaave syndrome. PMID:15881245

  2. Pilomyxoid astrocytoma of the pineal region: cytopathological features and differential diagnostic considerations by intraoperative smear preparation.

    PubMed

    Hayashi, Toshitetsu; Haba, Reiji; Kushida, Yoshio; Katsuki, Naomi; Shibuya, Shinsuke; Kadota, Kyuichi; Matsunaga, Toru; Miyake, Keisuke; Tamiya, Takashi

    2015-02-01

    Pilomyxoid astrocytoma (PMA) is a recently identified type of pilocytic astrocytoma (PA) with shorter progression-free and overall survival, higher rate of recurrence, and higher risk of leptomeningeal spread compared to pilocytic tumors (WHO grade 2 designation). A case is presented here in which intraoperative imprint smears of a pineal region tumor in a 14-year-old girl revealed cytologic monomorphism, elongated cells with bland nuclei embedded in a myxoid background. The tumor cells possessed uniformly round nuclei with a smooth nuclear outline, fine granular chromatin, and small nucleoli. Slender cytoplasmic fibrillary processes and angiocentric arrangement were observed but Rosenthal fibers or eosinophilic granular bodies were absent. A cytologic diagnosis of PMA of the pineal region was suggested by intraoperative smear preparation. Histology and immunohistochemical results confirmed the final diagnosis. This report shows that smear preparation can be trustworthy for the intraoperative diagnosis of PMA, helping to determine the appropriate neurosurgical procedure and therapeutic implications. PMID:24578310

  3. Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

    PubMed Central

    2014-01-01

    Background Fluid management in the perioperative period has been extensively studied but, despite that, “the right amount” still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today. Discussion In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence. Summary An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution. PMID:25104915

  4. 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.

  5. Serial FEM/XFEM-Based Update of Preoperative Brain Images Using Intraoperative MRI

    PubMed Central

    Vigneron, Lara M.; Noels, Ludovic; Warfield, Simon K.; Verly, Jacques G.; Robe, Pierre A.

    2012-01-01

    Current neuronavigation systems cannot adapt to changing intraoperative conditions over time. To overcome this limitation, we present an experimental end-to-end system capable of updating 3D preoperative images in the presence of brain shift and successive resections. The heart of our system is a nonrigid registration technique using a biomechanical model, driven by the deformations of key surfaces tracked in successive intraoperative images. The biomechanical model is deformed using FEM or XFEM, depending on the type of deformation under consideration, namely, brain shift or resection. We describe the operation of our system on two patient cases, each comprising five intraoperative MR images, and we demonstrate that our approach significantly improves the alignment of nonrigidly registered images. PMID:22287953

  6. Acute intraoperative neurogenic myocardial stunning during intracranial endoscopic fenestration and shunt revision in a pediatric patient.

    PubMed

    Dragan, Kristen Elizabeth; Patten, William D; Elzamzamy, Osama M; Attaallah, Ahmed Fikry

    2016-02-01

    Neurogenic stunned myocardium (NSM) is syndrome of myocardial dysfunction following an acute neurological insult. We report a case of NSM that occurred intraoperatively in a pediatric patient undergoing endoscopic fenestration and shunt revision. Accidental outflow occlusion of irrigation fluid and ventricular distension resulted in an acute increase in heart rate and arterial blood pressure. Subsequently, the patient developed stunned myocardium with global myocardial hypokinesia and pulmonary edema. She was promptly treated intraoperatively then admitted to the pediatric intensive care unit with resolution of her symptoms within 12 h. She was later discharged to home on the fourth postoperative day. In the current endoscopic era, this report highlights the possibility of intraoperative NSM and neurogenic pulmonary edema in the pediatric population. Early detection and treatment with a team approach help to achieve optimal control of this life-threatening condition and improve the outcome. PMID:26314948

  7. 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

  8. Intra-operative femoral neck fracture during attempted dislocation of a reduced hemi-arthroplasty.

    PubMed

    Ling, Samuel Ka Kin; Ma, Chun Man; Lui, Tun Hing

    2015-05-01

    Fragility hip fractures are increasingly common and hemiarthroplasty is one of the standard treatments. Although a common surgery, it should be performed with great caution because of the poor premorbid and bone quality in this demographic. Intra-operative fractures can occur while attempting press fit of the femoral implant. However; vigilance often steps down once the implant is secured and the hip reduced. This case report reminds surgeons that a large amount of torque can be transmitted during intra-operative positioning, such as during an attempt of hip dislocation. This torque, in addition to the risk factor of osteoporotic bone, can result in iatrogenic fractures. Published literature regarding management of an intra-operative fracture while the prosthetic hip is still reduced is lacking. The authors propose that temporary prophylactic cerclage wiring is a prudent and safe procedure prior to hip dislocation. PMID:26058283

  9. Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

    PubMed Central

    Wan Fadzlina, Wan Muhd Shukeri; Wan Mohd Nazaruddin, Wan Hassan; Rhendra Hardy, Mohamad Zaini

    2016-01-01

    Background Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB. Methods Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2–4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss. Results The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss. Conclusion The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies. PMID:27547112

  10. Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials

    PubMed Central

    Luo, Yeda; Regli, Luca; Bozinov, Oliver; Sarnthein, Johannes

    2015-01-01

    Objectives During surgeries that put the visual pathway at risk of injury, continuous monitoring of the visual function is desirable. However, the intraoperative monitoring of the visual evoked potential (VEP) is not yet widely used. We evaluate here the clinical utility of intraoperative VEP monitoring. Methods We analyzed retrospectively 46 consecutive surgeries in 2011-2013. High luminance stimulating devices delivered flash stimuli on the closed eyelid during intravenous anesthesia. We monitored VEP features N75 and P100 and took patients' preoperative and postoperative visual function from patient charts. Postoperative ophthalmologic workup was performed in 25 (54%) patients and preoperatively in 28 (61%) patients. Results VEP recordings were feasible in 62 of 85 eyes (73%) in 46 patients. All 23 eyes without VEP had impaired vision. During surgery, VEPs remained stable throughout surgery in 50 eyes. In 44 of these, visual function did not deteriorate and three patients (6 eyes) developed hemianopia. VEP decreased transiently in 10 eyes and visual function of all was preserved. VEPs were lost permanently in 2 eyes in two patients without new postoperative visual impairment. Conclusions Satisfactory intraoperative VEP monitoring was feasible in all patients except in those with severe visual impairment. Preservation of VEPs predicted preserved visual function. During resection of lesions in the visual cortex, VEP monitoring could not detect new major visual field defects due to injury in the posterior visual pathway. Intraoperative VEPs were sensitive enough to detect vascular damage during aneurysm clipping and mechanical manipulation of the anterior visual pathway in an early reversible stage. Intraoperative VEP monitoring influenced surgical decisions in selected patients and proved to be a useful supplement to the toolbox of intraoperative neurophysiological monitoring. PMID:25803287

  11. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty.

    PubMed

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-06-01

    Background and purpose - In hip arthroplasty, acetabular inclination and anteversion-and also femoral stem torsion-are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods - In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results - The mean difference between the 3D-CT results and intraoperative estimations by eye was -4.9° (-18 to 8.7) for inclination, 9.7° (-16 to 41) for anteversion, and -7.3° (-34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10-20° as defined by Tönnis, measured on 3D-CT. Interpretation - Even an experienced surgeon's intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  12. The impact of use of an intraoperative margin assessment device on re-excision rates.

    PubMed

    Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

    2015-01-01

    Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively

  13. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty

    PubMed Central

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-01-01

    Background and purpose In hip arthroplasty, acetabular inclination and anteversion—and also femoral stem torsion—are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results The mean difference between the 3D-CT results and intraoperative estimations by eye was −4.9° (−18 to 8.7) for inclination, 9.7° (−16 to 41) for anteversion, and −7.3° (−34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10–20° as defined by Tönnis, measured on 3D-CT. Interpretation Even an experienced surgeon’s intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  14. 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

  15. Intraoperative neurophysiologic monitoring in spine surgery. Developments and state of the art in France in 2011.

    PubMed

    Gavaret, M; Jouve, J L; Péréon, Y; Accadbled, F; André-Obadia, N; Azabou, E; Blondel, B; Bollini, G; Delécrin, J; Farcy, J-P; Fournet-Fayard, J; Garin, C; Henry, P; Manel, V; Mutschler, V; Perrin, G; Sales de Gauzy, J

    2013-10-01

    Intraoperative spinal cord monitoring consists in a subcontinuous evaluation of spinal cord sensory-motor functions and allows the reduction the incidence of neurological complications resulting from spinal surgery. A combination of techniques is used: somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), neurogenic motor evoked potentials (NMEP), D waves, and pedicular screw testing. In absence of intraoperative neurophysiological testing, the intraoperative wake-up test is a true form of monitoring even if its latency long and its precision variable. A 2011 survey of 117 French spinal surgeons showed that only 36% had neurophysiological monitoring available (public healthcare facilities, 42%; private facilities, 27%). Monitoring can be performed by a neurophysiologist in the operating room, remotely using a network, or directly by the surgeon. Intraoperative alerts allow real-time diagnosis of impending neurological injury. Use of spinal electrodes, moved along the medullary canal, can determine the lesion level (NMEP, D waves). The response to a monitoring alert should take into account the phase of the surgical intervention and does not systematically lead to interruption of the intervention. Multimodal intraoperative monitoring, in presence of a neurophysiologist, in collaboration with the anesthesiologist, is the most reliable technique available. However, no monitoring technique can predict a delayed-onset paraplegia that appears after the end of surgery. In cases of preexisting neurological deficit, monitoring contributes little. Monitoring of the L1-L4 spinal roots also shows low reliability. Therefore, monitoring has no indication in discal and degenerative surgery of the spinal surgery. However, testing pedicular screws can be useful. All in all, thoracic and thoracolumbar vertebral deviations, with normal preoperative neurological examination are currently the essential indication for spinal cord monitoring. Its absence in this

  16. 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

  17. 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.

  18. 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.

  19. Ecological stability in response to warming

    NASA Astrophysics Data System (ADS)

    Fussmann, Katarina E.; Schwarzmüller, Florian; Brose, Ulrich; Jousset, Alexandre; Rall, Björn C.

    2014-03-01

    That species’ biological rates including metabolism, growth and feeding scale with temperature is well established from warming experiments. The interactive influence of these changes on population dynamics, however, remains uncertain. As a result, uncertainty about ecological stability in response under warming remains correspondingly high. In previous studies, severe consumer extinction waves in warmed microcosms were explained in terms of warming-induced destabilization of population oscillations. Here, we show that warming stabilizes predator-prey dynamics at the risk of predator extinction. Our results are based on meta-analyses of a global database of temperature effects on metabolic and feeding rates and maximum population size that includes species of different phylogenetic groups and ecosystem types. To unravel population-level consequences we parameterized a bioenergetic predator-prey model and simulated warming effects within ecological, non-evolutionary timescales. In contrast to previous studies, we find that warming stabilized population oscillations up to a threshold temperature, which is true for most of the possible parameter combinations. Beyond the threshold level, warming caused predator extinction due to starvation. Predictions were tested in a microbial predator-prey system. Together, our results indicate a major change in how we expect climate change to alter natural ecosystems: warming should increase population stability while undermining species diversity.

  20. Stratospheric sudden warming and lunar tide

    NASA Astrophysics Data System (ADS)

    Yamazaki, Yosuke; Kosch, Michael

    2016-07-01

    A stratospheric sudden warming is a large-scale disturbance in the middle atmosphere. Recent studies have shown that the effect of stratospheric sudden warnings extends well into the upper atmosphere. A stratospheric sudden warming is often accompanied by an amplification of lunar tides in the ionosphere/theremosphere. However, there are occasionally winters when a stratospheric sudden warming occurs without an enhancement of the lunar tide in the upper atmosphere, and other winters when large lunar tides are observed without a strong stratospheric sudden warming. We examine the winters when the correlation breaks down and discuss possible causes.

  1. A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment.

    PubMed

    Hajiabadi, Mohamadreza; Samii, Madjid; Fahlbusch, Rudolf

    2016-09-01

    OBJECT Visual impairments are the most common objective manifestations of suprasellar lesions. Diffusion tensor imaging (DTI) is a noninvasive MRI modality that depicts the subcortical white matter tracts in vivo. In this study the authors tested the value of visual pathway tractography in comparison with visual field and visual acuity analyses. METHODS This prospective study consisted of 25 patients with progressive visual impairment due to suprasellar mass lesions and 6 control patients with normal vision without such lesions. Visual acuity, visual field, and the optic fundus were examined preoperatively and repeated 1 week and 3 months after surgery. Visual pathway DTI tractography was performed preoperatively, intraoperatively immediately after tumor resection, and 1 week and 3 months after surgery. RESULTS In the control group, pre- and postoperative visual status were normal and visual pathway tractography revealed fibers crossing the optic chiasm without any alteration. In patients with suprasellar lesions, vision improved in 24 of 25. The mean distance between optic tracts in tractography decreased after tumor resection and detectable fibers crossing the optic chiasm increased from 12% preoperatively to 72% postoperatively 3 months after tumor resection, and undetectable fibers crossing the optic chiasm decreased from 88% preoperatively to 27% postoperatively 3 months after tumor resection. Visual improvement after tumor removal 1 week and 3 months after surgery was significantly correlated with the distance between optic tracts in intraoperative tractography (p < 0.01). CONCLUSIONS Visual pathway DTI tractography appears to be a promising adjunct to the standard clinical and paraclinical visual examinations in patients with suprasellar mass lesions. The intraoperative findings, in particular the distance between optic tract fibers, can predict visual outcome after tumor resection. Furthermore, postoperative application of this technique may be useful in

  2. 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.

  3. Warm Climates in Earth History

    NASA Astrophysics Data System (ADS)

    Wilson, Gary

    Global warming and global environmental change are two key, inter-related topics that receive near-constant attention in the international press. Why? Because the political agencies that direct national and international economies are reluctant to admit that we may be conducting our own global scale experiment in atmospheric pollution. Perhaps they are right to do so. However, the arguments can only be tested properly by carefully documenting the natural climate system and by comparing recent and predicted future regional and global climate change with high-resolution geologic records of past changes and reorganization in response to climatic forcing. Geologic records on their own, though, are limited in their regional and global application and can only be properly applied to understanding the global climate system by integration with computer models and simulations.

  4. Local cooling despite global warming

    NASA Astrophysics Data System (ADS)

    Girihagama, Lakshika Nilmini Kumari

    How much warmer is the ocean surface than the atmosphere directly above it? Part 1 of the present study offers a means to quantify this temperature difference using a nonlinear one-dimensional global energy balance coupled ocean--atmosphere model ("Aqua Planet"). The significance of our model, which is of intermediate complexity, is its ability to obtain an analytical solution for the global average temperatures. Preliminary results show that, for the present climate, global mean ocean temperature is 291.1 K whereas surface atmospheric temperature is 287.4 K. Thus, the surface ocean is 3.7 K warmer than the atmosphere above it. Temporal perturbation of the global mean solution obtained for "Aqua Planet" showed a stable system. Oscillation amplitude of the atmospheric temperature anomaly is greater in magnitude to those found in the ocean. There is a phase shift (a lag in the ocean), which is caused by oceanic thermal inertia. Climate feedbacks due to selected climate parameters such as incoming radiation, cloud cover, and CO2 are discussed. Warming obtained with our model compares with Intergovernmental Panel on Climate Change's (IPCC) estimations. Application of our model to local regions illuminates the importance of evaporative cooling in determining derived air-sea temperature offsets, where an increase in the latter increases the systems overall sensitivity to evaporative cooling. In part 2, we wish to answer the fairly complicated question of whether global warming and an increased freshwater flux cause Northern Hemispheric warming or cooling. Starting from the assumption of the ocean as the primary source of variability in the Northern hemispheric ocean--atmosphere coupled system, we employed a simple non--linear one--dimensional coupled ocean--atmosphere model similar to the "Aqua Planet" model but with additional advective heat transports. The simplicity of this model allows us to analytically predict the evolution of many dynamical variables of interest

  5. Sudden stratospheric warmings as catastrophes

    NASA Technical Reports Server (NTRS)

    Chao, W. C.

    1985-01-01

    The sudden stratospheric warming (SSW) process is qualitatively studied using a conceptual and numerical approach guided by catastrophe theory. A simple example of a catastrophe taken from nonlinear dynamics is given, and results from previous modelling studies of SSW are interpreted in light of catastrophe theory. Properties of this theory such as hysteresis, cusp, and triggering essential to SSW are numerically demonstrated using the truncated quasi-geostrophic beta-plane model of Holton and Mass (1976). A qualitative explanation of the transition from the steady regime to the vacillation regime is given for the Holton and Mass model in terms of the topographically induced barotropic Rossby wave instability. Some implications for the simulation and prediction of SSW are discussed.

  6. Histopathological effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis

    SciTech Connect

    Hoekstra, H.J.; Restrepo, C.; Kinsella, T.J.; Sindelar, W.F.

    1988-02-01

    Intraoperative radiotherapy (IORT) has been utilized in the treatment of resectable and unresectable pancreatic carcinoma at the National Cancer Institute. Detailed autopsy analyses of the radiation effects on the pancreas and adjacent tissues were performed on 13 patients dying at various times following therapy. IORT can induce a progressive retroperitoneal fibrosis and fibrosis of the porta hepatis in patients with resectable pancreatic carcinoma. In unresectable pancreatic carcinoma, the major expression of intraoperative irradiation with external beam irradiation is a progressive fibrosis of the pancreas with vascular sclerosis, nerve degeneration, atrophy of acinar cells, and atypical changes in the ducts of the pancreas, as well as degenerative changes of the pancreatic tumor.

  7. Anaphylactoid reaction to intraoperative cholangiogram. Report of a case, review of literature, and guidelines for prevention.

    PubMed

    Moskovitz, A H; Bush, W H; Horvath, K D

    2001-10-01

    Anaphylactoid (pseudoallergic, idiosyncratic) reactions are a well recognized but uncommon consequence to radiographic contrast media. Most reported reactions are to intravascular injections, but systemic reactions to nonvascular injections of radiographic contrast also are well documented. Reactions to nonvascular radiographic contrast media have been reported during or after instillation of radiographic contrast into a multitude of nonvascular body compartments, but not with intraoperative cholangiogram. We describe a case of a systemic anaphylactoid reaction caused by intraoperative cholangiogram during laparoscopic cholecystectomy. We then discuss the clinical presentation, suspected etiology, and treatment of these idiosyncratic reactions as well as established guidelines for prevention in patients at risk. PMID:11727111

  8. 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.

  9. Intraoperative blood pressure. What patterns identify patients at risk for postoperative complications?

    PubMed Central

    Charlson, M E; MacKenzie, C R; Gold, J P; Ales, K L; Topkins, M; Shires, G T

    1990-01-01

    While monitoring blood pressure is a routine part of intraoperative management, several methods have been proposed to characterize intraoperative hemodynamic patterns as predictors of postoperative complications. In this prospective study of a high-risk population of hypertensive and diabetic patients undergoing elective noncardiac surgery, one objective was to compare different approaches to the assessment of intraoperative hemodynamic patterns to identify those patterns most likely to be associated with postoperative complications. Twenty-one per cent of the 254 patients sustained cardiac or renal complications after operation. Patients with more than 1 hour of greater than or equal to 20-mmHg decreases in mean arterial pressure (MAP) or patients with less than 1 hour of greater than or equal to 20-mmHg decreases and more than 15 minutes of greater than or equal to 20-mmHg increases were at highest risk for postoperative complications. Together these two patterns had a 46% sensitivity rate and a 70% specificity rate in predicting postoperative complications. Using 20% change in intraoperative MAP produced results nearly identical to 20-mmHg changes. When the duration of 20-mmHg changes was accounted for, changes of a greater magnitude (e.g., 40 mmHg) were not significant independent predictors of complications. The use of the mean difference from preoperative MAP was misleading because patients who experienced both high and low MAPs tended to have nearly normal mean MAPs, but high complication rates. The absolute magnitude of intraoperative MAPs, regardless of the preoperative levels, also was evaluated. The overall mean intraoperative MAP was not a significant predictor of complications. Specific intraoperative MAPs (e.g., less than 70 mmHg and more than 120 mmHg) also were evaluated. While neither was a significant predictor, there was a trend for increased complications among patients whose MAPs decreased to less than 70 mmHg. Intraoperative blood pressure

  10. 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

  11. An alternative tool for intraoperative assessment of renal vasculature after revascularization of a transplanted kidney.

    PubMed

    Sawada, Tokihiko; Solly, Mizrahi; Kita, Junji; Shimoda, Mitsugi; Kubota, Keiichi

    2010-06-01

    Intraoperative assessment of flow in the renal artery and vein after reconstruction is a crucial matter in kidney transplantation. Conventional Doppler ultrasound detects blood flow only in a limited area. The authors report a newly developed device that noninvasively visualizes the condition of perfusion of an entire allograft at one time from any angle and also clearly detects the state of anastomosis of the renal vessels. This near-infrared camera system provides the opportunity for the intraoperative assessment of the vasculature of renal allografts. PMID:20409513

  12. S-1 and S-2-alar-iliac screw fixation via intraoperative navigation.

    PubMed

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Adult deformity patients often require fixation to the sacrum and pelvis for construct stability and improved fusion rates. Although certain sacropelvic fixation techniques can be challenging, the availability of intraoperative navigation has made many of these techniques more feasible. In this video case presentation, the authors demonstrate the techniques of S-1 bicortical screw and S-2-alar-iliac screw fixation under intraoperative navigation in a 67-year-old female. This instrumentation placement was part of an overall T-10-pelvis construct for the correction of adult spinal deformity. The video can be found here: https://youtu.be/3HZo-80jQr8 . PMID:27364427

  13. 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.

  14. 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, +1.7°C, +3.4°C). 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 +1.84°C and +3.66°C at 10 cm soil depth and (∆T(above) ) of +1.82°C and +3.45°C 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

  15. WARM MOLECULAR HYDROGEN IN THE GALACTIC WIND OF M82

    SciTech Connect

    Veilleux, Sylvain; Swaters, Rob; Rupke, David S. N. E-mail: swaters@astro.umd.edu

    2009-08-01

    We report the detection of a complex of extraplanar warm H{sub 2} knots and filaments extending more than {approx}3 kpc above and below the galactic plane of M82, roughly coincident with the well-known galactic wind in this system. Comparisons of these data with published results at other wavelengths provide quantitative constraints on the topology, excitation, heating, and stability against disruption of the wind-entrained molecular interstellar matter in this prototypical galactic wind. Deep H{sub 2} 2.12 {mu}m observations such as these represent a promising new method to study the elusive but potentially important molecular component of galactic winds.

  16. Warming: mechanism and latitude dependence

    NASA Astrophysics Data System (ADS)

    Barkin, Yury

    2010-05-01

    Introduction. In the work it is shown, that in present warming of climate of the Earth and in style of its display a fundamental role the mechanism of the forced swing and relative oscillations of eccentric core of the Earth and its mantle plays. Relative displacements of the centers of mass of the core and the mantle are dictated by the features of orbital motions of bodies of solar system and nonineriality of the Earth reference frame (or ot the mantle) at the motion of the Earth with respect to a baricenter of solar system and at rotation of the planet. As a result in relative translational displacements of the core and the mantle the frequencies characteristic for orbital motion of all bodies of solar system, and also their combination are shown. Methods of a space geodesy, gravimetry, geophysics, etc. unequivocally and clearly confirm phenomenon of drift of the center of mass of the Earth in define northern direction. This drift is characterized by the significant velocity in about 5 mm/yr. The unique opportunity of its explanation consists in the natural assumption of existence of the unidirectional relative displacement (drift) the center of mass of the core and the center of mass of the mantle of the Earth. And this displacement (at superfluous mass of the core in 16.7 % from the mass of full the Earth) is characterized still more significant velocity in 2.6 cm/yr and occurs on our geodynamic studies in a direction to Taimyr peninsula. The dynamic explanation to century drift for today does not exist. It is possible to note, however, that data of observations of last years, indirectly testifying that similar drifts of the centers of mass in present epoch occur on other bodies of Solar system have been obtain: the Sun, Mars, the Titan, Enceladus, the Neptune, etc. We connect with mentioned phenomena the observed secular variations of natural processes on this celestial bodies. I.e. it is possible to assume, that observable eccentric positions of the centers

  17. 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)

  18. 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)

  19. 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.

  20. 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…

  1. 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)

  2. 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.

  3. 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)

  4. 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…

  5. Catching a Cold When It's Warm

    MedlinePlus

    ... our exit disclaimer . Subscribe Catching a Cold When It’s Warm What’s the Deal with Summertime Sniffles? Most ... be more unfair than catching a cold when it’s warm? How can cold symptoms arise when it’s ...

  6. Warming of Water in a Glass

    ERIC Educational Resources Information Center

    Paulins, Paulis; Krauze, Armands; Ozolinsh, Maris; Muiznieks, Andris

    2016-01-01

    The article focuses on the process of water warming from 0 °C in a glass. An experiment is performed that analyzes the temperature in the top and bottom layers of water during warming. The experimental equipment is very simple and can be easily set up using devices available in schools. The temperature curves obtained from the experiment help us…

  7. 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.…

  8. 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)

  9. 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.

  10. 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

  11. Eurasian Arctic abyssal waters are warming

    NASA Astrophysics Data System (ADS)

    Schauer, Ursula; von Appen, Wilken-Jon; Somavilla Cabrillo, Raquel; Behrendt, Axel; Rabe, Benjamin

    2016-04-01

    In the past decades, not only the upper water layers, but also the deepest layers of the Arctic Ocean have been warming. Observations show that the rate of warming varies markedly in the different basins with the fastest warming in the deep Greenland Sea (ca. 0.11°C per decade) and the Eurasian Basin featuring an average rate of ca. 0.01°C per decade. While the warming in the Greenland Sea is attributed to ongoing export of relatively warmer deep waters from the Arctic Ocean in combination with the halt of deep convection, the reason of Eurasian Basin deep warming is less clear. We discuss possible causes such as changes in the abyssal ventilation through slope convection, advection from other basins and/or geothermal heating through various sources.

  12. Mixing processes following the final stratospheric warming

    NASA Technical Reports Server (NTRS)

    Hess, Peter G.

    1991-01-01

    An investigation is made of the dynamics responsible for the mixing and dissolution of the polar vortex during the final stratospheric warmings. The dynamics and transport during a Northern Hemisphere final stratospheric warming are simulated via a GCM and an associated offline N2O transport model. The results are compared with those obtained from LIMS data for the final warming of 1979, with emphasis on the potential vorticity evolution in the two datasets, the modeled N2O evolution, and the observed O3 evolution. Following each warming, the remnants of the originally intact vortex are found to gradually homogenize with the atmosphere at large. Two processes leading to this homogenization are identified following the final warmings, namely, the potential vorticity field becomes decorrelated from that of the chemical tracer, and the vortex remnants begin to tilt dramatically in a vertical direction.

  13. Global Warming: Lessons from Ozone Depletion

    NASA Astrophysics Data System (ADS)

    Hobson, Art

    2010-11-01

    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 Arkansas have developed a conceptual understanding of energy and of electromagnetism, including the electromagnetic spectrum, I devote a lecture (and a textbook section) to ozone depletion and another lecture (and section) to global warming. Humankind came together in 1986 and quickly solved, to the extent that humans can solve it, ozone depletion. We could do the same with global warming, but we haven't and as yet there's no sign that we will. The parallel between the ozone and global warming cases, and the difference in outcomes, are striking and instructive.

  14. 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.

  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. Anesthesia during high-field intraoperative magnetic resonance imaging experience with 80 consecutive cases.

    PubMed

    Schmitz, Bernd; Nimsky, Christopher; Wendel, Georg; Wienerl, Juergen; Ganslandt, Oliver; Jacobi, Klaus; Fahlbusch, Rudolf; Schüttler, Juergen

    2003-07-01

    Intraoperative magnetic resonance imaging (MRI) has been used for years to update neuronavigation and for intraoperative resection control. For this purpose, low-field (0.1-0.2 T) MR scanners have been installed in the operating room, which, in contrast to machines using higher magnetic field strength, allowed the use of standard anesthetic and surgical equipment. However, these low-field MR systems provided only minor image quality and a limited battery of MR sequences, excluding functional MRI, diffusion-weighted MRI, or MR angiography and spectroscopy. Based on these advantages, a concept using high-field MRI (1.5 T) with intraoperative functional neuronavigational guidance has been developed that required adaptation of the anesthetic regimen to working in the close vicinity to the strong magnetic field. In this paper the authors present their experience with the first 80 consecutive patients who received anesthesia in a specially designed radio frequency-shielded operating room equipped with a high-field (1.5 T) MR scanner. We describe the MR-compatible anesthesia equipment used including ventilator, monitoring, and syringe pumps, which allow standard neuroanesthesia in this new and challenging environment. This equipment provides the use of total intravenous anesthesia with propofol and remifentanil allowing rapid extubation and neurologic examination following surgery. In addition, extended intraoperative monitoring including EEG monitoring required for intracranial surgery is possible. Moreover, problems and dangers related to the effects of the strong magnetic field are discussed. PMID:12826974

  17. 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

  18. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation

    PubMed Central

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; d’Inzeo, 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

  19. Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery.

    PubMed

    Tarabichi, Muaaz; Kapadia, Mustafa

    2016-10-01

    This article discusses the authors' approach to the assessment of the eustachian tube using opening pressure measurement, endoscopic assessment of the protympanic segment of the eustachian tube, and Valsalva computed tomography. A possible algorithm for the evaluation of eustachian tube obstructive disorders is detailed both preoperatively and intraoperatively. PMID:27468635

  20. Intraoperative Transcranial Motor-Evoked Potential Monitoring of the Facial Nerve during Cerebellopontine Angle Tumor Resection.

    PubMed

    Cosetti, Maura K; Xu, Ming; Rivera, Andrew; Jethanamest, Daniel; Kuhn, Maggie A; Beric, Aleksandar; Golfinos, John G; Roland, J Thomas

    2012-10-01

    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 < 0.05.) 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

  1. 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 < 0.05.) 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

  2. 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…

  3. Intraoperative cerebral high intensity transient signals and postoperative cognitive function: a systematic review

    PubMed Central

    Martin, Kristin K; Wigginton, Jeremy B.; Babikian, Viken L; Pochay, Val E.; Crittenden, Michael D.; Rudolph, James L.

    2009-01-01

    Summary Microemboli during surgery have been hypothesized to cause postoperative cognitive changes. The purpose of this article was to systematically review the available literature related to intraoperative microemboli, measured with transcranial Doppler ultrasound and postoperative cognitive function. The literature remains largely undecided on the role of microemboli and cognitive impairment after surgery, because most studies underpowered to show a relationship. PMID:18723157

  4. Parathyroid Carcinoma: Current Understanding and New Insights into Gene Expression and Intraoperative Parathyroid Hormone Kinetics

    PubMed Central

    Abdelgadir Adam, Mohamed; Untch, Brian R.

    2010-01-01

    Parathyroid carcinoma is an indolent but ultimately life-threatening malignancy. Due to the lack of definitive diagnostic markers and overlapping clinical features of benign primary hyperparathyroidism (PHPT), this disease is often misdiagnosed as parathyroid adenoma. Therefore, a high index of suspicion preoperatively and early intraoperative recognition with en bloc surgical resection are crucial for favorable outcome. Owing to the rarity of the disease, little is known about the molecular pathogenesis of parathyroid carcinoma. Here, we review the literature to present current understanding of the disease and provide new information on gene expression and use of intraoperative parathyroid hormone (PTH) monitoring in the surgical management of this rare malignancy. Specifically, using microarray transcriptome analysis of an unequivocal case of parathyroid carcinoma and a biopsy from the same patient's normal parathyroid gland, we identify APP, CDH1, KCNJ16, and UCHL1 as differentially expressed genes in parathyroid carcinoma. Further, using case records from four cases of unequivocal parathyroid carcinoma, we compared intraoperative PTH kinetics of these patients to 475 patients with benign PHPT, and show that intraoperative PTH monitoring is accurate in predicting postoperative normocalcemia in initial en bloc operations for parathyroid carcinoma. PMID:20051478

  5. A Novel Technique of Intraoperative Lateral Pectoral Nerve Block During Subpectoral Breast Implant Placement

    PubMed Central

    van der Rijt, Rhys; Downs, Catherine; Buckland, Garry

    2016-01-01

    Summary: Breast surgery is one of the most frequently performed surgeries in hospitals and can be associated with significant postoperative pain. We report a novel technique of intraoperative lateral pectoral nerve block under direct vision for analgesia post subpectoral implant placement for breast reconstruction. PMID:27257576

  6. 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

  7. Intraoperative anaphylactic shock in a child with no history of type I hypersensitivity.

    PubMed

    Atanasković-Marković, Marina; Gavrović-Jankulović, Marija; Cirković Velicković, Tanja; Vucković, Olja; Ivanovski, Petar; Nestorivić, Branimir; Cuturilo, Goran; Simić, Dusica

    2008-06-01

    Natural rubber latex is the second most implicated agent in intraoperative anaphylactic reactions. This report describes a case of intraoperative anaphylaxis occurring in a non-atopic fourteen-year-old girl undergoing multiple surgical procedures, but without spina bifida, in which latex surgical gloves were the main culprit for the anaphylactic reactions. Clinical manifestations of an anaphylactic reaction were also experienced during the examination of the possible cause of intraoperative anaphylaxis by skin prick testing with a latex allergen extract. Skin tests with anesthetics were negative. Specific IgE to latex was positive at 92.9 kUA/L (class 5). The molecular basis for the reported intraoperative anaphylaxis was ascribed to three low-molecular mass latex allergens (10-15 kD) detected in the brand of latex surgical gloves used during the operation. Given the potential of a dramatic outcome, latex allergy testing as a regular preoperative measure may contribute to the reduction of anaphylactic reactions during surgical interventions. PMID:18552412

  8. 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

  9. 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

  10. Robotic-assisted laparoscopic wedge resection of a gastric leiomyoma with intraoperative ultrasound localization.

    PubMed

    Abdel Khalek, Mohamed; Joshi, Virendra; Kandil, Emad

    2011-12-01

    Gastric leiomyoma is a rare gastric neoplasm that traditionally has been resected for negative margins using an open approach. The laparoscopic approach may also treat various gastric tumors without opening the gastric cavity. Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Herein, we describe a case of robotic-assisted laparoscopic wedge resection of a gastric leiomyoma. A 63-year-old male complaining of abdominal pain was found to have an incidental 3 cm antral mass on an abdominal CT. Endoscopy with endoscopic ultrasound (EUS) confirmed a submucosal mass. Biopsy of the lesion was consistent with a leiomyoma. The DaVinci robotic system was used for partial gastrectomy and reconstruction, with the addition of intraoperative ultrasound to localize the lesion intraoperatively. Pathological examination of the resected mass confirmed a diagnosis of leiomyoma with negative margins. There were no intraoperative or postoperative complications. The patient was discharged home on the second postoperative day. Intraoperative endoscopic ultrasound is a safe technique that may improve the success rate of surgery by confirming the location of the lesion. Robotic assistance in gastric resection offers an easy minimally invasive approach to such tumors. This approach can achieve adequate surgical margins and lead to short hospital stays. PMID:21919811

  11. 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

  12. Early global warming in the period 1850 to 1920

    NASA Astrophysics Data System (ADS)

    Venema, Victor; Lindau, Ralf; Brandsma, Theo; Auchmann, Renate; Esper, Jan; Haustein, Karsten

    2016-04-01

    The current global temperature datasets show no warming in the land surface temperature and the sea surface temperature for the period between 1850 and 1920. However, several lines of evidence suggest that the Earth's surface was warming during this period. Every line of evidence by itself is currently not compelling, but the consilience of evidence at least makes a good case for further research. This period is characterized by the introduction of Stevenson screens, which reduce radiation errors more than the monitoring methods used before. As a consequence, Stevenson screens typically observe cooler temperatures than earlier observations. Recent analyses of parallel measurements suggest that this cooling bias is larger than previously thought. Physical reasoning suggests this bias to be largest in sub-tropical and tropic regions; this pattern is also found in the limited number of parallel measurements available. We are missing information from continental climates. The Global Historical Climate Network (GHCNv3) does not change the trend between 1870 and 1920 and adjust 0.1°C between 1850 and 1970. This small adjustment seems to be less than needed for this transition compared to the size of this jump estimated from the limited evidence we have from parallel measurements Further evidence for warming during this period can be found in lake and river freeze and breakup times, which show a clear shortening of the freezing period between 1850 and 1920. Most of the glaciers for which we have data from this period show reductions in their lengths, which signals clear warming. Also temperature reconstructions from proxies show warming. The CMIP model ensemble shows 0.2°C warming in the global mean temperature. We will be looking at well-homogenized national datasets and compare them to the national averages from the global collections. For this period we have up to now 3 such comparisons (Austria, Italy and Spain), these have too much scatter relative to the BEST

  13. Experimental soil warming at the treeline shifts fungal communities species

    NASA Astrophysics Data System (ADS)

    Solly, Emily; Lindahl, Björn; Dawes, Melissa; Peter, Martina; Rixen, Christian; Hagedorn, Frank

    2016-04-01

    substantial reduction in fine root biomass (-40%) in warmed soils. In comparison, CO2 enrichment had a weaker effect on the composition of the fungal community. Collectively, our results show that soil warming alters fungal communities both directly, by higher temperature, and indirectly, by an improved nitrogen availability associated with an enhanced SOM cycling. These changes may have a vital effect on several ecosystem processes and, in particular, may alter the rate at which soil organic matter is formed and decomposed.

  14. 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 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 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

  15. 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

  16. Hyperacute abdominal compartment syndrome: an unrecognized complication of massive intraoperative resuscitation for extra-abdominal injuries.

    PubMed

    Rodas, Edgar B; Malhotra, Ajai K; Chhitwal, Reena; Aboutanos, Michel B; Duane, Therese M; Ivatury, Rao R

    2005-11-01

    Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperatively while repair of extra-abdominal injuries is being carried out simultaneous with massive resuscitation for shock caused by those injuries. The charts of patients requiring abdominal decompression (AD) for HACS at time of extra-abdominal surgery at our level I trauma center were reviewed. The following data was gathered: age, Injury Severity Score (ISS), mechanism, resuscitation details, time to AD, time to abdominal closure, and outcome. All continuous data are presented as mean +/- standard error of mean. Hemodynamic and ventilatory data pre- and post-AD was compared using paired t test with significance set at P < 0.05. Five (0.13%) of 3,750 trauma admissions developed HACS during the 15-month study period ending February 2004. Mean age was 32 +/- 7 years, and mean ISS was 19 +/- 2. Four of five patients arrived in hemorrhagic shock (blunt subclavian artery injury, 1; chest gunshot, 1; gunshot to brachial artery, 1; stab transection of femoral vessels, 1) and were immediately operated upon. One of five patients (70% burn) developed HACS during burn wound excision on day 2. HACS developed after massive crystalloid (15 +/- 1.7 L) and blood (11 +/- 0.4 units) resuscitation during prolonged surgery (4.8 +/- 0.8 hours). Pre- versus post-AD comparisons revealed significant (P < 0.05) improvements in mean arterial pressure (55 +/- 6 vs 88 +/- 3 mm Hg), peak airway pressure (44 +/- 5 vs 31 +/- 2 mm Hg), tidal volume (432 +/- 96 vs 758 +/- 93 mL), arterial pH (7.16 +/- 0.0 vs 7.26 +/- 0.04), and PaCO2 (52 +/- 6 vs 45 +/- 6 mm Hg). There was no mortality among the group, and all patients underwent abdominal closure by fascial reapproximation in 2-5 days. Two (40%) of the five patients required extremity fasciotomy for compartment syndrome. HACS is a rare complication of

  17. 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.

  18. 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.

  19. 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.

  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. Galaxy formation in warm dark matter cosmology

    NASA Astrophysics Data System (ADS)

    Menci, N.; Fiore, F.; Lamastra, A.

    2012-04-01

    We investigate for the first time the effects of a warm dark matter (WDM) power spectrum on the statistical properties of galaxies using a semi-analytic model of galaxy formation. The WDM spectrum we adopt as a reference case is suppressed - compared to the standard cold dark matter (CDM) case - below a cut-off scale ≈1 Mpc corresponding (for thermal relic WDM particles) to a mass mX= 0.75 keV. This ensures consistency with present bounds provided by the microwave background Wilkinson Microwave Anisotropy Probe data and by the comparison of hydrodynamical N-body simulations with observed Lyman-α forest. We run our fiducial semi-analytic model with such a WDM spectrum to derive galaxy luminosity functions (in B, UV and K bands) and the stellar mass distributions over a wide range of cosmic epochs, to compare with recent observations and with the results in the CDM case. The predicted colour distribution of galaxies in the WDM model is also checked against the data. When compared with the standard CDM case, the luminosity and stellar mass distributions we obtain assuming a WDM spectrum are characterized by (i) flattening of the faint-end slope and (ii) sharpening of the cut-off at the bright end for z≲ 0.8. We discuss how the former result is directly related to the smaller number of low-mass haloes collapsing in the WDM scenario, while the latter is related to the smaller number of satellite galaxies accumulating in massive haloes at a low redshift, thus suppressing the accretion of small lumps on the central, massive galaxies. These results shows how adopting a WDM power spectrum may contribute to solving two major problems of CDM galaxy formation scenarios, namely, the excess of predicted faint (low-mass) galaxies at low and - most of all - high redshifts, and the excess of bright (massive) galaxies at low redshifts.

  2. Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

    PubMed Central

    2013-01-01

    Background Implantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered. Methods In a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%. Results Five patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures. Conclusion Implantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs. PMID:23577747

  3. 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.

  4. Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride

    PubMed Central

    Horvath, K; Vultur, F; Simon, V; Voidazan, S; Mühlfay, 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

  5. Tailoring Adjuvant Radiation Therapy by Intraoperative Imaging to Detect Residual Cancer.

    PubMed

    Whitley, Melodi J; Weissleder, Ralph; Kirsch, David G

    2015-10-01

    For many solid cancers, radiation therapy is offered as an adjuvant to surgical resection to lower rates of local recurrence and improve survival. However, a subset of patients treated with surgery alone will not have a local recurrence. Currently, there is no way to accurately determine which patients have microscopic residual disease in the tumor bed after surgery and therefore are most likely to benefit from adjuvant radiation therapy. To address this problem, a number of technologies have been developed to try to improve margin assessment of resected tissue and to detect residual cancer in the tumor bed. Moreover, some of these approaches have been translated from the preclinical arena into clinical trials. Here, we review different types of intraoperative molecular imaging systems for cancer. Optical imaging techniques like epi-illumination, fluorescence molecular tomography and optoacoustic imaging can be coupled with exogenous fluorescent imaging probes that accumulate in tumors passively via the enhanced permeability and retention effect or are targeted to tumor tissues based on affinity or enzyme activity. In these approaches, detection of fluorescence in the tumor bed may indicate residual disease. Protease activated probes have generated great interest because of their potential for leading to high tumor to normal contrast. Recently, the first Phase I clinical trial to assess the safety and activation of a protease activated probe was conducted. Spectroscopic methods like radiofrequency spectroscopy and Raman spectroscopy, which are based on energy absorption and scattering, respectively, have also been tested in humans and are able to distinguish between normal and tumors tissues intraoperatively. Most recently, multimodal contrast agents have been developed that target tumors and contain both fluorescent dyes and magnetic resonance imaging contrast agents, allowing for preoperative planning and intraoperative margin assessment with a single contrast

  6. Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication

    PubMed Central

    2012-01-01

    Background Atrioventricular block (AVB) is a well-reported complication after closure of perimembranous ventricular septal defects (VSDs). To report the occurrence of AVB either during or following closure of perimembranous VSDs using a novel "hybrid" method involving a minimal inferior median incision and of intraoperative device closure of the perimembranous VSDs. Methods Between January 2009 and January 2011, patients diagnosed with perimembranous VSDs eligible for intraoperative device closure with a domestic occluder were identified. All patients were assessed by real-time transesophageal echocardiography (TEE) and electrocardiography. Results Of the 97 included patients, 94 were successfully occluded using this approach. Complete AVB occurred in only one case and one case of Mobitz type II AVB was diagnosed intraoperatively. In both patients, the procedure was aborted and the AVBs quickly resolved. Glucocorticosteroids were administered to another two patients who developed Mobitz type II AVB intraoperatively. Those two patients converted to Mobitz type I AVB 3 days and 5 days postsurgically. During the follow-up period (range, 6-24 months), one patient developed complete AVB 1 week following device insertion. Surgical device removal was followed by a rapid and complete recovery of atrioventricular conduction. Conclusions Intraoperative device closure of perimembranous VSDs with a domestic occluder resulted in excellent closure rates; however, AVB is a serious complication that can occur either during or any time after device closure of perimembranous VSDs. The technique described herein may reduce the incidence of perioperative AVB complications. Surgeons are encouraged to closely monitor all patients postsurgically to ensure AVB does not occur in their patients. Additional long-term data to better identify the prevalence and risk factors for AVB in treated patients are needed. PMID:22458934

  7. 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

  8. The Effect of Intraoperative Infusion of Dexmedetomidine on Quality of Recovery after Major Spinal Surgery

    PubMed Central

    Bekker, Alex; Haile, Michael; Kline, Richard; Didehvar, Sorosch; Babu, Ramesh; Martiniuk, Frank; Urban, Michael

    2013-01-01

    Background Surgery induces a variety of metabolic, endocrine and immune changes collectively known as the “stress response”, which often may lead to prolonged post-operative convalescence. Anesthetic management may modulate this physiological response thus affecting the postoperative course. We hypothesized that the intraoperative administration of dexmedetomidine (DEX), a sympatholytic agent, would reduce the stress response and improve the quality of recovery in patients undergoing major surgery. Methods We conducted a prospective randomized double-blinded study of 54 patients undergoing multilevel spinal fusion. Anesthesia was maintained with either propofol/fentanyl/dexmedetomidine (PFD) or propofol/fentanyl/placebo-saline (PFS). The quality of recovery (a primary end point) was assessed using a 40-item quality of recovery questionnaire (QoR40) and a 9 questions fatigue scale (FFS). The tests were administered preoperatively, on postoperative days (POD) 1, 2, 3 and 30. Blood samples were collected at baseline, in the post-anesthesia care unit (PACU) and POD 1 and were analyzed for levels of cortisol, C-reactive proteins (CRP) as well as the cytokines IL-1α, IL-1β, IL-1ra, IL-2, IL-6, IL-8, IL-10, and TNFα. Data were analyzed with SPSS software (version 18) using multivariate and mixed model approach to test for the effect of surgery and drug group. Pairwise comparisons were assessed with t-test or rank tests after correcting for multiple comparisons. Results The global QoR40 scores showed a significant effect of time (F4, 114= 22.63, p < 0.001), and drug ((F1, 51= 4.368, p = 0.042) with average scores falling to lower values on POD 1 (163.63 ± 2.47) and POD 2 (170.94 ± 2.38) than on baseline (180.56 ± 1.588, mean ± SE, 2-tailed t-tests, p<0.001). By POD 3, scores were significantly lower (−13.74 point difference, p=0.005) in the PFS group (169.3 ± 3.87) than in the PFD group (183.04 ± 2.76). All patients reported significantly higher levels of

  9. Relative roles of differential SST warming, uniform SST warming and land surface warming in determining the Walker circulation changes under global warming

    NASA Astrophysics Data System (ADS)

    Zhang, Lei; Li, Tim

    2016-04-01

    Most of CMIP5 models projected a weakened Walker circulation in tropical Pacific, but what causes such change is still an open question. By conducting idealized numerical simulations separating the effects of the spatially uniform sea surface temperature (SST) warming, extra land surface warming and differential SST warming, we demonstrate that the weakening of the Walker circulation is attributed to the western North Pacific (WNP) monsoon and South America land effects. The effect of the uniform SST warming is through so-called "richest-get-richer" mechanism. In response to a uniform surface warming, the WNP monsoon is enhanced by competing moisture with other large-scale convective branches. The strengthened WNP monsoon further induces surface westerlies in the equatorial western-central Pacific, weakening the Walker circulation. The increase of the greenhouse gases leads to a larger land surface warming than ocean surface. As a result, a greater thermal contrast occurs between American Continent and equatorial Pacific. The so-induced zonal pressure gradient anomaly forces low-level westerly anomalies over the equatorial eastern Pacific and weakens the Walker circulation. The differential SST warming also plays a role in driving low-level westerly anomalies over tropical Pacific. But such an effect involves a positive air-sea feedback that amplifies the weakening of both east-west SST gradient and Pacific trade winds.

  10. INTRAOPERATIVE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING AFTER INTERNAL LIMITING MEMBRANE PEELING IN IDIOPATHIC EPIRETINAL MEMBRANE WITH CONNECTING STRANDS

    PubMed Central

    NAM, DONG HEUN; DESOUZA, PHILIP J.; HAHN, PAUL; TAI, VINCENT; SEVILLA, MONICA B.; TRAN-VIET, DU; CUNEFARE, DAVID; FARSIU, SINA; IZATT, JOSEPH A.; TOTH, CYNTHIA A.

    2015-01-01

    Purpose To report the intraoperative optical coherence tomography findings in idiopathic epiretinal membrane (ERM) with connecting strands and to describe the postoperative outcomes. Methods A retrospective, case series study within a prospective observational intraoperative optical coherence tomography imaging study was performed. Epiretinal membranes with connecting strands were characterized on preoperative spectral domain optical coherence tomography images and assessed against corresponding intraoperative (after internal limiting membrane [ILM] peeling) and postoperative spectral domain optical coherence tomography images. Results Eleven locations of the connecting strands in 7 eyes were studied. The connecting strands had visible connections from the inner retinal surface to the ERM in all locations, and the reflectivity was moderate in 8 locations and high in 3 locations. After ERM and ILM peeling, disconnected strands were identified in all of the intraoperative optical coherence tomography images. The reflectivity of the remaining intraoperative strands was higher than that of the preoperative lesions and appeared as “finger-like” and branching projections. The remaining disconnected lesions were contiguous with the inner retinal layers. Postoperatively, the intraoperative lesions disappeared completely in all locations, and recurrent formation of ERM was not identified in any eyes. Conclusion In ERM eyes with connecting strands, intraoperative spectral domain optical coherence tomography imaging showed moderately to highly reflective sub-ILM finger-like lesions that persist immediately after membrane and ILM peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously without localized nerve fiber layer loss. The sub-ILM connecting strands may represent glial retinal attachments. PMID:25829349

  11. 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.

  12. Intraoperative MRI for deep brain stimulation lead placement in Parkinson's disease: 1 year motor and neuropsychological outcomes.

    PubMed

    Sidiropoulos, Christos; Rammo, Richard; Merker, Brad; Mahajan, Abhimanyu; LeWitt, Peter; Kaminski, Patricia; Womble, Melissa; Zec, Adrianna; Taylor, Danette; Wall, Julia; Schwalb, Jason M

    2016-06-01

    Traditional deep brain stimulation requires intraoperative neurophysiological confirmation of electrode placement. Recently, purely image guided methods are being evaluated as to their clinical efficacy in comparison to surgery using microelectrode recordings. We used the ClearPoint(®) system to place electrodes in both the subthalamic nucleus and globus pallidus internus in patients with advanced Parkinson's disease. Off medication UPDRS scores were assessed before and 1 year after surgery as well as pre- and 1 year post-operative neuropsychological outcomes. Targeting precision was also assessed. Patients implanted in the subthalamic nucleus improved by 46.2 % in their UPDRS scores post-operatively (p = 0.03) whereas the globus pallidus group improved by 41 % (p = 0.06). There were no significant adverse neuropsychological outcomes in either group of patients. Mean radial error for the STN group was 1.2 ± 0.7 mm and for the GPi group 0.8 mm ± 0.3 mm. Image guided DBS using the ClearPoint(®)system has high targeting precision with robust clinical outcomes. Our data are in accord with recent studies using the same or similar technologies and provide a rationale for a large comparative study of image-guided versus microelectrode guided DBS. PMID:27126457

  13. Intra-operative specimen analysis using faxitron microradiography for excision of mammographically suspicious, non-palpable breast lesions.

    PubMed

    Muttalib, M; Tisdall, M; Scawn, R; Shousha, S; Cummins, R S; Sinnett, H D

    2004-08-01

    Recent advances in digital imaging have made Faxitron microradiography an attractive alternative to intra-operative conventional specimen radiography (CSR) for the excision of wire-localized breast lesions. Faxitron specimen analysis time, usefulness of digital image manipulation and re-excision rates were evaluated in comparison to CSR in 299 consecutive wire-localized excisions for mammographically suspicious non-palpable breast lesions (172 procedures with Faxitron, 127 with CSR) in a non-randomized study. The corresponding mean operation times were 34.7 vs. 42.7 min and the respective re-excision rates were 19.8% vs. 31.5% (no significant difference on chi analysis P < 0.1). Faxitron digital image manipulation led to cavity biopsies in 50% (60/121) of the cancer excisions. In 19 of these (16%), histological excision margins were converted from incomplete to complete. The shorter Faxitron mean operating time enables an additional wire-localized operation per theatre list. Digital imaging guides the surgeon for additional cavity biopsies, resulting in re-excision rates as good as CSR. PMID:15325665

  14. Hot/Warm Gas Cleanup

    SciTech Connect

    Bissett, Larry A.

    2001-11-06

    Using regenerable sorbents and transport or fluid-bed contacting, the Gas Process Development Unit (GPDU) at NETL-Morgantown will be used to demonstrate the process feasibility of removing sulfur from coal gasification or other fuel gas streams at temperatures above dew point of the gas. This technology, also known as hot or warm gas desulfurization, is expected to remove sulfur to concentrations lower than conventional systems at comparable cost. The project was constructed under the U.S. Department of Energy (DOE) Integrated Gasification Combined Cycle (IGCC) power system program and is an ''enabling technology'' in the Vision 21 program. The GPDU was designed to be the smallest scale research and development facility capable of providing viable scale-up design data for new integrated transport or fluid-bed desulfurization processes. With the capability to test at process conditions representative of anticipated commercial applications in terms of temperatures, pressures, major compositions, velocities, and sorbent cycling, the unit is expected to generate important information on process control, configuration, and sorbent suitability. In this way, the GPDU fills a strategic role between past/current small-scale testing and large-scale demonstrations. A primary objective of the project is to gain insight into which reactor combination (i.e., both transport, both fluid bed, or mixed) is more suitable for desulfurization technology and why. Assuming process feasibility is demonstrated, this guides future development or commercial ventures by answering the question of what to build, and provides performance and scale-up data (e.g., required transport reactor densities). Another important objective, which naturally derives from the process development activities, is demonstration of sorbent suitability and readiness for commercial deployment (e.g., sorbent attrition and cycle life). In this sense, the GPDU can serve as a final testing ground to reduce the risks of

  15. Global Warming Estimation from MSU

    NASA Technical Reports Server (NTRS)

    Prabhakara, C.; Iacovazzi, Robert; Yoo, Jung-Moon

    1998-01-01

    Microwave Sounding Unit (MSU) radiometer observations in Ch 2 (53.74 GHz) from sequential, sun-synchronous, polar-orbiting NOAA satellites contain small systematic errors. Some of these errors are time-dependent and some are time-independent. Small errors in Ch 2 data of successive satellites arise from calibration differences. Also, successive NOAA satellites tend to have different Local Equatorial Crossing Times (LECT), which introduce differences in Ch 2 data due to the diurnal cycle. These two sources of systematic error are largely time independent. However, because of atmospheric drag, there can be a drift in the LECT of a given satellite, which introduces time-dependent systematic errors. One of these errors is due to the progressive chance in the diurnal cycle and the other is due to associated chances in instrument heating by the sun. In order to infer global temperature trend from the these MSU data, we have eliminated explicitly the time-independent systematic errors. Both of the time-dependent errors cannot be assessed from each satellite. For this reason, their cumulative effect on the global temperature trend is evaluated implicitly. Christy et al. (1998) (CSL). based on their method of analysis of the MSU Ch 2 data, infer a global temperature cooling trend (-0.046 K per decade) from 1979 to 1997, although their near nadir measurements yield near zero trend (0.003 K/decade). Utilising an independent method of analysis, we infer global temperature warmed by 0.12 +/- 0.06 C per decade from the observations of the MSU Ch 2 during the period 1980 to 1997.

  16. A Scientific Look at Global Warming

    NASA Astrophysics Data System (ADS)

    Glanz, Peter

    2007-10-01

    Scientists like we should ask ``Where's the Beef?'' when a global warming discussion comes up. Current issues like melting glaciers, rising sea levels, disappearing polar bears and increasing tornado activity (among many) are put to the WTB test.

  17. Carbon cycle: Global warming then and now

    NASA Astrophysics Data System (ADS)

    Stassen, Peter

    2016-04-01

    A rapid warming event 55.8 million years ago was caused by extensive carbon emissions. The rate of change of carbon and oxygen isotopes in marine shelf sediments suggests that carbon emission rates were much slower than anthropogenic emissions.

  18. Global temperatures and the global warming ``debate''

    NASA Astrophysics Data System (ADS)

    Aubrecht, Gordon

    2009-04-01

    Many ordinary citizens listen to pronouncements on talk radio casting doubt on anthropogenic global warming. Some op-ed columnists likewise cast doubts, and are read by credulous citizens. For example, on 8 March 2009, the Boston Globe published a column by Jeff Jacoby, ``Where's global warming?'' According to Jacoby, ``But it isn't such hints of a planetary warming trend that have been piling up in profusion lately. Just the opposite.'' He goes on to write, ``the science of climate change is not nearly as important as the religion of climate change,'' and blamed Al Gore for getting his mistaken views accepted. George Will at the Washington Post also expressed denial. As a result, 44% of U.S. voters, according to the January 19 2009 Rasmussen Report, blame long-term planetary trends for global warming, not human beings. Is there global cooling, as skeptics claim? We examine the temperature record.

  19. Chamberless residential warm air furnace design

    SciTech Connect

    Godfree, J.

    1996-07-01

    This brief paper is an introduction to the concept of designing residential warm air furnaces without combustion chambers. This is possible since some small burners do not require the thermal support of a combustion chamber to complete the combustion process.

  20. Observational constraints on monomial warm inflation

    NASA Astrophysics Data System (ADS)

    Visinelli, Luca

    2016-07-01

    Warm inflation is, as of today, one of the best motivated mechanisms for explaining an early inflationary period. In this paper, we derive and analyze the current bounds on warm inflation with a monomial potential U propto phip, using the constraints from the PLANCK mission. In particular, we discuss the parameter space of the tensor-to-scalar ratio r and the potential coupling λ of the monomial warm inflation in terms of the number of e-folds. We obtain that the theoretical tensor-to-scalar ratio r ~ 10‑8 is much smaller than the current observational constrain r lesssim 0.12, despite a relatively large value of the field excursion Δ phi ~ 0.1MPl. Warm inflation thus eludes the Lyth bound set on the tensor-to-scalar ratio by the field excursion.

  1. 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

  2. Scaling Potential Evapotranspiration with Greenhouse Warming (Invited)

    NASA Astrophysics Data System (ADS)

    Scheff, J.; Frierson, D. M.

    2013-12-01

    Potential evapotranspiration (PET) is a supply-independent measure of the evaporative demand of a terrestrial climate, of basic importance in climatology, hydrology, and agriculture. Future increases in PET from greenhouse warming are often cited as key drivers of global trends toward drought and aridity. The present work computes recent and business-as-usual-future Penman-Monteith (i.e. physically-based) PET fields at 3-hourly resolution in 14 modern global climate models. The %-change in local annual-mean PET over the upcoming century is almost always positive, modally low double-digit in magnitude, usually increasing with latitude, yet quite divergent between models. These patterns are understood as follows. In every model, the global field of PET %-change is found to be dominated by the direct, positive effects of constant-relative-humidity warming (via increasing vapor pressure deficit and increasing Clausius-Clapeyron slope.) This direct-warming term very accurately scales as the PET-weighted (warm-season daytime) local warming, times 5-6% per degree (related to the Clausius-Clapeyron equation), times an analytic factor ranging from about 0.25 in warm climates to 0.75 in cold climates, plus a small correction. With warming of several degrees, this product is of low double-digit magnitude, and the strong temperature dependence gives the latitude dependence. Similarly, the inter-model spread in the amount of warming gives most of the spread in this term. Additional spread in the total change comes from strong disagreement on radiation, relative-humidity, and windspeed changes, which make smaller yet substantial contributions to the full PET %-change fields.

  3. 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.

    1995-06-01

    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 seven percent 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 3-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. Crack tip 3DEPFE analysis indicated that partially unloaded and completely unloaded data should be treated separately, and that the amount of unloading is unimportant for partially unloaded data. The regression models, which use K{sub I} at WPS (K{sub Iwps}) and K{sub Ic} as independent variables, better represented the WPS benefit than did the more complicated Chell model. An adequate accounting was made for constraint in the WPS experiments. The subclad flaw data support the use of the partial unload regression model, provided that some care is taken to represent the effect of intact cladding if present. The effect of strain aging at or below 260 C (500 F) on WPS benefit was of no consequence for the pressure vessel steels and WPS temperatures used to derive the regression models. The presence of ductile tearing precludes the use of the regression models. The regression model for partial unloading accurately predicted the behavior of full scale

  4. Global warming and nuclear power

    SciTech Connect

    Wood, L., LLNL

    1998-07-10

    -fold reduction might be attained. Even the first such halving of carbon intensivity of stationary-source energy production world-wide might permit continued slow power-demand growth in the highly developed countries and rapid development of the other 80% of the world, both without active governmental suppression of fossil fuel usage - while also stabilizing carbon input-rates into the Earth`s atmosphere. The second two-fold reduction might obviate most global warming concerns.

  5. Televised news coverage of global warming

    SciTech Connect

    Nitz, M.; Jarvis, S.; Kenski, H.

    1996-12-31

    Citizens are expressing increased concern over the number and variety of environmental problems. Global warming in particular is a focus of concern for scientists and environmental groups. Such concern should naturally motivate individuals to seek information about these topics. Many people turn to the media, most usually television, for information on the nature of these problems. Consequently, this paper studied media coverage of environmental issues, specifically global warming. Television coverage was examined for: (1) the general nature of coverage, (2) biases in coverage, (3) visual images used to cover global warming, and (4) the congruity between visual and verbal messages in newscasts. Nightly newscasts from the three major American television networks were analyzed from 1993--1995 to determine the overall nature of global warming coverage since the Earth Summit in 1992. Results indicated that television news suffers from some serious inadequacies in its portrayal of global warming issues. The paper concludes by first discussing how its results intertwine with other work in the global warming and mass media field. Finally, the implications of inadequacies in media coverage for policy-makers when it comes to sound management of critical resources in this area are also discussed.

  6. Television news coverage of global warming

    SciTech Connect

    Nitz, M.; Jarvis, S.; Kenski, H.

    1996-06-01

    Citizens are expressing increased concern over the number and variety of environmental problems. Global warming in particular is a focus of concern for scientists and environmental groups. Such concern should naturally motivate individuals to seek information about these topics. Many people turn to the media, most usually television, for information on the nature of these problems. Consequently, this paper studied media coverage of environmental issues, specifically global warming. Television coverage was examined for: (1) the general nature of coverage; (2) biases in coverage; (3) visual images used to cover global warming; and (4) the congruity between visual and verbal messages in newscasts. Nightly newscasts from the three major American television networks were analyzed from 1993--1995 to determine the overall nature of global warming coverage since the Earth Summit in 1992. Results indicated that television news suffers from some serious inadequacies in its portrayal of global warming issues. The paper concludes by first discussing how its results intertwine with other work in the global warming and mass media field. Finally, the implications of inadequacies in media coverage for policy-makers when it comes to sound management of critical resources in this area are also discussed.

  7. Metagenomics-Enabled Understanding of Soil Microbial Feedbacks to Climate Warming

    NASA Astrophysics Data System (ADS)

    Zhou, J.; Wu, L.; Zhili, H.; Kostas, K.; Luo, Y.; Schuur, E. A. G.; Cole, J. R.; Tiedje, J. M.

    2014-12-01

    Understanding the response of biological communities to climate warming is a central issue in ecology and global change biology, but it is poorly understood microbial communities. To advance system-level predictive understanding of the feedbacks of belowground microbial communities to multiple climate change factors and their impacts on soil carbon (C) and nitrogen (N) cycling processes, we have used integrated metagenomic technologies (e.g., target gene and shotgun metagenome sequencing, GeoChip, and isotope) to analyze soil microbial communities from experimental warming sites in Alaska (AK) and Oklahoma (OK), and long-term laboratory incubation. Rapid feedbacks of microbial communities to warming were observed in the AK site. Consistent with the changes in soil temperature, moisture and ecosystem respiration, microbial functional community structure was shifted after only 1.5-year warming, indicating rapid responses and high sensitivity of this permafrost ecosystem to climate warming. Also, warming stimulated not only functional genes involved in aerobic respiration of both labile and recalcitrant C, contributing to an observed 24% increase in 2010 growing season and 56% increase of decomposition of a standard substrate, but also functional genes for anaerobic processes (e.g., denitrification, sulfate reduction, methanogenesis). Further comparisons by shotgun sequencing showed significant differences of microbial community structure between AK and OK sites. The OK site was enriched in genes annotated for cellulose degradation, CO2 production, denitrification, sporulation, heat shock response, and cellular surface structures (e.g., trans-membrane transporters for glucosides), while the AK warmed plots were enriched in metabolic pathways related to labile C decomposition. Together, our results demonstrate the vulnerability of permafrost ecosystem C to climate warming and the importance of microbial feedbacks in mediating such vulnerability.

  8. The importance of warm season warming to western U.S. streamflow changes

    USGS Publications Warehouse

    Das, T.; Pierce, D.W.; Cayan, D.R.; Vano, J.A.; Lettenmaier, D.P.

    2011-01-01

    Warm season climate warming will be a key driver of annual streamflow changes in four major river basins of the western U.S., as shown by hydrological model simulations using fixed precipitation and idealized seasonal temperature changes based on climate projections with SRES A2 forcing. Warm season (April-September) warming reduces streamflow throughout the year; streamflow declines both immediately and in the subsequent cool season. Cool season (October-March) warming, by contrast, increases streamflow immediately, partially compensating for streamflow reductions during the subsequent warm season. A uniform warm season warming of 3C drives a wide range of annual flow declines across the basins: 13.3%, 7.2%, 1.8%, and 3.6% in the Colorado, Columbia, Northern and Southern Sierra basins, respectively. The same warming applied during the cool season gives annual declines of only 3.5%, 1.7%, 2.1%, and 3.1%, respectively. Copyright 2011 by the American Geophysical Union.

  9. Warming shifts `worming': effects of experimental warming on invasive earthworms in northern North America

    NASA Astrophysics Data System (ADS)

    Eisenhauer, Nico; Stefanski, Artur; Fisichelli, Nicholas A.; Rice, Karen; Rich, Roy; Reich, Peter B.

    2014-11-01

    Climate change causes species range shifts and potentially alters biological invasions. The invasion of European earthworm species across northern North America has severe impacts on native ecosystems. Given the long and cold winters in that region that to date supposedly have slowed earthworm invasion, future warming is hypothesized to accelerate earthworm invasions into yet non-invaded regions. Alternatively, warming-induced reductions in soil water content (SWC) can also decrease earthworm performance. We tested these hypotheses in a field warming experiment at two sites in Minnesota, USA by sampling earthworms in closed and open canopy in three temperature treatments in 2010 and 2012. Structural equation modeling revealed that detrimental warming effects on earthworm densities and biomass could indeed be partly explained by warming-induced reductions in SWC. The direction of warming effects depended on the current average SWC: warming had neutral to positive effects at high SWC, whereas the opposite was true at low SWC. Our results suggest that warming limits the invasion of earthworms in northern North America by causing less favorable soil abiotic conditions, unless warming is accompanied by increased and temporally even distributions of rainfall sufficient to offset greater water losses from higher evapotranspiration.

  10. Warming shifts ‘worming': effects of experimental warming on invasive earthworms in northern North America

    PubMed Central

    Eisenhauer, Nico; Stefanski, Artur; Fisichelli, Nicholas A.; Rice, Karen; Rich, Roy; Reich, Peter B.

    2014-01-01

    Climate change causes species range shifts and potentially alters biological invasions. The invasion of European earthworm species across northern North America has severe impacts on native ecosystems. Given the long and cold winters in that region that to date supposedly have slowed earthworm invasion, future warming is hypothesized to accelerate earthworm invasions into yet non-invaded regions. Alternatively, warming-induced reductions in soil water content (SWC) can also decrease earthworm performance. We tested these hypotheses in a field warming experiment at two sites in Minnesota, USA by sampling earthworms in closed and open canopy in three temperature treatments in 2010 and 2012. Structural equation modeling revealed that detrimental warming effects on earthworm densities and biomass could indeed be partly explained by warming-induced reductions in SWC. The direction of warming effects depended on the current average SWC: warming had neutral to positive effects at high SWC, whereas the opposite was true at low SWC. Our results suggest that warming limits the invasion of earthworms in northern North America by causing less favorable soil abiotic conditions, unless warming is accompanied by increased and temporally even distributions of rainfall sufficient to offset greater water losses from higher evapotranspiration. PMID:25363633

  11. Warming shifts 'worming': effects of experimental warming on invasive earthworms in northern North America.

    PubMed

    Eisenhauer, Nico; Stefanski, Artur; Fisichelli, Nicholas A; Rice, Karen; Rich, Roy; Reich, Peter B

    2014-01-01

    Climate change causes species range shifts and potentially alters biological invasions. The invasion of European earthworm species across northern North America has severe impacts on native ecosystems. Given the long and cold winters in that region that to date supposedly have slowed earthworm invasion, future warming is hypothesized to accelerate earthworm invasions into yet non-invaded regions. Alternatively, warming-induced reductions in soil water content (SWC) can also decrease earthworm performance. We tested these hypotheses in a field warming experiment at two sites in Minnesota, USA by sampling earthworms in closed and open canopy in three temperature treatments in 2010 and 2012. Structural equation modeling revealed that detrimental warming effects on earthworm densities and biomass could indeed be partly explained by warming-induced reductions in SWC. The direction of warming effects depended on the current average SWC: warming had neutral to positive effects at high SWC, whereas the opposite was true at low SWC. Our results suggest that warming limits the invasion of earthworms in northern North America by causing less favorable soil abiotic conditions, unless warming is accompanied by increased and temporally even distributions of rainfall sufficient to offset greater water losses from higher evapotranspiration. PMID:25363633

  12. Intraoperative acquired pressure ulcer on lower lip: a complication of rhinoplasty.

    PubMed

    Yamashita, Masanobu; Nishio, Akiko; Daizo, Haruhisa; Kishibe, Miyuki; Shimada, Kenichi

    2014-01-01

    Device-related pressure ulcers are not rare. However, few studies have reported pressure ulcers of the lower lip. We encountered 2 patients with an intraoperative pressure ulcer on the lower lip caused by an endotracheal tube during rhinoplasty. A 46-year-old man showed a deviated nose and nasal obstruction. Surgery was performed under general anesthesia with endotracheal intubation. The surgery time was 270 minutes. A 23-year-old man also showed a deviated nose and nasal obstruction. Surgery was performed under general anesthesia in the same fashion. The surgery time was 273 minutes. A preformed endotracheal tube was inserted and positioned over the mandible and secured with polyurethane film intraoperatively. Both patients had pressure ulcers on their lower lip. One showed a slightly visible scar. Care must be taken to avoid ulcers of the lower lip in rhinoplasty patients. PMID:24275776

  13. An intraoperative probe combining positron detection and OCT imaging for ovarian cancer detection and characterization

    NASA Astrophysics Data System (ADS)

    Yang, Yi; Wang, Tianheng; Biswal, Nrusingh; Kumavor, Patrick; Wang, Xiaohong; Karimeddini, Mozafareddin; Vento, John; Sanders, Melinda; Brewer, Molly; Zhu, Quing

    2012-01-01

    In this paper, we report an intraoperative approach by combining optical coherence tomography (OCT) and position detection to detect and characterize ovarian cancers. A total of 18 ovaries were studied ex vivo. Based on histopathology result, they were classified into normal and malignant groups, respectively. On average positron count rate of 8.0-fold higher was found between malignant and normal ovaries. OCT imaging of ovaries revealed many detailed morphologic features that could be potentially valuable for detecting early malignant changes in ovarian tissue. Optical scattering coefficients of these ovaries were estimated from OCT A-lines. Normal ovarian tissue showed higher scattering coefficient than that of malignant ovarian tissue. Using a threshold of 2.00 mm-1 for all ovaries, a sensitivity of 100% and a specificity of 100% were achieved. This initial data shows our intraoperative probe based on OCT and positron detection has a great potential for ovarian cancer detection and characterization.

  14. 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

  15. A Case Series of Rapid Prototyping and Intraoperative Imaging in Orbital Reconstruction

    PubMed Central

    Lim, Christopher G.T.; Campbell, Duncan I.; Cook, Nicholas; Erasmus, Jason

    2014-01-01

    In Christchurch Hospital, rapid prototyping (RP) and intraoperative imaging are the standard of care in orbital trauma and has been used since February 2013. RP allows the fabrication of an anatomical model to visualize complex anatomical structures which is dimensionally accurate and cost effective. This assists diagnosis, planning, and preoperative implant adaptation for orbital reconstruction. Intraoperative imaging involves a computed tomography scan during surgery to evaluate surgical implants and restored anatomy and allows the clinician to correct errors in implant positioning that may occur during the same procedure. This article aims to demonstrate the potential clinical and cost saving benefits when both these technologies are used in orbital reconstruction which minimize the need for revision surgery. PMID:26000080

  16. Intraoperative transesophageal two-dimensional echocardiography: a basic vertical plane patient examination sequence.

    PubMed Central

    Rafferty, T. D.; Tousignant, G.

    1995-01-01

    We have previously reported a standardized stepwise transesophageal echocardiography transverse plane (monoplane) patient examination sequence suitable for intraoperative use. Biplane transesophageal echocardiography furnishes images of the heart and great vessels in both transverse and vertical planes. This report describes a seven-step vertical plane examination, the completion component of a comprehensive intraoperative biplane evaluation. Each step is illustrated by presentation of a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. Examples of clinical presentations complete the report. Images Figure 2 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14a Figure 14b Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21a Figure 21b Figure 21c PMID:8792603

  17. Pelvic intraoperative neuromonitoring during robotic-assisted low anterior resection for rectal cancer.

    PubMed

    Grade, Marian; Beham, Alexander W; Schüler, P; Kneist, Werner; Ghadimi, B Michael

    2016-06-01

    While the oncological outcome of patients with rectal cancer has been considerably improved within the last decades, anorectal, urinary and sexual functions remained impaired at high levels, regardless of whether radical surgery was performed open or laparoscopically. Consequently, intraoperative monitoring of the autonomic pelvic nerves with simultaneous electromyography of the internal anal sphincter and manometry of the urinary bladder has been introduced to advance nerve-sparing surgery and to improve functional outcome. Initial results suggested that pelvic neuromonitoring may result in better functional outcomes. Very recently, it has also been demonstrated that minimally invasive neuromonitoring is technically feasible. Because, to the best of our knowledge, pelvic neuromonitoring has not been performed during robotic surgery, we report the first case of robotic-assisted low anterior rectal resection combined with intraoperative monitoring of the autonomic pelvic nerves. PMID:26705113

  18. A Case Report of Preoperative, Intraoperative, and Postoperative Anterior Chamber Shallowing Resulting from Different Mechanisms.

    PubMed

    Mori, Yujiro; Ikeda, Yoshifumi; Sano, Ichiya; Fujihara, Etsuko; Tanito, Masaki

    2016-01-01

    A 54-year-old woman with an epiretinal membrane in her left eye accompanied by a shallow anterior chamber due to primary angle closure glaucoma underwent vitrectomy and cataract surgery. During the cataract surgery, immediately after the ultrasonic tip had been removed from the anterior chamber, anterior chamber flattening occurred. An intraoperative fundus examination showed the development of acute intraoperative choroidal effusion. Postoperatively, the anterior chamber remained shallow even after the choroidal detachment had subsided; capsular bag distension seen by ultrasound biomicroscopy suggested the development of early postoperative capsular block syndrome. After neodymium:yttrium-aluminium-garnet laser capsulotomy, the anterior chamber deepened. Depending on the perioperative period, the mechanism of a flat anterior chamber can change, and understanding the underlying mechanisms is required for appropriate treatment. PMID:27293412

  19. A novel device for intraoperative cauterization of bleeding points in endoscopic sinus surgery.

    PubMed

    Pagella, Fabio; Pusateri, Alessandro; Berardi, Anna; Zaccari, Dario; Avato, Irene; Matti, Elina

    2016-08-01

    Hemostasis is a critical point in endoscopic sinus and skull base surgery. A variety of techniques are presently available for reducing intraoperative bleeding; however, several limitations of the classical instruments should be stated. For example, reaching bleeding points in an anatomically angled site with straightforward bipolar devices could be quite difficult. With the aim of solving this problem, we developed a simple system using a standard curved suction tube, a rubber catheter and a monopolar system. This device provides an integrated suction function and is able to reach all paranasal and skull base areas, making it extremely useful in gaining precise access to the site of bleeding while providing excellent endoscopic vision. The described monopolar suction tube has proven to be a valid instrument for intraoperative hemostasis in endoscopic procedures; moreover, it does not add any further cost, making it applicable in particular healthcare settings, such as those in developing countries. PMID:27216302

  20. An extraordinary mechanism causing intraoperative migration of the Kirschner-wire.

    PubMed

    Eroğlu, Mehmet; Özcan, Özal; Şentürk, İhsan; Yücehan, 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