Science.gov

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. 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.

  10. 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

  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. 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

  20. 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.

  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. 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.

  12. 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

  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. 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

  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. 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

  17. 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

  18. 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

  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. 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.

  4. 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

  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. 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

  8. 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

  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. 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

  12. 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.

  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 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

  3. 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

  4. 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

  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

    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

  7. 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.

  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. 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

  15. 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

  16. 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

  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. Goal-directed therapy in intraoperative fluid and hemodynamic management

    PubMed Central

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

    2013-01-01

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

  8. 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

  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. 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

  11. 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

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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

  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. 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.

  19. 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.

  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. 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.

  3. 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.

  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. 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

  8. 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

  9. 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

  10. 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

  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. [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

  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. 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

  16. 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

  17. 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.

  18. 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

  19. 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,…

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  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. 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.

  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. 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

  12. 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).

  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. 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.

  9. 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

  10. 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

  11. 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

  12. [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

  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. 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

  17. 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

  18. [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

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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

  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. 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.

  9. 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.

  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. [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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. 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…

  9. 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.

  10. 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

  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. 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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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...

  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.