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1

[Multidirectional shoulder instability and open surgical procedures].  

PubMed

The principles and procedures for multidirectional instability do not substantially differ from those for anterior instability. Correct diagnosis is difficult, but it is important for a successful treatment. Conservative treatment should be attempted before surgery. Open surgical treatment using the inferior capsular shift procedure is the gold standard. It can be carried out either anteriorly or posteriorly. We prefer a laterally-based capsular shift because it facilitates capsular plication. PMID:15925922

Ekin, Ahmet; Ozkan, Mustafa; Bölükba?i, Selçuk; Kanatli, Ulunay; Karci, Tolga

2005-01-01

2

Laparoscopic telescope with alpha port and aesop to view open surgical procedures.  

PubMed

Laparoscopy has advanced surgery by allowing the surgeon to operate within a patient's abdominal and pelvic cavity with minimal trauma and scarring. The coupling of a video camera to the laparoscopic telescope has had the secondary effect of allowing others to view the surgical field either on color video monitors or by watching the video feed over the Internet at a remote location. These advancements have allowed better teaching and mentoring of operations. Open procedures can benefit from this technology as well but have suffered in the past from inadequate methods to depict the open surgical field. We used the Alpha Port and Aesop robot to position a sterile laparoscopic telescope near the surgical field to view open cholecystectomies performed on five pigs and to send the video feed over the Internet to remote physicians. Viewing the video on the monitor, the surgeons performed the operation in a comfortable ergonomic upright position. Both the surgeons and the remote physicians found the quality of the video to be excellent, and the remote physicians felt comfortable learning and mentoring surgical procedures using this technique. PMID:11569510

Russell, K M; Broderick, T J; Demaria, E J; Kothari, S N; Merrell, R C

2001-08-01

3

[Surgical procedures for neuropathic pain].  

PubMed

Different surgical procedures are available for the treatment of many neuropathic pain syndromes. These surgical procedures can be divided into 2 main sections: non-destructive and destructive procedures. In recent years, the non-destructive neurostimulation method has undergone rapid development. Neurostimulation can be applied to a large part of the nervous system including the brain, spinal cord, and peripheral nerves. Spinal cord stimulation has become a dominant pain relief modality because of its minimal invasiveness and the development of a multi-contact stimulating electrode system powered by a multi-programmable and rechargeable stimulator. Currently, destructive surgical procedures have a limited range of indications for pain control. However, the advantages of destructive procedures over non-destructive ones include continuous pain reduction without implantation of a stimulation system. Each of the surgical procedures has great potential for providing patients with significant relief from neuropathic pain. PMID:23131742

Goto, Shinichi; Taira, Takaomi

2012-11-01

4

Surgical procedures for voice restoration  

PubMed Central

Surgical procedures for voice restoration serve to improve oral communication by better vocal function. They comprise of phonomicrosurgery, with direct and indirect access to the larynx; laryngoplasty; laryngeal injections; and surgical laryngeal reinnervation. The basis for modern surgical techniques for voice disorders is the knowledge about the ultrastructure of the vocal folds and the increasing experience of surgeons in voice surgery, while facing high social and professional demands on the voice. Vocal activity limitation and participation restriction has become more important in the artistic and social areas. A number of surgical methods that have been developed worldwide for this reason, are presented in this article. Functional oriented surgery has to meet high standards. The diagnostics of vocal function has to be multi-dimensional in order to determine the indication and the appropriate surgical intervention.

Nawka, Tadeus; Hosemann, Werner

2005-01-01

5

Augmented reality in surgical procedures  

NASA Astrophysics Data System (ADS)

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

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

2008-03-01

6

Surgical Procedures. Second Edition. Teacher Edition.  

ERIC Educational Resources Information Center

This teacher's guide contains 13 units of instruction for a course that will prepare students with the entry-level competencies needed by a surgical technologist. The course covers the following topics: introduction to surgical procedures; diagnostic procedures; general surgery; gastrointestinal surgery; obstetrics and gynecological surgery;…

Baker, Beverly; And Others

7

[Living donor kidney transplant: the surgical procedure].  

PubMed

The ideal nephrectomy technique for living donors should preserve donor safety and maximize graft quality for the recipient. The laparoscopic technique performs as well as the traditional open technique and has become the procedure of choice in up to 70% of the transplant centers in the US. Since November 2001, 70 living donor kidney transplants have been performed at the Transplant Center of Padua: 42 of the donors underwent laparoscopic left nephrectomy, 28 standard open nephrectomy. Donor and recipient results were analyzed retrospectively. After a mean follow-up of 38+/-26 months (laparoscopic group) and 40+/-27 months (open nephrectomy group) no deaths had occurred among the donors. Only one minor surgical complication was registered (hernia at the port site in a laparoscopic donor). Renal function was optimal in both groups of recipients, without significant differences in the incidence of delayed graft function and acute rejection. Minimally invasive approaches to donor nephrectomy are as safe and effective as the traditional open technique, minimizing postoperative pain and disability, and providing a better cosmetic result. PMID:19644840

Furian, L; Rigotti, Paolo

2009-01-01

8

Evaluation of surgical procedures for trigeminal neuralgia.  

PubMed Central

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

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

2003-01-01

9

Costs of surgical procedures in Indian hospitals  

PubMed Central

Objective Despite a growing volume of surgical procedures in low-income and middle-income countries, the costs of these procedures are not well understood. We estimated the costs of 12 surgical procedures commonly conducted in five different types of hospitals in India from the provider perspective, using a microcosting method. Design Cost and utilisation data were collected retrospectively from April 2010 to March 2011 to avoid seasonal variability. Setting For this study, we chose five hospitals of different types: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed district hospital, a 655-bed private teaching hospital and a 778-bed tertiary care teaching hospital based on their willingness to cooperate and data accessibility. The hospitals were from four states in India. The private, charitable and tertiary care hospitals serve urban populations, the district hospital serves a semiurban area and the private teaching hospital serves a rural population. Results Costs of conducting lower section caesarean section ranged from rupees 2469 to 41?087; hysterectomy rupees 4124 to 57?622 and appendectomy rupees 2421 to 3616 (US$1=rupees 52). We computed the costs of conducting lap and open cholecystectomy (rupees 27?732 and 44?142, respectively); hernia repair (rupees 13?204); external fixation (rupees 8406); intestinal obstruction (rupees 6406); amputation (rupees 5158); coronary artery bypass graft (rupees 177?141); craniotomy (rupees 75?982) and functional endoscopic sinus surgery (rupees 53?398). Conclusions Estimated costs are roughly comparable with rates of reimbursement provided by the Rashtriya Swasthya Bima Yojana (RSBY)—India's government-financed health insurance scheme that covers 32.4 million poor families. Results from this type of study can be used to set and revise the reimbursement rates.

Chatterjee, Susmita; Laxminarayan, Ramanan

2013-01-01

10

Characterization of aerosols produced by surgical procedures  

SciTech Connect

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

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

1994-07-01

11

Circumcision no longer a "routine" surgical procedure.  

PubMed Central

Nonmedical circumcision can no longer be considered routine in a new era of children's rights and more careful scrutiny of the medical necessity of surgical procedures. Although the minor procedure has been practised for centuries, custom and cultural factors may have had greater influence on the incidence of circumcision than the prevalence of problems such as penile cancer and urinary-tract infection that it was thought to prevent.

LeBourdais, E

1995-01-01

12

Surgical Procedures in Predoctoral Periodontics Programs.  

ERIC Educational Resources Information Center

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

Radentz, William H.; Caffesse, Raul G.

1991-01-01

13

Antibiotic prophylaxis in “clean” surgical procedures  

Microsoft Academic Search

The incidence of infection for clean surgical procedures should be less than 2%. The majority of infections are exogenous fromStaphylococcus aureus.These exogenous sources of bacteria include the ward, the theater environment, medical personnel, bed linen, and other infected patients. Endogenous infections may arise from the patient's own nose and skin; and although the majority of bacteria are staphylococcal, gram-negative intestinal

Colin Strachan

1982-01-01

14

Two stage surgical procedure for root coverage  

PubMed Central

Gingival recession may present problems that include root sensitivity, esthetic concern, and predilection to root caries, cervical abrasion and compromising of a restorative effort. When marginal tissue health cannot be maintained and recession is deep, the need for treatment arises. This literature has documented that recession can be successfully treated by means of a two stage surgical approach, the first stage consisting of creation of attached gingiva by means of free gingival graft, and in the second stage, a lateral sliding flap of grafted tissue to cover the recession. This indirect technique ensures development of an adequate width of attached gingiva. The outcome of this technique suggests that two stage surgical procedures are highly predictable for root coverage in case of isolated deep recession and lack of attached gingiva.

George, Anjana Mary; Rajesh, K. S.; Hegde, Shashikanth; Kumar, Arun

2012-01-01

15

Pectoralis major tendon rupture. Surgical procedures review.  

PubMed Central

Summary Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures.

Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

2012-01-01

16

Non-surgical deep intrauterine transfer of superfine open pulled straw (SOPS)-vitrified porcine embryos: evaluation of critical steps of the procedure.  

PubMed

Previous trials achieved extremely poor results when using the one-step warming method in a syringe in combination with non-surgical deep intrauterine transfer (NET) of superfine open pulled straw (SOPS)-vitrified embryos. This study aimed to assess the effect of the warming procedure on the in vitro and in vivo development of SOPS-vitrified embryos. The effect of the passage of the vitrified-warmed (VW) embryos through the NET catheter was also evaluated. Groups of 4 to 6 morulae and blastocysts, collected from weaned sows, were SOPS-vitrified in 1 ?L of vitrification medium, warmed by the one-step warming method in a dish or in a 1-mL syringe and cultured in vitro for 48 h to evaluate the embryo survival (ES) and hatching rates (HR). Warming in syringe had a deleterious effect (P < 0.05) on the in vitro ES (60.5 ± 10.4%) and HR (39.6 ± 9.5%) of VW embryos in comparison with embryos warmed in a dish (85.4 ± 10.6% and 69.0 ± 8.4%, respectively). This decreased embryonic development was due to the increased time required between the removal of the straws from the liquid nitrogen and the contact of the embryos with the warming medium when the warming was performed in a syringe in comparison with that for the warming in a dish. After verifying that the passage of VW embryos through the NET catheter does not have a damaging effect on their further in vitro development, the negative effect of warming in a syringe was also confirmed after NET. Fifteen fresh and SOPS-vitrified embryos warmed in a syringe or in a dish were transferred to each recipient (n = 28) and recovered 24 h later to assess their developmental progression. All embryos from the syringe group were found to have degenerated at recovery. The in vivo ES and HR from the dish group (80.4 ± 3.4% and 14.2 ± 7.2%, respectively) were lower (P < 0.05) than those from the fresh group (94.0 ± 4.1% and 36.8 ± 7.8%, respectively). Combining the warming in a dish and the NET procedure, 35 VW embryos were transferred to each of 10 gilts. Five recipients farrowed an average of 10.4 ± 0.9 piglets. In conclusion, the method of one-step warming in a syringe has a negative effect on the in vitro and in vivo viability of SOPS-vitrified porcine embryos. In addition, NET of SOPS-vitrified embryos warmed by the one-step method in a dish showed promising reproductive performance of recipients. However, despite the great potential of this technology, further developments are required for large-scale commercial applications. PMID:22898027

Gomis, J; Cuello, C; Sanchez-Osorio, J; Gil, M A; Parrilla, I; Angel, M A; Maside, C; del Olmo, D; Vazquez, J M; Roca, J; Martinez, E A

2012-10-01

17

[Diverticular disease - choice of surgical procedure].  

PubMed

The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. The tenets of surgical treatment of diverticulitis are resection of the entire sigmoid and creation of a tension-free anastomosis in the upper rectum. With respect to the required extent of resection according to current data it is not necessary to remove the entire colonic segment bearing diverticula because such a strategy does not reduce the recurrence rate. In the emergency situation due to free perforation a primary anastomosis with defunctioning ileostomy should be favored because the stoma reversal rate after primary anastomosis is higher than after Hartmann's procedure. The Hartmann procedure should be reserved for perforated diverticulitis with severe septic complications; however, the final treatment decision for primary anastomosis or Hartmann's procedure should be dependent on the individual patient. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis as an alternative to resection surgery. In cases of diverticular bleeding a subtotal colectomy should be performed if the diverticular bleeding site cannot be localized. PMID:24599385

Holmer, C; Kreis, M E

2014-04-01

18

Management of giant posttraumatic abdominal aortic pseudoaneurysm and aortic occlusion using a unique hybrid procedure combining transcatheter device closure and open surgical repair.  

PubMed

Posttraumatic abdominal aortic pseudoaneurysm (AAP) is a rare but life-threating disease. Here, we described a case of posttraumatic AAP with acute abdominal aortic occlusion and its successful treatment using a unique hybrid procedure. An 18-year-old male was referred, with a giant AAP among visceral arteries, which occluded the aorta and left renal artery. An infrequently used ventricular septal device was delivered via femoral access and successfully plugged the tear. Then the isolated pseudoaneurysm was resected through open surgery without major bleeding. At 6 months after operation, the patient was alive without evidence of complications. This hybrid procedure combining transcatheter device closure and open surgery was a successful attempt in the subemergency treatment of posttraumatic AAP. PMID:24509368

Li, Xiao; Zhao, Ji-Chun; Huang, Bin; Feng, Yuan

2014-07-01

19

A Review of Liposuction as a Cosmetic Surgical Procedure  

PubMed Central

Liposuction (suction-assisted lipectomy) is today an accepted, closed surgical technique utilized by physicians practicing in a number of different specialties. It is a procedure that can be learned and used as an adjunct to a number of open procedures, including rhytidectomy and abdominoplasty. The two principal keys to successful liposuction procedures are: (1) good patient selection, and (2) realistic expectations. Good selection should be based on physiological skin age of the patient rather than chronological age. Many liposuction procedures can be performed under local anesthesia in an office surgical suite. A conservative approach is always appropriate, as overcorrection is difficult to treat. Areas that can be suctioned effectively include the face, chin, neck, anterior and posterior axilary areas, arms, breasts, abdomen, waist, hips, buttocks, thighs, knees, and ankles. Using the blunt cannula technique pioneered by Fischer and modified and popularized by Illouz and Fournier yields a high percentage of good results. A low percentage of possible complications and undesired sequelae have been documented.

Sumrall, Arthur J.

1987-01-01

20

Operative treatment of Haglund's syndrome. Basics, indications, procedures, surgical techniques, results and problems  

Microsoft Academic Search

The treatment of patients with calcaneal exostosis is discussed. After unsuccessful conservative treatment, surgical procedures are advised by many authors. The open procedure for bursectomy and resection of the calcaneal exostosis is well described in the literature. The clinical studies show a high rate of poor results with a relative high incidence of complications. The minimal invasive endoscopic calcaneoplasty (ECP)

J. Schunck; J. Jerosch

2005-01-01

21

Randomised Trial Support for Orthopaedic Surgical Procedures  

PubMed Central

We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as “supportive” or “not supportive” of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.

Lim, Hyeung C.; Adie, Sam; Naylor, Justine M.; Harris, Ian A.

2014-01-01

22

Analgesia for Surgical Husbandry Procedures in Sheep and Other Livestock  

Microsoft Academic Search

SUMMARY Surgical husbandry procedures in livestock are invariably associated with pain and stress, yet are traditionally performed without analgesia. Concern for the welfare of animals undergoing these procedures is contributing to major conflicts between farmers and animal advocacy organisations with important negative trade implications. Whilst the ultimate long term solution is to breed animals that do not require these procedures,

Meredith L Sheil

23

Characterization of Aerosols Produced during Surgical Procedures in Hospitals  

Microsoft Academic Search

In orthopedic surgical procedures, surgical power tools, such as electrocautery, bone saws, reamers, and drills, are commonly used. In laboratory experiments using these tools, it has been demonstrated that inhalable aerosols can be produced. In order to assess the potential exposure of health care workers to these aerosols during orthopedic surgery, it is necessary to characterize the aerosols. In this

H. C. Yeh; R. S. Turner; R. K. Jones; B. A. Muggenburg; D. L. Lundgren; J. P. Smith

1995-01-01

24

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2013 CFR

...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must beâ (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

2013-10-01

25

[Surgical procedures involved in claims for alleged defects in praxis].  

PubMed

Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to "non-curative" medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called "non-curative" medicine. PMID:24913754

Arimany-Manso, Josep; Benet-Travé, J; Bruguera-Cortada, M; Torné-Escasany, R; Klamburg-Pujol, J; Gómez-Durán, Esperanza L

2014-03-01

26

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...hours recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must beâ (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

2010-10-01

27

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...hours recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must beâ (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

2009-10-01

28

Trends in specialized surgical procedures at teaching and nonteaching hospitals.  

PubMed

Teaching hospitals are the principal site of many specialized surgical procedures. The recipients of these procedures tend to be younger, male, and nonwhite and tend to reside in either the poorest or the most affluent neighborhoods. Although the numbers of these procedures performed at major teaching hospitals increased dramatically between 1989 and 1995, they accounted for only a modest proportion of hospital discharges and patient days. Concentration of specialized surgical procedures in major teaching hospitals will likely continue. This trend has implications not only for these hospitals but for health care purchasers, policymakers, medical educators, and clinical researchers as well. PMID:10645091

Levin, R; Moy, E; Griner, P F

2000-01-01

29

Surgical Procedure Profile in a Comprehensive Hip Surgery Program  

PubMed Central

Surgical management of hip disease in adolescents and young to middle-aged adults is rapidly evolving, and a variety of operative techniques are needed to provide comprehensive care. The purpose of this study was to determine the utilization of surgical procedures and recent changes in procedure utilization in a comprehensive hip surgery program. We performed a retrospective review of 983 hip procedures in 854 patients performed over a seven year time period. The average patient age was 37.4 years (range 10-55). Five hundred fifty-six procedures were performed in female patients and 427 in male patients. Total hip arthroplasty (32.9%), hip arthroscopy (25.1%), and periacetabular osteotomy (13.1%) were the most common surgical procedures. Techniques utilized less often included osteochondroplasty of the femoral head-neck junction (7.9%), hip implant revisions (7.9%), and proximal femoral osteotomy (4.1%). Uncommon procedures included core decompression (2.2%), soft tissue releases (1.2%), femoral head resurfacing (0.6%), arthrodesis (0.3%,) and Chiari pelvic osteotomy (0.2%). The most dramatic changes in utilization over the seven year time period included a marked increase in hip arthroscopies and osteochondroplasties of the femoral head-neck junction. These data underscore the variety of surgical techniques needed to treat this patient population, and emphasize an expanding role for nonarthroplasty surgical interventions.

Clohisy, John C; Curry, Madelyn C; Fejfar, Shane T; Schoenecker, Perry L

2006-01-01

30

Posterior approach (Kraske procedure) for surgical treatment of presacral tumors  

PubMed Central

Presacral tumors are rare, but can comprise a great variety of histological types. Congenital tumors are the most common. Once the diagnosis is established, surgical resection is essential because of the potential for malignancy or infection. Previous biopsy is not necessary or may be even harmful. To decide the best surgical approach (abdominal, sacral or combined) an individual and multidisciplinary analysis must be carried out. We report three cases of cystic presacral masses in which a posterior approach (Kraske procedure) enabled complete resection, the only way to decrease local recurrence. All patients had a satisfactory recovery. A brief overview of retrorectal tumors is presented, focusing on classification, clinical presentation, diagnosis and surgical management.

Aranda-Narvaez, Jose Manuel; Gonzalez-Sanchez, Antonio Jesus; Montiel-Casado, Custodia; Sanchez-Perez, Belinda; Jimenez-Mazure, Carolina; Valle-Carbajo, Marta; Santoyo-Santoyo, Julio

2012-01-01

31

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

PubMed Central

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

Roch, Alexandra; Teyssedou, Jerome; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick

2014-01-01

32

Major surgical procedures in children with cerebral palsy.  

PubMed

There are 3 surgical procedures that patients with cerebral palsy (CP) undergo that may be considered major procedures: femoral osteotomies combined with pelvic osteotomies, spine fusion, and intrathecal baclofen pump implant for the treatment of spasticity. Many complications are known to occur at a higher rate in this population, and some may be avoided with prior awareness of the preoperative pathophysiology of the patient with CP. PMID:24491650

Theroux, Mary C; DiCindio, Sabina

2014-03-01

33

Preventing adhesions in obstetric and gynecologic surgical procedures.  

PubMed

Adhesive disease represents a significant cause of morbidity for postoperative patients. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. The technology of adhesion prevention has significantly progressed. There are 3 methods approved by the US Food and Drug Administration for the prevention of postoperative adhesions, including Adept((R)), Interceed((R)), and Seprafilm((R)). The latter barrier is the most widely studied. This article reviews the current choices available for adhesion prevention barriers as well as surgical adjuncts that traditionally have been studied for that purpose. PMID:19399293

González-Quintero, Víctor Hugo; Cruz-Pachano, Francisco E

2009-01-01

34

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

PubMed

General guidelines exist for the use of recombinant activated factor VII (rFVIIa) to maintain haemostasis during surgery in congenital haemophilia A and B patients with high responding inhibitors (CHwI). Individual surgical plans are required and based upon historical therapy response, adverse events and anticipated procedure. Surgical interventions are feasible, yet it remains unclear how many US hemophilia treatment centres (HTCs) perform procedures in this fragile population. To better understand the US HTC surgical experience in CHwI patients and the number/types of procedures performed, a 21-question survey was sent to 133 US HTCs, with follow-up for response clarification and to non-responders. 98/133 HTCs (74%) responded, with 87 currently treating CHwI patients. In the last decade, 76/85 HTCs performed 994 surgeries on CHwI patients. Sites were experienced in the following procedures: central line insertion/removal (73 HTCs), dental (58), orthopaedic (52), abdominal (23), cardiovascular (14) and otolaryngologic (11). Experience with orthopaedic surgeries included synovectomies - arthroscopic (23 HTCs), radioisotopic (22), and open (7); joint replacement (18); fracture repair (14); and arthrodesis (8). Treatment modalities included rFVIIa bolus (83 HTCs) or continuous infusions (9), plasma-derived activated prothrombin complex concentrate (pd-aPCC) (55), antifibrinolytics (51), topical haemostatic agents (29), factor VIII (16) and fibrin sealants (14). Protocols for bypassing agents were used by 31/92 (33%) HTCs. Most US HTCs surveyed care for CHwI patients (74%) and have experience in minor surgery; fewer HTCs reported complex orthopaedic surgical experience. Identification of best practices and surgical barriers is required to guide future initiatives to support these patients. PMID:22168829

Shapiro, A; Cooper, D L

2012-05-01

35

Functional separation of septic and aseptic surgical procedures  

PubMed Central

Current evidence does not favour constructional over functional separation of septic and aseptic surgical procedures in terms of overall hygiene maintenance and incidence of skin and soft tissue infections. In both laminar and turbulent flow air operating theatres, air is not a relevant source of pathogens if surface disinfection is carried out properly. Final cleaning after a septic procedure includes a thorough wipe-disinfection of all potentially contaminated near and distant surfaces, including maintaining the necessary and effective exposure time of the chosen surface disinfectant. Cleaning utensils and clothes of all team members must be disposed of before leaving the theatre, and a complete change of gowns is mandatory before re-entering the operating room area. Strict adherence to this code of behaviour will allow for efficient functional separation of clean and contaminated surgical procedures without compromising patient safety.

Kramer, Axel; Assadian, Ojan; Wendt, Michael; Stengel, Dirk; Seifert, Julia

2011-01-01

36

Surgical Treatment of Patients with Open Tibial Fractures  

Microsoft Academic Search

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitisf-which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm

Chris Brown; Shirley Henderson; Shirley Moore

1996-01-01

37

Surgical navigation in the open MRI.  

PubMed

The introduction of MRI into neurosurgery has opened multiple avenues, but also introduced new challenges. The open-configuration intraoperative MRI installed at the Brigham and Women's Hospital in 1996 has been used for more than 500 open craniotomies and beyond 100 biopsies. Furthermore the versatile applicability, employing the same principles, is evident by its frequent use in other areas of the body. However, while intraoperative scanning in the SignaSP yielded unprecedented imaging during neurosurgical procedures their usage for navigation proved bulky and unhandy. To be fully integrated into the procedure, acquisition and display of intraoperative data have to be dynamic and primarily driven by the surgeon performing the procedure. To use the benefits of computer-assisted navigation systems together with immediate availability of intraoperative imaging we developed a software package. This "3D Slicer" has been used routinely for biopsies and open craniotomies. The system is stable and reliable. Pre- and intraoperative data can be visualized to plan and perform surgery, as well as to accommodate for intraoperative deformations, "brain shift", by providing online data acquisition. PMID:12570147

Nabavi, A; Gering, D T; Kacher, D F; Talos, I F; Wells, W M; Kikinis, R; Black, P McL; Jolesz, F A

2003-01-01

38

THD Doppler procedure for hemorrhoids: the surgical technique.  

PubMed

Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called "mucopexy") can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Following adequate clinical assessment, patients undergo THD under general or spinal anesthesia, in either the lithotomy or the prone position. In all patients, distal Doppler-guided dearterialization is performed, providing the selective ligation of hemorrhoidal arteries identified by Doppler. In patients with hemorrhoidal/muco-hemorrhoidal prolapse, the mucopexy is performed with a continuous suture including the redundant and prolapsing mucosa and submucosa. The description of the surgical procedure is complemented by an accompanying video (see supplementary material). In long-term follow-up, there is resolution of symptoms in the vast majority of patients. The most common complication is transient tenesmus, which sometimes can result in rectal discomfort or pain. Rectal bleeding occurs in a very limited number of patients. Neither fecal incontinence nor chronic pain should occur. Anorectal physiology parameters should be unaltered, and anal sphincters should not be injured by following this procedure. When accurately performed and for the correct indications, THD is a safe procedure and one of the most effective treatments for hemorrhoidal disease. PMID:24026315

Ratto, C

2014-03-01

39

Are Minimally Invasive Procedures Harder to Acquire than Conventional Surgical Procedures?  

Microsoft Academic Search

Background: It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents’ learning curves of both surgical skills are compared. Methods: Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during

Ellen Hiemstra; Wendela Kolkman; Saskia le Cessie; Frank Willem Jansen

2011-01-01

40

Developing clinically relevant aspects of the nuss procedure surgical simulator.  

PubMed

Surgical simulators can avail minimizing the risk of surgery and help achieving a better outcome. This is also the case for the Nuss procedure, a minimally invasive surgery for correcting pectus excavatum (PE) - a congenital chest wall deformity. A simulator can be of great benefit if it provides realistic behavior and representation of the actual surgery. In this paper, we address various clinical aspects of the procedure for a training simulation, reproducing a virtual model of the patient's thoracic cavity and internal organs with realistic textures, as well as physical behaviors. In addition, a high fidelity haptic force feedback system is constructed to provide the surgeon with a close-to-real sensation while interacting with the virtual model. PMID:24732479

Chemlal, Salim; Rechowicz, Krzysztof J; Obeid, Mohammad F; Kelly, Robert E; McKenzie, Frederic D

2014-01-01

41

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

Code of Federal Regulations, 2010 CFR

...Payment for facility services related to covered ASC surgical procedures performed in hospitals...for facility services related to covered ASC surgical procedures performed in hospitals...to covered ambulatory surgical center (ASC) procedures performed in a hospital...

2009-10-01

42

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

Code of Federal Regulations, 2010 CFR

...Payment for facility services related to covered ASC surgical procedures performed in hospitals...for facility services related to covered ASC surgical procedures performed in hospitals...to covered ambulatory surgical center (ASC) procedures performed in a hospital...

2010-10-01

43

Cost analysis of three different surgical procedures for treatment of a pelvic tumour  

Microsoft Academic Search

Introduction: Malignant pelvic tumours are rare, but adequate treatment is difficult because of anatomical and functional reasons. Different\\u000a surgical procedures are recommended. Besides aspects influencing the quality of life due to the different surgical techniques,\\u000a costs of these surgical procedures and the perioperative time interval, depending on the chosen surgical procedure, must also\\u000a be considered. Methods: Costs of three kinds

J. Bruns; S. Luessenhop; P. Behrens

1998-01-01

44

Outpatient surgical procedures: which is the ideal teaching procedure for a resident surgeon?  

PubMed Central

Summary Aim The aim of our study is to evaluate which surgical procedures can be considered the ideal teaching procedure for a resident surgeon. Materials and methods This is a retrospective study. A chart review was performed on all patients who underwent inguinal hernia repair, saphenectomy, excision of pilonidal sinus and hemorrhoidectomy at our institution, between September 2000 and July 2011, and have at least 1 year of follow-up. We evaluated operative time and complications comparing the results obtained by resident or attending surgeon. Results We obtained a higher operative time among the procedures performed by resident surgeons for all evaluated interventions. Whereas the occurrence of complications after hernia repair and excision and primary closure of pilonidal sinus were similar in case and control subjects (p = 0,1 and p = 0,1), the occurrence of complications after hemorrhoidectomy and saphenectomy was significantly higher in the case group (p = 0,08 and p = 0,1). Conclusion Hernia repair and excision and primary closure of pilonidal sinus have to be considered the ideal teaching procedure in a residency program, giving to the young surgeon the opportunity of reach several skills that he needs to master most difficult surgical procedures. Saphenectomy and hemorrhoidectomy should be considered safe only if performed by a senior resident surgeon.

MILONE, M.; MUSELLA, M.; MAIETTA, P.; BIANCO, P.; TAFFURI, C.; SALVATORE, G.; MILONE, F.

2013-01-01

45

Safety issues regarding colonic cleansing for diagnostic and surgical procedures.  

PubMed

There are various methods available to cleanse the colon in preparation for diagnostic and surgical procedures. The popular options are diet and cathartic regimens, gut lavage and phosphate preparations. Each method has its own unique characteristics and safety profile. Diet and cathartic regimens are based on traditional methods of colonoscopy preparation and remain an acceptable and safe alternative for patients unwilling or unable to tolerate other bowel preparations. Gut lavage methods involve ingestion of 2-4L of osmotically balanced solutions containing polyethylene glycol, which have been shown to be safe and effective for colon cleansing, including for special patient populations with cardiac, renal or hepatic dysfunction. Phosphate preparations have also been shown to be safe and effective for colon cleansing and are generally better tolerated than counterpart gut lavage solutions. However, this method has safety concerns for some patients with cardiac, renal and hepatic dysfunctions. PMID:15588118

Clark, Larry E; Dipalma, Jack A

2004-01-01

46

Effect of Surgical Training Course on Performance of Minor Surgical Procedures in Family Medicine Physicians' Offices: an Observational Study  

PubMed Central

Aim To examine the influence of a practical surgical course on the number of minor surgical procedures performed by family physicians. Methods We compared the number of minor surgical procedures performed by family physicians in 59 offices in the city of Osijek and surrounding rural area, Croatia, during 12 months before and after the 40-hour practical surgical course held in September 2006 by surgeons and family medicine specialists. Minor surgical procedures taught in the course included management of ingrown toenails, abscesses/comedones, and minor wounds, anesthesia application, disinfection, use and sterilization of surgical instruments, and antibiotic treatment. Results The number of minor surgical procedures performed in family medicine offices almost doubled (503 vs 906 after the course, P<0.001, Wilcoxon test). The median number of abscesses/comedones treatments per physician increased from 1 to 6 (P<0.001, Wilcoxon test), the number of managed wounds increased from 111 to 217 (P<0.001, Wilcoxon test), while the number of ingrown toenail resections increased from 120 to 186 (P?=?0.004, Wilcoxon test). Fifty percent of physicians did not treat patients surgically, irrespective of the training. We found no association between the number of performed procedures and age, length of employment, or location of the physician’s office (urban vs rural). However, we found that male physicians performed more surgical treatments both before and after the course (abscesses/comedones: P<0.001 and P?=?0.108 respectively; ingrown toenail resections: P?=?0.008 and P?=?0.008 respectively; minor wounds: P?=?0.030 and P<0.001; respectively). Conclusion Practical courses can encourage practitioners to treat the patients surgically in their offices and, thus, increase the number of services offered in primary care. Female physicians should be more encouraged to perform minor surgical procedures in their offices.

Gmajnic, Rudika; Pribic, Sanda; Lukic, Anita; Ebling, Barbara; Cupic, Nikola; Markovic, Ivana

2008-01-01

47

Comparing Automatic Simulator Assessment with Expert Assessment of Virtual Surgical Procedures  

Microsoft Academic Search

\\u000a This study focuses on the comparison of expert assessment of virtual surgical procedures through Objective Structured Assessment\\u000a of Technical Skills (OSATS) with the automatic assessment and feedback provided by a surgical simulator for hysteroscopic\\u000a procedures. The existing multi-metric scoring system of the simulator was extended to include hysteroscopic myomectomy. The\\u000a original OSATS was also modified for the examined surgical procedure.

Stefan Tuchschmid; Michael Bajka; Matthias Harders

2010-01-01

48

Generating Models of Surgical Procedures using UMLS Concepts and Multiple Sequence Alignment  

PubMed Central

Surgical procedures can be viewed as a process composed of a sequence of steps performed on, by, or with the patient’s anatomy. This sequence is typically the pattern followed by surgeons when generating surgical report narratives for documenting surgical procedures. This paper describes a methodology for semi-automatically deriving a model of conducted surgeries, utilizing a sequence of derived Unified Medical Language System (UMLS) concepts for representing surgical procedures. A multiple sequence alignment was computed from a collection of such sequences and was used for generating the model. These models have the potential of being useful in a variety of informatics applications such as information retrieval and automatic document generation.

Meng, Frank; D'Avolio, Leonard W.; Chen, Andrew A.; Taira, Ricky K.; Kangarloo, Hooshang

2005-01-01

49

Surgical Navigation in the Open MRI  

Microsoft Academic Search

\\u000a The introduction of MRI into neurosurgery has opened multiple avenues, but also introduced new challenges.\\u000a \\u000a The open-configuration intraoperative MRI installed at the Brigham and Women’s Hospital in 1996 has been used for more than\\u000a 500 open craniotomies and beyond 100 biopsies. Furthermore the versatile applicability, employing the same principles, is\\u000a evident by its frequent use in other areas of the

A. Nabavi; D. T. Gering; D. F. Kacher; I. F. Talos; W. M. Wells; R. Kikinis; P. Mc L. Black; F. A. Jolesz

50

42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Performance of listed surgical procedures on an...MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM...Before January 1, 2008 § 416.75 Performance of listed surgical procedures on an...

2013-10-01

51

Endoscopic goniotomy: a potential surgical procedure for primary infantile glaucoma  

NASA Astrophysics Data System (ADS)

Goniotomy is an effective treatment for primary infantile glaucoma. Unlike trabeculotomy, goniotomy facilitates the visualization of the trabecular meshwork and does not disturb the conjunctiva. Because a cloudy cornea may prevent a clear view of the anterior chamber angle through the operating microscope, we investigated whether an endoscope would improve visualization during goniotomy in pig cadaver eyes. We deepened the anterior chamber of each pig eye with viscoelastic material. A modified 23-gauge needle attached to an Olympus 0.8 mm diameter flexible fiberoptic endoscope entered the anterior chamber through a 3 mm limbal incision. The angle was clearly seen on a videoscreen as the needle approached and incised the trabecular pillars for 120 degree(s); the iris immediately fell back. Following the procedure, the eyes were fixed in formalin and sectioned for light microscopy, or fixed in 2% glutaraldehyde for scanning electron microscopy. Trabecular pillars were present from the iris root to Schwalbe's line in the untreated region of the anterior chamber angle. The treated area demonstrated incision of the trabecular pillars with opening of the underlying trabecular meshwork.

Joos, Karen M.; Alward, Wallace L.; Folberg, Robert

1993-06-01

52

Surgical correction of the splayfoot: the Giannestras procedure.  

PubMed

Clinically, the splayfoot is characterized by valgus of the great toe with bunion formation in association with a relative varus position of the first metatarsal. On the lateral side of the foot, there is varus of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. Radiographically, splayfoot is characterized by an intermetatarsal angle between the first and second metatarsals of greater than 12 degrees, and an intermetatarsal angle between the fourth and fifth metatarsals of greater than 8 degrees. The Giannestras splayfoot procedure consists of excision of the bunion and bunionette, adductor tenotomy, opening-wedge osteotomy of the first and fifth metatarsal bases, and realignment of the first and fifth toes. One-hundred and sixteen splayfoot operations were performed in 72 patients, with an average follow-up of 5.2 years. Results were considered excellent in 33% (39 feet), good in 45% (52 feet), fair in 14% (16 feet), and poor in 8% (9 feet). The primary cause of a fair or poor result was collapse of the bone graft at the base of the first metatarsal, causing recurrent varus and symptomatic hallux valgus. PMID:6989537

Bishop, J; Kahn, A; Turba, J E

1980-01-01

53

Development of a patient-specific surgical simulator for pediatric laparoscopic procedures.  

PubMed

The purpose of this study is to develop and evaluate a pediatric patient-specific surgical simulator for the planning, practice, and validation of laparoscopic surgical procedures prior to intervention, initially focusing on the choledochal cyst resection and reconstruction scenario. The simulator is comprised of software elements including a deformable body physics engine, virtual surgical tools, and abdominal organs. Hardware components such as haptics-enabled hand controllers and a representative endoscopic tool have also been integrated. The prototype is able to perform a number of surgical tasks and further development work is under way to simulate the complete procedure with acceptable fidelity and accuracy. PMID:24732536

Saber, Nikoo R; Menon, Vinay; St-Pierre, Jean C; Looi, Thomas; Drake, James M; Cyril, Xavier

2014-01-01

54

Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution.  

PubMed

Background.?Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to mupirocin. Methods.?We conducted an investigator-initiated, open-label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery. Results.?In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03). Conclusions.?Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI. Trial registration.?ClinicalTrials.gov identifier: NCT01313182 . PMID:24915210

Phillips, Michael; Rosenberg, Andrew; Shopsin, Bo; Cuff, Germaine; Skeete, Faith; Foti, Alycia; Kraemer, Kandy; Inglima, Kenneth; Press, Robert; Bosco, Joseph

2014-07-01

55

Surgical and endovascular procedures for treating isolated iliac artery aneurysms: ten-year experience.  

PubMed

Characteristics of atherosclerotic isolated iliac artery aneurysms (IAAs) and various strategies for their treatment were assessed retrospectively. The computerized medical records of 18 patients who underwent surgical or endovascular treatment of an IAA during the 10 years from April 1993 to March 2003 at our university hospital were reviewed to obtain information on patient demographics, risk factors, type of IAA treatment, and outcome. Additional data were obtained by mail and telephone. Patients with an IAA were compared with 168 patients treated for an abdominal aortic aneurysm (AAA) also at our institution. Early in the series of isolated IAA repairs, patients underwent prosthetic graft interposition ( n = 7) or thromboexclusion ( n = 4). Subsequently, patients had either endovascular thromboembolization ( n = 4) or endovascular thromboembolization with femorofemoral crossover bypass ( n = 3). No perioperative deaths occurred in the series. Deep venous thrombosis developed postoperatively in one patient; there were no other serious complications. The cumulative patency rate for the implanted interposition grafts during the mean observation time of 5.5 years was 100%. No endoleakage was observed after the endovascular procedures. In the long-term, five patients died of causes unrelated to the IAA treatment. A statistical analysis revealed no significant differences between the IAA group and the AAA group with respect to atherosclerotic risk factors. In conclusion, open surgical procedures to repair isolated IAAs generally have a good outcome, although the risk of injury to adjacent iliac veins remains. Endovascular treatments appear to have some advantages, but studies including long-term follow-up are needed to assess the efficacy and durability of prosthetic grafts used for these procedures. PMID:15457361

Matsumoto, Kenji; Matsubara, Kentaro; Watada, Susumu; Akiyoshi, Takurin; Inoue, Fumihiko; Kaneda, Munehisa; Shintani, Tsunehiro; Kitajima, Masaki

2004-08-01

56

A test procedure for evaluating surgical hand disinfection.  

PubMed

A technique for assessing the immediate and prolonged efficacy of surgical scrubs and alcoholic hand rubs is described. A mean baseline count is obtained from all volunteers and logarithmic reductions in resident skin flora immediately after one or more applications, and after wearing gloves for 3 h, are measured. Loose-fitting surgical gloves are used for sampling resident flora. Preparations were applied using a standard technique for 2 min, apart from one test with 70% isopropanol (IPA) in which the application time was 30 s. Two studies are described, one of which compared four chlorhexidine scrubs, and the second 70% IPA, 7.5% povidone-iodine scrub, 2% triclosan cleanser and unmedicated bar soap. In spite of their constituent similarity, the four chlorhexidine scrubs varied considerably in efficacy and user acceptability. A 2 min application of 70% IPA was the most effective treatment, and gave log10 reductions of 1.65 for immediate and 1.58 for prolonged effect. This was marginally more effective than a 30 s application, but the difference was not significant. 'Hibiscrub' was the most effective aqueous formulation and gave reductions of 1.01 for immediate effect and 1.16 for prolonged effect. The test described could be used by reference centres and manufacturers to assess the efficacy of new and existing surgical hand disinfection formulations. PMID:1679446

Babb, J R; Davies, J G; Ayliffe, G A

1991-06-01

57

Open surgical dislocation versus arthroscopic treatment of femoroacetabular impingement.  

PubMed

It is unclear if open surgical dislocation or arthroscopy of the hip is superior for the treatment of femoroacetabular impingement (FAI). We prospectively compared the clinical results of these 2 surgical methods performed by a single surgeon. Five patients met the inclusion criteria for the open surgical dislocation group and 18 for the arthroscopic group. Patient-reported scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) and Hip Outcome Score-Activities of Daily Living (HOS-ADL) were used preoperatively, and at 3 months, 6 months, and 1 year postoperatively to compare the 2 groups. Average follow-up was 14.7 months (range, 12 to 25 months); both groups showed significant improvement in their postoperative scores compared with preoperative scores (P < .01). The arthroscopic group had better, earlier improvement at 3- and 6-month follow-up, with NAHS significantly better at 3 months (P < .0002). However, improvements were comparable between the 2 groups at 1 year. Open surgical dislocation and arthroscopy are viable options for the treatment of FAI. The arthroscopic group demonstrated a trend toward faster recovery and quicker return to sports, but larger and longer-term studies are needed. PMID:24839626

Botser, Itamar B; Jackson, Timothy J; Smith, Thomas W; Leonard, James P; Stake, Christine E; Domb, Benjamin G

2014-05-01

58

Open and Arthroscopic Surgical Anatomy of the Ankle  

PubMed Central

Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach.

Frank, Rachel M.; Hsu, Andrew R.; Gross, Christopher E.; Walton, David M.

2013-01-01

59

A prospective analysis of 211 robotic-assisted surgical procedures  

Microsoft Academic Search

Background: The Academic Robotics Group prospectively studied 211 robotically assisted operations to assess the safety and utility of robotically assisted surgery. Methods: All operations took place at one of four member institutions between June 2000 and June 2001 using the recently FDA-approved daVinci robotic system. A variety of procedures were undertaken, including antireflux surgery (69), cholecystectomy (36), Heller myotomy (26),

M. A. Talamini; S. Chapman; S. Horgan; W. S. Melvin

2003-01-01

60

Surgical procedure logging with use of a hand-held computer  

PubMed Central

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

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

2002-01-01

61

Surgical procedures for functional improvement of the velum  

Microsoft Academic Search

The velopharyngoplasty, developed by the author (1966) usually results in lengthening of the palatal roof and improving the tensor function. When needed, it can be performed in conjunction with any of the three following procedures:1.A Levatorplasty, where a new levator sling is formed by a muscle transposition from the M. Pterygoideus medialis.2.An Arcus palatopharyngoplasty, where a bulkier vault is obtained.3.An

Otto Neuner

1972-01-01

62

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

PubMed

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student "t" Test. Results. Initial baseline values of biologic width were 2.55?mm (Gingivectomy procedure B1 Group) and 1.95?mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15?mm and 1.25?mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening. PMID:22969804

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

2012-01-01

63

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

PubMed Central

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

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

2012-01-01

64

Cesarean section and osteosynthesis of lower limb fractures in the same surgical procedure?  

PubMed Central

INTRODUCTION Orthopedic trauma during pregnancy can cause serious complications such as premature birth, stillbirth and maternal morbidities. PRESENTATION OF CASE We report the case of a patient at 38 weeks pregnancy who fractured the left ankle and the right fifth metatarsal after falling. Cesarean section and osteosynthesis were performed in the usual manner in the same surgical procedure. There were no postoperative complications. DISCUSSION Pregnancy and puerperium are associated with a hypercoagulable state. The early mobilization provided by surgical treatment of the fractures reduced the risks of thromboembolic events. CONCLUSION The approach adopted may be used as an example for future procedures done in similar situations.

Wajnsztejn, Andre; Ejnisman, Leandro; Zlotnik, Eduardo; Zitron, Luiz Roberto; Ejnisman, Benno; Cohen, Moises

2013-01-01

65

Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS)  

Microsoft Academic Search

Summary Surgical results of paediatric patients with Moyamoya disease who were treated by indirect revascularization procedures are reported. Encephalo-duro-arterio-synangiosis (EDAS), encephalomyo-arterio-synangiosis (EMAS), and\\/or encephalo-myo-synangiosis (EMS) were performed on 47 sides of 29 children with Moyamoya disease. The results of those non-anastomotic EC-IC bypass procedures were evaluated clinically, angiographically, and by computed tomography (CT). Postoperative external carotid angiograms showed a good

T. Matsushima; S. Fujiwara; S. Nagata; K. Fujii; M. Fukui; K. Kitamura; K. Hasuo

1989-01-01

66

Surgical Procedure for the Chronic Cannulation of the Carotid Artery and the Jugular Vein in Dogs.  

National Technical Information Service (NTIS)

A surgical procedure has been developed for the implantation of chronic cannulae in the carotid artery and the jugular vein. The method is simple to perform and allows serial blood samples to be drawn. Infusions of various drugs may be done at the same ti...

K. E. Leach L. Prud'homme-Lalonde R. K. Harding M. Bosc-Davie

1986-01-01

67

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence  

Microsoft Academic Search

The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality

U. Ulmsten; L. Henriksson; P. Johnson; G. Varhos

1996-01-01

68

The interaction between cost-management and learning for major surgical procedures - lessons from asymmetric information  

Microsoft Academic Search

The theory of the learning curve states that learning effects are of particular importance in industries, where human skills play an important role. Consequently, one would expect to find large learning effects for surgical procedures because the physician's experience is quite important for this type of work. For hospitals, there exists indeed a well-documented effect that shows a positive relationship

Christian M. Ernst

2003-01-01

69

The results of surgical treatment of middle ear cholesteatoma by using open and closed techniques.  

PubMed

Middle ear cholesteatoma caused by repeated ear infections over time, destroys the delicate middle ear bones and causes permanent hearing loss or dizziness. It may grow to involve the facial nerve causing facial paralysis. In some instances, cholesteatomas can expand up into the brain, causing meningitis, sinus thrombosis, facial nerve palsy, vestibulitis and differently localized abscess. Nearly all patients with cholesteatoma require surgery to cure the disease. Therapeutic and rehabilitative surgical procedures were done, using either a closed technique (TCT) or an open technique: tympanoplasty in open technique (TOT). The aim of the work was to compare the advantages of TCT and TOT surgical technique for the treatment of cholesteatoma disease. The research was conducted in Tbilisi State Medical University Otorhino-laryngological Clinic on 65 patients with middle ear cholesteatoma: 21 women and 44 men in 2006-2008. Their average age was 29. The youngest was 7 years old, and the oldest one - 67. The investigation revealed that after TCT recidivations were noted in 16% of patients; after TOT in 42.3% of patients. It is concluded that CT technique is the most appropriate and optimal surgical interference for the treatment of chronic middle ear diseases. PMID:18997248

Khujadze, M; Vashakidze, N; Gogniashvili, G; Khelashvili, B

2008-10-01

70

78 FR 24347 - Approval and Promulgation of Implementation Plans; Oregon: Open Burning and Enforcement Procedures  

Federal Register 2010, 2011, 2012, 2013

...Implementation Plans; Oregon: Open Burning and Enforcement Procedures AGENCY: Environmental Protection...that relate to open burning rules, enforcement procedures, civil penalties, and procedures...revisions relate to open burning rules, enforcement procedures, civil penalties, and...

2013-04-25

71

Raven-II: an open platform for surgical robotics research.  

PubMed

The Raven-II is a platform for collaborative research on advances in surgical robotics. Seven universities have begun research using this platform. The Raven-II system has two 3-DOF spherical positioning mechanisms capable of attaching interchangeable four DOF instruments. The Raven-II software is based on open standards such as Linux and ROS to maximally facilitate software development. The mechanism is robust enough for repeated experiments and animal surgery experiments, but is not engineered to sufficient safety standards for human use. Mechanisms in place for interaction among the user community and dissemination of results include an electronic forum, an online software SVN repository, and meetings and workshops at major robotics conferences. PMID:23204264

Hannaford, Blake; Rosen, Jacob; Friedman, Diana W; King, Hawkeye; Roan, Phillip; Cheng, Lei; Glozman, Daniel; Ma, Ji; Kosari, Sina Nia; White, Lee

2013-04-01

72

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

PubMed

In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min. PMID:1684604

Rehork, B; Rüden, H

1991-10-01

73

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

PubMed Central

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

Johnston, P. C.; Silversides, J. A.; Wallace, H.; Farling, P. A.; Hutchinson, A.; Hunter, S. J.; Eatock, F.; Mullan, K. R.

2013-01-01

74

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

PubMed

Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients. Findings demonstrate that pediatric patients experienced prolonged fasting before procedures and that the majority of NPO orders were non-compliant with national guidelines. We have developed strategies to reduce fasting times and ensure compliance with recommended national fasting standards. PMID:24365219

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

2014-01-01

75

Surgical technique for spinal cord delivery of therapies: demonstration of procedure in gottingen minipigs.  

PubMed

This is a compact visual description of a combination of surgical technique and device for the delivery of (gene and cell) therapies into the spinal cord. While the technique is demonstrated in the animal, the procedure is FDA-approved and currently being used for stem cell transplantation into the spinal cords of patients with ALS. While the FDA has recognized proof-of-principle data on therapeutic efficacy in highly characterized rodent models, the use of large animals is considered critical for validating the combination of a surgical procedure, a device, and the safety of a final therapy for human use. The size, anatomy, and general vulnerability of the spine and spinal cord of the swine are recognized to better model the human. Moreover, the surgical process of exposing and manipulating the spinal cord as well as closing the wound in the pig is virtually indistinguishable from the human. We believe that the healthy pig model represents a critical first step in the study of procedural safety. PMID:23242422

Federici, Thais; Hurtig, Carl V; Burks, Kentrell L; Riley, Jonathan P; Krishna, Vibhor; Miller, Brandon A; Sribnick, Eric A; Miller, Joseph H; Grin, Natalia; Lamanna, Jason J; Boulis, Nicholas M

2012-01-01

76

Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation.  

PubMed

Gastroduodenal outlet obstruction is a complication of advanced gastrointestinal malignant disease. In the past it was usually treated by an open surgical bypass procedure. During the last decade, endoscopic self-expandable stents (SEMS) have been used. The aim of this study was to compare these two palliative strategies concerning clinical outcome and health economy. A series of 36 patients with incurable malignant disease and gastroduodenal outlet obstruction syndrome were treated in a prospective study. According to the attending hospital and endoscopist on duty, 21 of the 36 patients were endoscopically treated with SEMS and 15 underwent an open surgical gastroenteroanastomosis. Health economic evaluation was based on the monetary charges for each patient associated with the procedure, postoperative care, and hospital stay. The hospital stay was 7.3 days for the stented group compared with 14.7 days for the open surgery group ( p > 0.05). The survivals were 76 and 99 days, respectively (NS). In the stented group all 15 patients (100%) alive after 1 month were able to eat or drink, and 11 (73%) of them tolerated solid food. In the surgical bypass group,9 out of 11 (81%) patients alive after 1 month could eat or drink, and 5 of them (45%) could eat solid food. The mean charges (U.S. dollars) during the hospital stay were $7215 for the stented group and $10,190 for the open surgery group ( p < 0.05). Palliation of the gastroduodenal obstruction in patients with malignant disease were at least as good, and the charges were lower for the endoscopic stenting procedure than for an open surgical bypass. PMID:15457364

Johnsson, Erik; Thune, Anders; Liedman, Bengt

2004-08-01

77

Treatment of patients with ruptured aneurysm by neurosurgeons that perform both open surgical and endovascular techniques is safe and effective: results of a single centre in Europe.  

PubMed

In Europe only few neurosurgeons are trained in both open surgical clipping as well as in endovascular techniques for treatment of intracranial aneurysms. To investigate the safety and efficacy of performing both techniques we, two dual trained neurosurgeons, analyzed our results in repairing ruptured intracranial aneurysms. Prospectively collected data from 356 patients that underwent open surgical or endovascular repair of a ruptured intracranial aneurysm at the Neurosurgical Centre Nijmegen from 2006 to 2012 by two dual trained neurosurgeons were retrospectively analyzed. Complication rates, occlusion rates, and retreatment rates were obtained. Combined procedural persistent neurological morbidity and mortality after endovascular treatment and open surgical clipping were 2.1 % and 1.4 %, respectively. Overall procedure-related clinical complication rate for endovascular treatment was 5.9 % in 285 procedures for 295 aneurysms. Overall procedure-related clinical complication rate for open treatment was 9.9 % in 71 procedures for 72 aneurysms. Follow-up was available for 255 out of 295 coiled aneurysms, 48 aneurysms recurred and 34 needed retreatment. For clipping 54 out of 72 treated aneurysms had follow-up; four aneurysms were incompletely clipped. One aneurysm was retreated. Treatment of ruptured intracranial aneurysms by neurosurgeons that perform both open surgical clipping as well as endovascular techniques is safe and effective. Developing training programs in Europe for hybrid neurosurgeons that can provide comprehensive patient care should be considered. PMID:24789710

de Vries, Joost; Boogaarts, Hieronymus D

2014-07-01

78

Successful surgical in situ treatment of prosthetic graft infection by staged procedure after Bentall operation and total aortic arch replacement.  

PubMed

We report a case of a 29-year-old Marfan patient who developed prosthetic graft infection 10 months after Bentall operation and successive replacement of the remaining ascending aorta and the entire aortic arch for acute aortic dissection. Instead of an aggressive high-risk aortic redo procedure with removal and replacement of the infected prosthetic graft we elected a staged graft-sparing surgical approach. After 18 months of close follow-up the patient is in good condition and free from infectious sequela. This case and our review of the literature suggest that open extensive disinfection followed by tissue flap coverage is highly effective in controlling thoracic aortic prosthetic graft infection and may be considered as first-line treatment in such high-risk aortic arch redo patients. PMID:24741478

Tossios, Paschalis; Karatzopoulos, Avgerinos; Tsagakis, Konstantinos; Sapalidis, Konstantinos; Triantafillopoulou, Konstantina; Kalogera, Anna; Karapanagiotidis, Georgios T; Grosomanidis, Vasilios

2014-01-01

79

Validation study of a computer-based open surgical trainer: SimPraxis® simulation platform  

PubMed Central

Background Technological advances have dramatically changed medical education, particularly in the era of work-hour restrictions, which increasingly highlights a need for novel methods to teach surgical skills. The purpose of this study was to evaluate the validity of a novel, computer-based, interactive, cognitive simulator for training surgeons to perform pelvic lymph node dissection (PLND). Methods Eight prostate cancer experts evaluated the content of the simulator. Contextual aspects of the simulator were rated on a five-point Likert scale. The experts and nine first-year residents completed a simulated PLND. Time and deviations were logged, and the results were compared between experts and novices using the Mann–Whitney test. Results Before training, 88% of the experts felt that a validated simulator would be useful for PLND training. After testing, 100% of the experts felt that it would be more useful than standard video training. Eighty-eight percent stated that they would like to see the simulator in the curriculum of residency programs and 56% thought it would be useful for accreditation purposes. The experts felt that the simulator aided in overall understanding, training indications, concepts and steps of the procedure, training how to use an assistant, and enhanced the knowledge of anatomy. Median performance times taken by experts and interns to complete a PLND procedure on the simulator were 12.62 and 23.97 minutes, respectively. Median deviation from the incorporated procedure pathway for experts was 24.5 and was 89 for novices. Conclusion We describe an interactive, computer-based simulator designed to assist in mastery of the cognitive steps of an open surgical procedure. This platform is intuitive and flexible, and could be applied to any stepwise medical procedure. Overall, experts outperformed novices in their performance on the trainer. Experts agreed that the content was acceptable, accurate, and representative.

Tran, Linh N; Gupta, Priyanka; Poniatowski, Lauren H; Alanee, Shaheen; Dall'Era, Marc A; Sweet, Robert M

2013-01-01

80

Multifactor Screener in OPEN: Scoring Procedures  

Cancer.gov

Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables, using USDA's 1994-96 Continuing Survey of Food Intakes of Individuals (CSFII 94-96) dietary recall data.

81

Human fallopian tube: a new source of multipotent adult mesenchymal stem cells discarded in surgical procedures  

Microsoft Academic Search

BACKGROUND: The possibility of using stem cells for regenerative medicine has opened a new field of investigation. The search for sources to obtain multipotent stem cells from discarded tissues or through non-invasive procedures is of great interest. It has been shown that mesenchymal stem cells (MSCs) obtained from umbilical cords, dental pulp and adipose tissue, which are all biological discards,

Tatiana Jazedje; Paulo M Perin; Carlos E Czeresnia; Mariangela Maluf; Silvio Halpern; Mariane Secco; Daniela F Bueno; Natassia M Vieira; Eder Zucconi; Mayana Zatz

2009-01-01

82

[From plastic surgery to space conquest. First microsurgical procedure and first surgical procedure in man during weightlessness].  

PubMed

The authors present their experience of surgery in weightlessness conditions. Russians and Americans already focused on that subject but two questions were still unsolved: what was the limit of human skill in these extreme conditions and was it possible to operate a human under total safety? Between 2003 and 2007, using a 0G plane for our experiment, we focused on two goals: firstly, the conception of a microsurgical module to test complex microsurgical procedures in rats and secondly, the construction of a surgical workstation with specific air filtration device and define surgical and anaesthetic protocols to carry on a surgery in man. In September 2003, we succeeded to perform the microscopic report of a 0,5mm artery (which is the smallest we can suture in terrestrial conditions) by using seven stitches of 10 x 0 monofilament suture. The 27th of September 2007, we removed a lipoma from the forearm of a 47-year-old man. These experiments take place in a wide program of development of telesurgery controlled through satellite transmission with all forthcoming civil, military and humanitarian applications. PMID:18930573

Martin, D; de Coninck, L; Pinsolle, V; Delia, G

2008-12-01

83

A Modified Surgical Procedure for Endoscopic Optic Nerve Decompression for the Treatment of Traumatic Optic Neuropathy  

PubMed Central

Background: Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored. Aims: The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression. Materials and Methods: We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae. Results: After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage. Conclusions: The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.

Chen, Fenghong; Zuo, Kejun; Feng, Shaoyan; Guo, Jiebo; Fan, Yunping; Shi, Jianbo; Li, Huabin

2014-01-01

84

Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data  

PubMed Central

Background Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003–2012, and to identify risk factors for complex sternal site infections. Methods Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.

2014-01-01

85

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients  

PubMed Central

A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.

Eggspuehler, Andreas; Grob, Dieter; Porchet, Francois; Jeszenszky, Dezso; Dvorak, Jiri

2007-01-01

86

The Surgical Procedure Is the Most Important Factor Affecting Continence Recovery after Laparoscopic Radical Prostatectomy  

PubMed Central

Purpose We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. Materials and Methods Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. Results Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06±2.56 and 11.81±2.87 mm, and prostatic urethral lengths were 36.39±6.15 and 37.45±7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25±0.06 and 0.24±0.06, and prostatic-posterior urethral length ratios were 0.75±0.06 and 0.76±0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. Conclusions The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.

Lee, Seungsoo; Yoon, Chang Jin; Park, Hyun Jun; Lee, Jeong Zoo

2013-01-01

87

Outcomes after the regionalization of major surgical procedures in the Alberta Capital Health Region (Edmonton)  

PubMed Central

Objective To evaluate the impact of regionalization on the outcomes of 16 surgical procedures performed in the Capital Health Region (Edmonton) of Alberta. Design A computer search of hospital discharge abstracts coded for the Canadian Institute for Health Information. Setting Two major hospitals in Edmonton. Patients The study population comprised 9250 patients (9727 procedures [4524, pre-regionalization, 5203 post-regionalization]) who underwent any of 16 major procedures in the 2 years before and the 2 years after restructuring. Outcome measures Demographic data, Charlson’s comorbidity index, number of urgent and emergent cases, death rate, average length of hospital stay and the readmission rate. Results The post-regionalization patient group was slightly older, had a higher comorbidity index, and fewer urgent and emergent cases. The case volume increased by 15%, and 43.6% of patients used some form of community-based health care services. The median length of hospital stay decreased from 8.0 days pre-regionalization to 7.0 days post-regionalization (p < 0.001). Overall and for specific procedures the death rate was unchanged (3.1% pre-regionalization, 2.4% post-regionalization, p = 0.06). The readmission rates were similar for both groups (8.0% versus 7.0%). Conclusions The consolidation of these 16 major surgical procedures had minimal impact on death and readmission rates even though patients in the post-regionalization group were slightly older and had greater comorbidity. There was a significant decline in the length of hospital stay, which occurred nationally over the same period, and a corresponding increase in the use of community-based services.

Hamilton, Stewart M.; Johnston, William C.; Voaklander, Donald C.

2001-01-01

88

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques.  

PubMed

Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques. PMID:24785480

Uribe, Juan S; Deukmedjian, Armen R; Mummaneni, Praveen V; Fu, Kai-Ming G; Mundis, Gregory M; Okonkwo, David O; Kanter, Adam S; Eastlack, Robert; Wang, Michael Y; Anand, Neel; Fessler, Richard G; La Marca, Frank; Park, Paul; Lafage, Virginie; Deviren, Vedat; Bess, Shay; Shaffrey, Christopher I

2014-05-01

89

Quality control of surgical and interventional procedures: a review of the CUSUM  

PubMed Central

Background The report of the CUSUM across surgical and interventional procedures has spawned a fair confusion in the literature. Aim To assess the use of the CUSUM and to clarify its utilisation in the perspective of future studies. Nature of the study Retrospective review. Methods A systematic literature search of Medline was carried out. From each article, data regarding the design of the study, the specialty, the performance criterion, the unit under control, the methodology and the model of the CUSUM used, the use of a graph, the use of a test and the type of test applied were retrieved. Results 31 studies were found relevant. The design was mainly retrospective for the analysis of the learning curve. The main performance criteria under control were morbidity, mortality and success of the procedure. A graph was plotted in all studies as a CUSUM plot or as cumulative sums of non?negative values. A test was used in 17 studies. Mislabelling of the plot and the test, and misuse of control limits were the most commonly reported mistakes. Conclusion The CUSUM tool is not yet properly reported in the surgical literature. Therefore, reporting of the CUSUM should be clarified and standardised before its use widens.

Biau, David J; Resche-Rigon, Mathieu; Godiris-Petit, Gaelle; Nizard, Remy S; Porcher, Raphael

2007-01-01

90

Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension  

PubMed Central

AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding. METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed. RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05). CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.

Yang, Lin; Yuan, Li-Juan; Dong, Rui; Yin, Ji-Kai; Wang, Qing; Li, Tao; Li, Jiang-Bin; Du, Xi-Lin; Lu, Jian-Guo

2013-01-01

91

Open surgical approach to a maxillary impacted canine: a case report.  

PubMed

Palatally impacted permanent maxillary canines are a relatively common dental anomaly mandating surgical exposure before moving them orthodontically into correct alignment. The open technique for exposing these palatal canines involves their orthodontic movement into its correct position above the palatal mucosa in contrast to the closed approach in which canine is moved beneath the palatal mucosa. This case report describes the orthodontic eruption of a palatally impacted canine in a 22-year-old female using open surgical approach. PMID:24358653

Chugh, Vinay Kumar; Tandon, Pradeep; Prasad, Veerendra

2013-01-01

92

Racial differences in type of surgical procedure performed for proximal humerus fractures  

Microsoft Academic Search

Background  Proximal humeral fracture constitutes a medical emergency on most occasions in which the decision to perform either open reduction\\u000a and internal fixation (ORIF) or hemiarthroplasty is determined by the operating surgeon. Hemiarthroplasty is a more expensive\\u000a and technically challenging procedure that requires compliance with rigorous and prolonged rehabilitation postsurgically.\\u000a We assessed whether racial differences exist in utilization of hemiarthroplasty versus

Nitin B. JainLaurence; Laurence D. Higgins; Elena Losina; Ricardo Pietrobon; Jeffrey N. Katz

93

The surgical learning curve for laparoscopic compared to open radical prostatectomy: a retrospective cohort study  

PubMed Central

Background We previously reported the learning curve for open radical prostatectomy, defined in terms of prostate cancer recurrence. We sought to characterize the learning curve for laparoscopic radical prostatectomy. Methods We conducted a retrospective cohort study of 5328 prostate cancer patients treated laparoscopically by one of 29 surgeons from 7 institutions in Europe and North America between 1998 and 2007. Multivariable models were used to evaluate the association between surgeon experience at the time of each patient's operation and prostate cancer recurrence, with adjustment for established predictors. Findings After adjusting for casemix, greater surgeon experience was associated with a lower risk of recurrence (P=0.0053). The 5-year risk of recurrence decreased from 17% to 16% to 9% for a patient treated by a surgeon with 10, 250 and 750 prior laparoscopic procedures (risk difference 8.0% 95% CI: 4.4%, 12.0%). The learning curve for laparoscopic radical prostatectomy was slower than the previously reported learning curve for open surgery (p<0.001). Surgeons with previous experience of open radical prostatectomy had significantly poorer results than those whose first operation was laparoscopic (risk difference 12.3%; 95% CI: 8.8%, 15.7%). Interpretation Increasing surgical experience is associated with substantial reductions in cancer recurrence after laparoscopic radical prostatectomy. Improvements in outcome seem to accrue more slowly in comparison with open surgery. Laparoscopic radical prostatectomy appears to involve skills that do not translate well from open experience. Funding source This paper was supported by funds from the National Cancer Institute, the Allbritton Fund and the David J. Koch Foundation.

Vickers, Andrew J; Savage, Caroline J; Hruza, Marcel; Tuerk, Ingolf; Koenig, Philippe; Martinez-Pineiro, Luis; Janetschek, Gunther; Guillonneau, Bertrand

2009-01-01

94

Use of perioperative antibiotic prophylaxis in selected surgical procedures — Results of a survey in 889 surgical departments in German hospitals  

Microsoft Academic Search

Summary In 1989, a survey on perioperative antibiotic prophylaxis was conducted in 2,739 surgical (general surgical, orthopedic, traumatologic, and cardiothoracic) departments of German hospitals. In all, 889 (32.5%) questionnaires were returned. Regarding the choice of antibiotic and the duration of prophylaxis the respective rates of correct statements were as follows: 32.6% and 55.0% in gastric surgery, 29.5% and 42.9% in

Ines Kappstein; F. D. Daschner

1991-01-01

95

Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis  

PubMed Central

Background: Approach for surgical treatment of thoracolumbar tuberculosis has been controversial. The aim of present study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the surgical treatment of thoracic and thoracolumbar tuberculosis. Materials and Methods: 70 patients with spinal tuberculosis treated surgically between Jan 2001 and Dec 2006 were included in the study. Thirty four patients (group I) with mean age 34.9 years underwent anterior debridement, decompression and instrumentation by anterior transthoracic, transpleural and/or retroperitoneal diaphragm cutting approach. Thirty six patients (group II) with mean age of 33.6 years were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Various parameters like blood loss, surgical time, levels of instrumentation, neurological recovery, and kyphosis improvement were compared. Fusion assessment was done as per Bridwell criteria. Functional outcome was assessed using Prolo scale. Mean followup was 26 months. Results: Mean surgical time in group I was 5 h 10 min versus 4 h 50 min in group II (P>0.05). Average blood loss in group I was 900 ml compared to 1100 ml in group II (P>0.05). In group I, the percentage immediate correction in kyphosis was 52.27% versus 72.80% in group II. Satisfactory bony fusion (grades I and II) was seen in 100% patients in group I versus 97.22% in group II. Three patients in group I needed prolonged immediate postoperative ICU support compared to one in group II. Injury to lung parenchyma was seen in one patient in group I while the anterior procedure had to be abandoned in one case due to pleural adhesions. Functional outcome (Prolo scale) in group II was good in 94.4% patients compared to 88.23% patients in group I. Conclusion: Though the anterior approach is an equally good method for debridement and stabilization, kyphus correction is better with posterior instrumentation and the posterior approach is associated with less morbidity and complications.

Garg, Bhavuk; Kandwal, Pankaj; Nagaraja, Upendra Bidre; Goswami, Ankur; Jayaswal, Arvind

2012-01-01

96

Single-incision laparoscopic surgery for gallstone ileus: An alternative surgical procedure  

PubMed Central

INTRODUCTION Gallstone ileus (GI) results from the passage of a stone through a cholecystoenteric fistula, subsequently causing a bowel obstruction. The ideal treatment procedure for GI remains controversial. PRESENTATION OF CASE A 63-year-old female was admitted to our hospital following persistent nausea and vomiting for 7 days. Computed tomography revealed a partially calcified 4-cm circular object in the jejunum, and the proximal intestine was dilated, with concomitant pneumobilia. Based on the preoperative diagnosis of GI, enterotomy with stone extraction by single-incision laparoscopic surgery (SILS) was performed. The patient's postoperative course was uneventful, and the cholecystoduodenal fistula closed spontaneously 4 months after the surgery. DISCUSSION Recent studies have reported that enterotomy with stone extraction alone is associated with better outcomes than with more invasive techniques. This case also suggests that enterotomy with stone extraction alone and careful postoperative follow-up is feasible for the management of GI. Although the use of laparoscopy in the management of GI has been described previously, laparoscopic surgery has not been widely performed, and SILS is not generally performed. When only this less demanding procedure is required, laparoscopic surgery, including SILS, can be a viable option. CONCLUSION SILS can be an alternative surgical procedure for the management of GI.

Watanabe, Yusuke; Takemoto, Junkichi; Miyatake, Eiji; Kawata, Jun; Ohzono, Keigo; Suzuki, Hiroyuki; Inoue, Masaaki; Ishimitsu, Toshiyuki; Yoshida, Junichi; Shinohara, Masahiro; Nakahara, Chihiro

2014-01-01

97

A circumcision method in an old surgical textbook (cerrahiyyetul haniyye): reminding of a forgotten procedure.  

PubMed

 Purpose: Circumcision is one of the historical surgical procedures. Some sources throughout the history contain various definitions about different circumcision methods. we described the details of the method, and aimed to remind the possibility of contemporary usage. Materials and Methods: We compared circumcision chapters of Sabuncuoglu and Zahrawi to explain the historical origin of Sabuncuoglu's favorite circumcision method. Results: We found a method which might be summarized as "knotting with rope technique" in one of historical textbooks named as Cerrahiyyetul Haniyye (Imperial Surgery) written by Serefeddin Sabuncuoglu (1385-1468?) in 1465. Conclusion: This circumcision method is not used currently. In addition this method has not been defined in the history of medical literature yet.  PMID:25015628

Senayli, Atilla; Aksu, Murat; Atalar, Munir

2014-01-01

98

Use of the tendon of the palmaris longus muscle in surgical procedures: study on cadavers  

PubMed Central

Objective Demonstrate that the tendon of palmar long can be estimated in relation to its length and width before using it as a graft in surgical procedure. Methods There were examined 60 forearms of 30 corpses of black ethnicity; measure the length and width of the tendon of the palmaris longus muscle and compared the length of the forearm. Results There are notes their absence unilateral right in two female corpses. The medium length and width were more or less respectively 11.9, 15.2 mm and 4.1 + 1.5 mm. The total average forearm length of 275.4 was more or less 17.9 mm. Conclusion There is a significant relationship between the length of the tendon and the length of the forearm; so we can evaluate the size of the tendon of the palmaris longus muscle when it is necessary to use it for grafts. Levels of Evidence IV, Case series.

Angelini Junior, Luiz Carlos; Angelini, Felipe Berdelli; de Oliveira, Bruna Craveiro; Soares, Sonia Aparecida; Angelini, Luiz Carlos; Cabral, Richard Halti

2012-01-01

99

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

PubMed

Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as studies on graft preservation and ischemia-reperfusion injury, immunological responses, hemodynamics, and small-for-size syndrome. The rat OLT is among the most difficult animal models in experimental surgery and demands advanced microsurgical skills that take a long time to learn. Consequently, the use of this model has been limited. Since the reliability and reproducibility of results are key components of the experiments in which such complex animal models are used, it is essential for surgeons who are involved in rat OLT to be trained in well-standardized and sophisticated procedures for this model. While various techniques and modifications of OLT in rats have been reported since the first model was described by Lee et al. in 1973, the elimination of the hepatic arterial reconstruction and the introduction of the cuff anastomosis technique by Kamada et al. were a major advancement in this model, because they simplified the reconstruction procedures to a great degree. In the model by Kamada et al., the hepatic rearterialization was also eliminated. Since rats could survive without hepatic arterial flow after liver transplantation, there was considerable controversy over the value of hepatic arterialization. However, the physiological superiority of the arterialized model has been increasingly acknowledged, especially in terms of preserving the bile duct system and the liver integrity. In this article, we present detailed surgical procedures for a rat model of OLT with hepatic arterial reconstruction using a 50% partial graft after ex vivo liver resection. The reconstruction procedures for each vessel and the bile duct are performed by the following methods: a 7-0 polypropylene continuous suture for the supra- and infrahepatic vena cava; a cuff technique for the portal vein; and a stent technique for the hepatic artery and the bile duct. PMID:23524839

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

2013-01-01

100

Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients  

PubMed Central

A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor-evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed.

Sutter, Martin A.; Grob, Dieter; Jeszenszky, Dezso; Porchet, Francois; Dvorak, Jiri

2007-01-01

101

Submental/Transmylohyoid Route for Endotracheal Intubation in Maxillofacial Surgical Procedures: A Review  

PubMed Central

Patients with severe panfacial injuries usually require long-term airway management. Nasal intubation may be contraindicated in case of nasoorbitoethmoidal fractures and also there may be a need for intraoperative and short-term postoperative intermaxillary fixation to achieve optimum reduction of fractures. The need for unobstructed access to the perinasal area during bimaxillary orthognathic procedures is felt many a time and to avoid a tracheostomy with its attending morbidity, many techniques have evolved that involve a submandibular/transmylohyoid or submental approach for temporary oroendotracheal intubation. In this article, we present our experience of patients by using submental/transmylohyoid route for endotracheal intubation. technique gives the surgeon and the anesthetist comfortable control over their respective domains, is easy to learn and implement in the operating protocol with no added costs. How to cite the article: Prakash VJ, Chakravarthy C, Attar AH. Submental/transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: A review. J Int Oral Health 2014;6(3):125-8.

Prakash, V Jeevan; Chakravarthy, Chitra; Attar, Abdul Hameed

2014-01-01

102

Comparison of surgical and nonsurgical treatment of bilateral condylar fractures based on maximal mouth opening.  

PubMed

This study presents a comparative analysis of the open surgical and nonsurgical treatment of patients with bilateral condylar fractures. Sixty-seven (67) patients were treated, and the completed data on 55 patients were reviewed to compare both therapeutic modalities, which consisted of nonsurgical and surgical treatment in 37 and 18 patients, respectively. In the nonsurgical group, 23 patients (23/37, 62%) had normal mouth opening. Functional success rate was 79% (15/19) and 44% (8/18) in young adult patients (-29yrs) and older patients (30+yrs), respectively, and there was a significant difference of outcome between the two groups. In nonsurgically treated young patients with disorders, bilateral dislocation and existence of concomitant mandibular fractures were commonly observed. In the open surgical group, seven (7/11, 64%) young adult and three (3/7, 43%) older patients gained normal mouth opening, and no significant difference was observed. Additionally, there was no difference between non-surgical and surgical treatment in any category. Patients undergoing rigid fixation benefited from restoring maximum mouth opening, although there was no significant difference between the rigid and non-rigid fixation groups. Based on these findings, nonrigid fixation should be avoided, and rigid fixation might improve outcome in young adult patients with severe fracture pattern, such as bilateral dislocation and concomitant mandibular fracture. PMID:17304913

Ishihama, Kohji; Iida, Seiji; Kimura, Tetsuo; Koizumi, Hidehiko; Yamazawa, Michikuni; Kogo, Mikihiko

2007-01-01

103

Minor surgical procedures and musculoskeletal injections by primary care physicians - an Israeli experience  

PubMed Central

Abstarct Background Since minor surgical and musculoskeletal problems are commonly seen in primary care, primary care physicians are expected to possess the skills required to perform minor surgical procedures (MSP) and musculoskeletal injections (MSI). Objective To evaluate the performance of MSP and MSI by primary care physicians in the Southern District (Negev) of Clalit Health Services (CHS) health maintenance organization (HMO) in Israel. Methods A structured self-report questionnaire was sent to all 277 primary care physicians, other than pediatricians, working in the Southern District (Negev) of CHS HMO. Results One hundred fifty one of the 277 questionnaires (54%) were completed and returned. Sixty five percent of the primary care physicians perform any MSP and 46% perform any MSI. The main barriers reported for performing MSP and MSI were lack of time (74% and 66%, respectively) and training (41% and 60%, respectively). Forty percent of the physicians cited remuneration as a potential motivating factor. A logistic regression model showed that male physicians and physicians who work full or part-time in rural areas, are more likely to perform MSP (Odds ratio 2.12 and 2.24, respectively). Male physicians, especially board-certified family physicians, are more likely to perform MSI (Odds ratio 2.86 and 7.0 respectively). Conclusion MSP and MSI are practiced by only some primary care physicians. HMOs and individuals responsible for designing training curricula in family medicine and primary care can encourage primary care physicians to perform MSP and MSI by providing courses, specific compensation, and dedicated time. This can strengthen the bond between primary care physicians and patients, reduce waiting time for patients, and save money for HMO’s.

2014-01-01

104

Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia.  

PubMed

Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ?2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial. PMID:23715341

Saha, N; Biswas, I; Rahman, M A; Islam, M K

2013-04-01

105

The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update  

Microsoft Academic Search

Six years ago, the inside–out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress\\u000a urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue\\u000a dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates\\u000a and low morbidity at short

David Waltregny; Jean de Leval

2009-01-01

106

Comparison of Laparoscopic, Hand-Assisted, and Open Surgical Nephroureterectomy  

PubMed Central

Background and Objectives: The aim of this study was to compare oncologic outcomes after laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy for upper urinary tract urothelial cancer. Methods: Between April 1995 and August 2010, 189 patients underwent laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, or open nephroureterectomy for upper urinary tract urothelial cancer. Of these patients, 110 with no previous or concurrent bladder cancer or any metastatic disease were included in this study. Cancer-specific survival, recurrence-free survival, and intravesical recurrence-free survival rates were analyzed by the Kaplan-Meier method and compared with the log-rank test. The median follow-up period for the cohort was 70 months (range, 6–192 months). Results: The 3 groups were well matched for tumor stage, grade, and the presence of lymphovascular invasion and concomitant carcinoma in situ. The estimated 5-year cancer-specific survival rates were 81.1%, 65.6%, and 65.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .4179). The estimated 5-year recurrence-free survival rates were 33.8%, 10.0%, and 41.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .0245). The estimated 5-year intravesical recurrence-free survival rates were 64.8%, 10.0%, and 76.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P < .0001). Conclusion: Although there was no significant difference in cancer-specific survival rate among the laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy groups, hand-assisted laparoscopic nephroureterectomy may be inferior to laparoscopic nephroureterectomy or open nephroureterectomy with regard to recurrence-free survival and intravesical recurrence-free survival rates.

Maeda, Toshihiro; Tanaka, Toshiaki; Fukuta, Fumimasa; Kobayashi, Ko; Nishiyama, Naotaka; Takahashi, Satoshi; Masumori, Naoya

2014-01-01

107

[Specialized surgical care for children (victims of the earthquake) with open injuries].  

PubMed

The article presents the authors' experience of providing specialized surgical care for 197 children who had been affected by the earthquake in Pakistan (2005), Indonesia (2006 and 2009) and Haiti (2010). All victims had open injuries of soft tissues and bones. The article recites the strategy and principles of work organization of the mobile team of specialists from the Research Institute of Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology in disaster areas. It includes the creation of a center for specialized surgical care for children, consultative work in all regional hospitals to where victims are initially evacuated, transportation and concentration of children with the most severe injuries in a specialized center. The basic principles of interaction with the central and local public health authorities and medical staff of hospitals were developed. The main characteristics of such injuries and their complications were defined as well. Mistakes made by the local and international surgical teams at the stages of primary and specialized surgical care were described. The effectiveness of the applied strategy of active surgical treatment of open injuries of soft tissue and bones complicated by surgical infection has been analyzed. PMID:24429717

Roshal', L M; Mitish, V A; Medinski?, P V

2014-01-01

108

A Human Factors Analysis of Technical and Team Skills Among Surgical Trainees During Procedural Simulations in a Simulated Operating Theatre  

PubMed Central

Background: High-risk organizations such as aviation rely on simulations for the training and assessment of technical and team performance. The aim of this study was to develop a simulated environment for surgical trainees using similar principles. Methods: A total of 27 surgical trainees carried out a simulated procedure in a Simulated Operating Theatre with a standardized OR team. Observation of OR events was carried out by an unobtrusive data collection system: clinical data recorder. Assessment of performance consisted of blinded rating of technical skills, a checklist of technical events, an assessment of communication, and a global rating of team skills by a human factors expert and trained surgical research fellows. The participants underwent a debriefing session, and the face validity of the simulated environment was evaluated. Results: While technical skills rating discriminated between surgeons according to experience (P = 0.002), there were no differences in terms of the checklist and team skills (P = 0.70). While all trainees were observed to gown/glove and handle sharps correctly, low scores were observed for some key features of communication with other team members. Low scores were obtained by the entire cohort for vigilance. Interobserver reliability was 0.90 and 0.89 for technical and team skills ratings. Conclusions: The simulated operating theatre could serve as an environment for the development of surgical competence among surgical trainees. Objective, structured, and multimodal assessment of performance during simulated procedures could serve as a basis for focused feedback during training of technical and team skills.

Moorthy, Krishna; Munz, Yaron; Adams, Sally; Pandey, Vikas; Darzi, Ara

2005-01-01

109

Elbow denervation in dogs: Development of an in vivo surgical procedure and pilot testing  

Microsoft Academic Search

The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on

Helia Zamprogno; Jon Hash; Don A. Hulse; B. Duncan X. Lascelles

110

The prophylactic use of C1 inhibitor in hereditary angioedema patients undergoing invasive surgical procedures: a retrospective study  

PubMed Central

Background Hereditary Angioedema (HAE) is a rare autosomal dominant condition characterized by episodic angioedema, which may be triggered by invasive procedures and surgery. C1 inhibitor (C1 INH) was approved in the United States and Canada in 2009 and 2010, respectively, for the treatment of acute attacks. Most recently in April 2013, it was approved in Europe for short-term prophylaxis (STP), prior to medical, dental, or surgical procedures, to prevent HAE attacks in both children and adults. Currently, C1 INH is not approved in Canada or the United States for STP of HAE attacks. Our objective was to demonstrate the effectiveness of C1 INH as a short-term prophylactic treatment for patients with Type I HAE undergoing invasive surgical procedures. Methods A retrospective chart review between 1997-2013 was performed at one Canadian Tertiary Care Allergy and Asthma Clinic affiliated with The Ottawa Hospital, in Ottawa, Canada. The standard dose of C1 INH for STP was 10 or 20 U/kg. Results In all 24 procedures, there were no post-procedure HAE attacks after short-term prophylactic administration of C1 INH. Conclusions In this retrospective chart review at one tertiary care Allergy and Clinical Immunology Clinic, short-term prophylactic use of C1 INH was found to be effective at preventing post-procedure HAE attacks, in patients diagnosed with Type I HAE.

2014-01-01

111

Surgical site infection risk factors identified for patients undergoing colon procedures, new york state 2009-2010.  

PubMed

Background.?Since 2007, New York State (NYS) hospitals have been required to report surgical site infections (SSIs) following colon procedures to the NYS Department of Health, using the National Healthcare Safety Network (NHSN). The purpose of this study was to identify risk factors for the development of SSIs in patients undergoing colon procedures. Methods.?NYS has been conducting validation studies at hospitals to assess the accuracy of the surveillance data reported by the participating hospitals. A sample of patients undergoing colon procedures in NYS hospitals were included in hospital-acquired infection program validation studies in 2009 and 2010. Medical chart reviews and on-site visits were performed to verify patient information reported and to evaluate additional risk factors for SSI. Bivariable and multivariable logistic regressions were performed. Results.?A total of 2,656 colon procedures were included in this analysis, including 698 SSI cases. Multivariable analysis indicated that SSI following colon procedure was associated with body mass index greater than 30 (odds ratio [OR], 1.48 [95% confidence interval (CI), 1.21-1.80]), male sex (OR, 1.34 [95% CI, 1.10-1.64]), American Society of Anesthesiologists physical classification score greater than 3 (OR, 1.33 [95% CI, 1.08-1.64]), procedure duration, transfusion (OR, 1.32 [95% CI, 1.05-1.66]), left-side colon surgical procedures, other gastroenterologic procedures, irrigation, hospital bed size greater than 500, and medical school affiliation. Conclusions.?Male sex, obesity, transfusion, type of procedure, and prolonged duration were significant factors associated with overall infection risk after adjusting other factors. Additional factors not collected in the NHSN slightly improved prediction of SSIs. PMID:25026617

Tserenpuntsag, Boldtsetseg; Haley, Valerie; Van Antwerpen, Carole; Doughty, Diana; Gase, Kathleen A; Ann Hazamy, Peggy; Tsivitis, Marie

2014-08-01

112

Correction of metatarsus primus varus with an opening wedge plate: a review of 18 procedures.  

PubMed

The opening base wedge osteotomy is a safe and useful surgical alternative for correction of moderate to severe hallux valgus deformities with substantial metatarsus primus varus. The authors combine the modified McBride bunionectomy with a proximal first metatarsal opening base wedge osteotomy. Osteotomy stabilization was achieved without bone grafting with a titanium fixation plate specifically designed for opening proximal osteotomies. To assess outcomes achieved by the use of this fixation device, we reviewed the records of 18 procedures (16 patients). Preoperative and postoperative weight-bearing radiographs were measured to compare changes in the following radiographic variables: intermetatarsal angle 1-2, hallux valgus angle, the first metatarsal protrusion distance, and the Seiberg Index. The mean follow-up duration was 11 months (range, 6-17 months). The median intermetatarsal angle decreased by 9 degrees (range, 2 degrees-15 degrees), the hallux valgus angle decreased by 13.5 degrees (range, 0 degrees-56 degrees), and the change in first metatarsal protrusion distance was +2.6 mm (range, -0.8 to 6.6 mm), and all of these changes were statistically significant (P < or = .001). The preoperative to postoperative change in the Seiberg Index was not statistically significant (P = .17). In regard to the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal score, the postoperative scores were statistically significantly higher than the preoperative scores (P < .001). Complications included 2 (11.11%) recurrences, and 1 (5.56%) case of deep vein thrombosis. Fourteen patients (16/18 feet, 88.89%) reported satisfaction with the surgical results. Level of Clinical Evidence: 4. PMID:19577716

Wukich, Dane K; Roussel, Andy J; Dial, Dekarlos M

2009-01-01

113

The stratification of cardiac surgical procedures according to use of blood products: a retrospective analysis of 1480 cases  

Microsoft Academic Search

The use of blood products in 1480 consecutive cases of adult cardiac surgical procedures over a period of 15 mth was studied\\u000a retrospectively using the database of the Department of Anaesthesia of the Institut de Cardiologie de Montreal. Use of blood\\u000a products was compared in patients having (1) coronary artery bypass grafting, (2) valvular surgery, (3) or a combination of

Jean-François Hardy; Jean Perrault; Normand Tremblay; Danielle Robitaille; Robert Blain; Michel Carrier

1991-01-01

114

MD Anderson study finds African American women with breast cancer less likely to have newer, recommended surgical procedure  

Cancer.gov

African American women with early stage, invasive breast cancer were 12 percent less likely than Caucasian women with the same diagnosis to receive a minimally invasive technique, axillary sentinel lymph node (SLN) biopsy, years after the procedure had become the standard of surgical practice, according to research from The University of Texas MD Anderson Cancer Center. The study, presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, also found that those African American women who underwent the older, more invasive procedure, axillary lymph node (ALN) dissection, had higher rates of lymphedema.

115

Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study  

PubMed Central

Background/Aims Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures. Methods We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012. Results In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding. Conclusions In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.

Stumpf, Michael; Sun, Rui; Theilmann, Lorenz

2013-01-01

116

Defining indications to ALPPS procedure: technical aspects and open issues.  

PubMed

The limit to surgical treatment of patients with hepatic tumors is represented by the proportion of residual hepatic parenchyma at the end of surgery (FLR, future liver remnant) that provides an estimation of the risk of postoperative liver failure. Recently, a new two-stage technique has been developed with the acronym (ALPPS) associating liver partitioning and portal vein ligation for staged hepatectomy with the aim of obtaining a more rapid and effective increase in FLR, even though indications are not clear yet. Between January and December 2012, eight patients were candidates to ALPPS at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milan. The first three patients (Series 1) underwent right trisectionectomy and were affected by tumors infiltrating biliary confluence, while the others (Series 2) were candidates to right hepatectomy for colorectal liver metastases. Two patients were then excluded from Series 2 because intraoperative finding of irresectable disease. Intra- and postoperative outcome was evaluated with the aim of defining indications to ALPPS. All patients reached an adequate FLR after a median of 7.5 days from the first procedure (rate of program completion 100 %). In Series 1 two patients developed complications related to bile leakage from the raw surface of the liver to be resected and septic events secondary to ischemic necrosis of the liver segment IV. One patient died following multi-organ failure secondary to sepsis. In Series 2 postoperative course was uneventful in all the patients, and in particular no patient showed disease progression between the two procedures or signs of postoperative liver failure. ALPPS approach was initially considered suitable for patients affected by Klatskin tumors who require, despite a small tumor volume, extended hepatectomies associated with surgery of the biliary tract: the analysis of this first series of patients has led to a re-evaluation of the indication to this strategy, as a consequence of encountered criticisms. Actually only a subset of patients affected by colorectal liver metastases are candidates to ALPPS. PMID:24343420

Ratti, Francesca; Cipriani, Federica; Gagliano, Annalisa; Catena, Marco; Paganelli, Michele; Aldrighetti, Luca

2014-03-01

117

Opening Procedures Handbook. A Guide for Boards of Trustees and Leaders of New Charter Schools  

ERIC Educational Resources Information Center

The Charter School Office has created the Opening Procedures Handbook as a tool to assist charter school founding groups prepare for the exciting, yet challenging, task of opening a Massachusetts public charter school. The Handbook summarizes the opening procedures process, identifies the action items that must be completed prior to the school's…

Massachusetts Department of Education, 2006

2006-01-01

118

Rotator Cuff Tears: Surgical Treatment Options  

MedlinePLUS

... rotator cu? tears. Advancements in surgical techniques for rotator cu? repair include less invasive procedures. While each of the ... Surgeons. The three techniques most commonly used for rotator cu? repair include traditional open repair, arthroscopic repair, and mini- ...

119

A Multiphysics Modeling Approach to Develop Right Ventricle Pulmonary Valve Replacement Surgical Procedures with a Contracting Band to Improve Ventricle Ejection Fraction.  

PubMed

Patients with repaired tetralogy of Fallot account for the majority of cases with late onset right ventricle (RV) failure. A new surgical procedure placing an elastic band in the right ventricle is proposed to improve RV function measured by ejection fraction. A multiphysics modeling approach is developed to combine cardiac magnetic resonance imaging, modeling, tissue engineering and mechanical testing to demonstrate feasibility of the new surgical procedure. Our modeling results indicated that the new surgical procedure has the potential to improve right ventricle ejection fraction by 2-7% which compared favorably with recently published drug trials to treat LV heart failure. PMID:23667272

Tang, Dalin; Yang, Chun; Geva, Tal; Rathod, Rahul; Yamauchi, Haruo; Gooty, Vasu; Tang, Alexander; Kural, Mehmet H; Billiar, Kristen L; Gaudette, Glenn; Del Nido, Pedro J

2013-06-01

120

A Multiphysics Modeling Approach to Develop Right Ventricle Pulmonary Valve Replacement Surgical Procedures with a Contracting Band to Improve Ventricle Ejection Fraction  

PubMed Central

Patients with repaired tetralogy of Fallot account for the majority of cases with late onset right ventricle (RV) failure. A new surgical procedure placing an elastic band in the right ventricle is proposed to improve RV function measured by ejection fraction. A multiphysics modeling approach is developed to combine cardiac magnetic resonance imaging, modeling, tissue engineering and mechanical testing to demonstrate feasibility of the new surgical procedure. Our modeling results indicated that the new surgical procedure has the potential to improve right ventricle ejection fraction by 2–7% which compared favorably with recently published drug trials to treat LV heart failure.

Tang, Dalin; Yang, Chun; Geva, Tal; Rathod, Rahul; Yamauchi, Haruo; Gooty, Vasu; Tang, Alexander; Kural, Mehmet H.; Billiar, Kristen L.; Gaudette, Glenn; del Nido, Pedro J.

2012-01-01

121

Effectiveness of a transforaminal surgical procedure for spinal extradural arachnoid cyst in the upper lumbar spine  

Microsoft Academic Search

Spinal extradural arachnoid cysts are relatively rare, and the pathogenesis is still unclear. Here, we report a 24-year-old woman with a Type I lesion by Nabors' classification (extradural arachnoid cyst without spinal nerve root fiber involvements), who complained of low back pain and right thigh pain, treated surgically using a transforaminal approach. Magnetic resonance imaging (MRI) and myelography showed a

K. Ido; H. Matsuoka; H. Urushidani

2002-01-01

122

Non-surgical closure of post-pneumonectomy empyema with bronchopleural fistula after open window thoracotomy using basic fibroblast growth factor.  

PubMed

Empyema with bronchopleural fistula (BPF) is one of the severest complications following pneumonectomy. Many papers have reported that it is difficult to cure, with a high rate of associated mortality. Closure of the fistula and an appropriate choice of obliteration materials are crucial for successful treatment. However, obliteration is sometimes impractical because of a lack of suitable materials, excessive surgical risk, or lack of patient willingness to undergo the procedure. We report a case of post-pneumonectomy empyema with BPF that was treated by non-surgical closure after open-window thoracotomy (OWT) with the use of basic fibroblast growth factor (bFGF), which was sprayed into the unepithelialized empyema cavity transiting from epidermis and surrounding the fistula. After spraying, the orifice of the OWT was covered by a film dressing. This procedure yielded successful results after two months. PMID:19706719

Okuda, Masaya; Yokomise, Hiroyasu; Tarumi, Shintaro; Huang, Chen-Long

2009-11-01

123

The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures.  

PubMed

Meniscal injuries represent one of the most frequent lesions in sport practicing and in particular in soccer players and skiers. Pain, functional limitation and swelling are typical symptoms associated with meniscal tears. Epidemiological studies showed that all meniscal lesions, in different sports athletes, involves 24% of medial meniscus, while 8% of lateral meniscus and about 20-30% of meniscal lesions are associated with other ligament injuries. Meniscal tears can be treated conservatively or surgically. Surgery leads in many cases to complete resolution of symptoms and allows the return to sport activity. However many studies show that this treatment can induce more frequently the development of degenerative conditions if not correctly associated to a specific rehabilitation protocol. The aim of this article is to compare different timing in specific rehabilitation programs related to the most actual surgical options. PMID:23738313

Frizziero, Antonio; Ferrari, Raffaello; Giannotti, Erika; Ferroni, Costanza; Poli, Patrizia; Masiero, Stefano

2012-10-01

124

Effect of age and surgical technique on symptomatic arrhythmias after the Fontan procedure  

Microsoft Academic Search

The purpose of this study was to determine the effects of newer Fontan modifications (lateral tunnel with or without fenestration) and patient's age at surgery on the incidence and impact of symptomatic postoperative early and intermediate arrhythmias. Modifications to the Fontan procedure are used to decrease postoperative complications, and the Fontan procedure is now being performed on younger patients to

Frank Cecchin; Christopher L Johnsrude; James C. Perry; Richard A. Friedman

1995-01-01

125

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

Microsoft Academic Search

Aim:To compare the outcome of various surgical approaches of orbital decompression in patients with Graves’ orbitopathy (GO) receiving surgery for disfiguring proptosis.Method:Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed.Results:Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular

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

2009-01-01

126

Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?  

PubMed Central

Background Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients. Methods A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35?±?7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504?±?1842 days. Results Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. Conclusions In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results.

2014-01-01

127

Comparison between open and laparoscopic reversal of Hartmann's procedure for diverticulitis  

PubMed Central

AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis. METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis. Other indications for Hartmann’s procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann’s reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups. RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay. CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR.

de'Angelis, Nicola; Brunetti, Francesco; Memeo, Riccardo; Batista da Costa, Jose; Schneck, Anne Sophie; Carra, Maria Clotilde; Azoulay, Daniel

2013-01-01

128

The surgical treatment of children with congenital convex foot (vertical talus): evaluation of midtarsal surgical release and open reduction.  

PubMed

In this study we evaluated the results of midtarsal release and open reduction for the treatment of children with convex congenital foot (CCF) (vertical talus) and compared them with the published results of peritalar release. Between 1977 and 2009, a total of 22 children (31 feet) underwent this procedure. In 15 children (48%) the CCF was isolated and in the remainder it was not (seven with arthrogryposis, two with spinal dysraphism, one with a polymalformative syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to 175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°). The procedure included talonavicular and calcaneocuboid joint capsulotomies, lengthening of tendons of tibialis anterior and the extensors of the toes, allowing reduction of the midtarsal joints. Lengthening of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed by the Adelaar score, were good in 24 feet (77.4%), fair in six (19.3%) and poor in one foot (3.3%), with no difference between those with isolated CCF and those without. The mean American Orthopaedic Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8 (36 to 93) for those with isolated CCF and those without, respectively. At the final follow-up, the mean tibiotalar (120°; 90 to 152) and calcaneal pitch angles (4°; -13 to 22) had improved significantly (p < 0.0001). Dislocation of the talonavicular and calcaneocuboid joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet, respectively. Three children (five feet) underwent further surgery at a mean of 8.5 years post-operatively, three with pes planovalgus and two in whom the deformity had been undercorrected. No child developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory procedure, which may provide better results than peritalar release. Complications include the development of pes planovalgus and persistent dorsal subluxation of the talonavicular joint. Cite this article: Bone Joint J 2014;96-B:837-44. PMID:24891587

Ramanoudjame, M; Loriaut, P; Seringe, R; Glorion, C; Wicart, P

2014-06-01

129

"Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique.  

PubMed

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs. PMID:23820678

Marinis, A; Gkiokas, G; Argyra, E; Fragulidis, G; Polymeneas, G; Voros, D

2013-01-01

130

Comparison of Bariatric Surgical Procedures for Diabetes Remission: Efficacy and Mechanisms  

PubMed Central

Bariatric surgery induces a mean weight loss of 15–30% of initial body weight (depending on the procedure), as well as a 45–95% rate of diabetes remission. Procedures that induce greater weight loss are associated with higher rates of diabetes remission. Improvements in glucose homeostasis after bariatric surgery are likely mediated by a combination of caloric restriction (followed by weight loss) and the effects of altered gut anatomy on the secretion of glucoregulatory gut hormones.

Vetter, Marion L.; Ritter, Scott; Wadden, Thomas A.; Sarwer, David B.

2012-01-01

131

Surgical treatment of odontogenic myxoma and facial deformity in the same procedure  

PubMed Central

Odontogenic myxoma (OM) is an uncommon benign tumor with aggressive and invasive behavior. Predominant symptoms are usually slow and painless swelling, sometimes resulting in perforation of the cortical borders of the affected bone. In this paper, a case report of a patient with an OM on the right maxillary sinus and a vertical excess of maxilla will be presented. The treatment chosen was tumor resection in association with orthognathic surgery with biomodels assessment for surgical planning. A 3-year follow-up showed disease free and stability of the new position of maxilla. The international literature is evaluated to discuss this case report.

Mayrink, Gabriela; Luna, Anibal Henrique Barbosa; Olate, Sergio; Asprino, Luciana; De Moraes, Marcio

2013-01-01

132

High-speed 3-dimensional imaging in robot-assisted thoracic surgical procedures.  

PubMed

We used a high-speed 3-dimensional (3D) image analysis system (SYNAPSE VINCENT, Fujifilm Corp, Tokyo, Japan) to determine the best positioning of robotic arms and instruments preoperatively. The da Vinci S (Intuitive Surgical Inc, Sunnyvale, CA) was easily set up accurately and rapidly for this operation. Preoperative simulation and intraoperative navigation using the SYNAPSE VINCENT for robot-assisted thoracic operations enabled efficient planning of the operation settings. The SYNAPSE VINCENT can detect the tumor location and depict surrounding tissues quickly, accurately, and safely. This system is also excellent for navigational and educational use. PMID:24882302

Kajiwara, Naohiro; Akata, Soichi; Hagiwara, Masaru; Yoshida, Koichi; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2014-06-01

133

Gauze Packing of Open Surgical Wounds: Empirical or Evidence-Based Practice?  

PubMed Central

INTRODUCTION Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities. RESULTS This review summarises the some of the modern alternatives available and the evidence – or the lack of it – for their use in both the acute and chronic setting.

Dinah, F; Adhikari, A

2006-01-01

134

Anaplastic Carcinoma of the Pancreas: Is There a Role for Palliative Surgical Procedure?  

PubMed Central

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

Vaithianathan, Rajan; Panneerselvam, Senthil; Santhanam, Ramachandran

2014-01-01

135

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

PubMed Central

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

Epstein, Nancy E.

2014-01-01

136

Change in quality of life and cost/utility analysis in open stage-related surgical treatment of elbow stiffness.  

PubMed

The goals of this study were to examine the improvement in quality of life achieved after open surgical treatment of elbow stiffness and to verify the cost/utility ratio of surgery. Thirty-three patients (22 men and 11 women) underwent surgery. The etiologies of elbow stiffness were posttraumatic conditions (n=26), primary osteoarthritis (n=5), and rheumatoid arthritis (n=2). Surgery included 14 ulnohumeral arthroplasties, 6 ulnohumeral arthroplasties associated with radiocapitellar replacement, 5 ulnohumeral arthroplasties associated with radial head replacement, and 8 total elbow arthroplasties. All patients were evaluated pre- and postoperatively with the Mayo Elbow Performance Score, the Mayo Elbow Performance Index, the modified American Shoulder and Elbow Surgeons score, the Quick Disabilities of the Arm, Shoulder and Hand score, and the Short Form 36 after a mean follow-up of 26 months. Possible variables affecting clinical outcome and quality of life improvement were assessed. The cost/utility ratio was evaluated as diagnosis-related group reimbursement per quality-adjusted life year. Mayo Elbow Performance Scores and modified American Shoulder and Elbow Surgeons scores increased, on average, by 43 and 41 points, respectively (P<.0001). Quick Disabilities of the Arm, Shoulder and Hand scores decreased, on average, by 44 points (P<.0001). The improvement in the SF-36 physical and mental component summary score was 7.6 and 7, respectively (P=.0001 and .0018). The cost/utility ratio ranged between 670 and 817 Euro/quality-adjusted life year. A significant correlation was found between pain score and quality of life improvement. An inverse correlation emerged between pre- and postoperative quality of life score. The current study shows that open surgery significantly improves quality of life and elbow function. Selecting the surgical procedure that most effectively reduces pain appears to be the most relevant variable responsible for quality of life improvement. Surgery shows a satisfactory cost/utility ratio, justifying a health spending increase to reduce the social costs resulting from lingering elbow stiffness. PMID:23823051

Giannicola, Giuseppe; Bullitta, Gianluca; Sacchetti, Federico M; Scacchi, Marco; Polimanti, David; Citoni, Guido; Cinotti, Gianluca

2013-07-01

137

Comparison of Acquisition Costs of Surgical Supplies in Different Health Care Systems for Cataract and Glaucoma Procedures.  

PubMed

PURPOSE:: To determine cost identification and acquisition cost comparison of surgical supplies for performing cataract and glaucoma procedures. METHODS:: This is a nonrandomized comparative and cross-sectional study. Six health care systems [state-run charity hospital, a private university hospital, 2 ambulatory surgical centers (ASCs), and 2 Veterans Affairs Medical Centers] participated in the study. A list of input prices for disposable surgical items necessary for phacoemulsification with intraocular lens and for trabeculectomy with mitomycin-C (MMC), Ex-PRESS shunt placement, and Ahmed glaucoma valve (AGV) with scleral patch graft was administered to 6 facilities. The total acquisition costs for each surgery at each facility was calculated as the sum of necessary items' costs. All costs are expressed in 2011 US dollars. Total acquisition costs for phacoemulsification/intraocular lens, trabeculectomy with MMC, Ex-PRESS shunt and AGV with scleral patch graft implantation in different health care settings were the main outcome measures. RESULTS:: The state-run hospital had the highest overall cost of disposable items for both cataract surgery ($648) and trabeculectomy with MMC ($339), whereas the Veterans Affairs Medical Centers had the lowest acquisition costs for cataract ($386) and the ASC ($96) for trabeculectomy. The ASC system had the lowest cost for both Ex-PRESS shunt ($707) and AGV ($865), whereas the University ($1352 for the Ex-PRESS) and the state ($1338 for AGV) had the highest cost. Average difference between total disposable item acquisition costs and Medicare payment after different surgeries per case is as follows: $544.29 for cataract surgery, $1834.50 for trabeculectomy, $763.30 for Ex-PRESS shunt, and $1315.00 for the AGV surgery. CONCLUSIONS:: The ASC system had the lowest acquisition cost for disposable items for both cataract and glaucoma surgeries, whereas the university hospital and the state hospital carried the highest costs on an average. Among the 3 glaucoma procedures compared, trabeculectomy has the lowest acquisition costs for disposable items. PMID:23221907

Valentine, Jeremy; Zurakowski, David; Ayyala, Ramesh S

2012-12-01

138

[Endocavitary surgical procedures, an alternative to myomectomy in patients with symptomatic fibroids].  

PubMed

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet. PMID:22100862

De Jesus, I

2011-12-01

139

Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears  

PubMed Central

Summary Purpose: simple tenotomy in the treatment of long head biceps (LHB) lesion offers good results, as well as tenotomy/tenodesis. Materials and methods: we prospectively evaluated 252 patients, divided into 3 groups, treated with rotator cuff repair associated with LHB tenotomy or 2 different types of tenodesis in cases where there had been a partial lesion of the LHB or instability of the bicipital groove. We ascertained whether there was residual pain and the presence of the “Popeye sign” in the post-operative stage. Results: patients who underwent tenotomy alone achieved an improvement on the Visual Analogue Scale (VAS), Simple Shoulder Test (SST) and modified UCLA shoulder rating compared to patients who underwent LHB tenodesis. A positive Popeye sign is poorly perceived by patients. Conclusion: we considered the LHB tenotomy as treatment of choice for the rotator cuff surgical repair when there was an evident LHB lesion.

Biz, Carlo; Vinanti, Giovanni Battista; Rossato, Alberto; Arnaldi, Enrico; Aldegheri, Roberto

2012-01-01

140

Pes cavovarus. Review of a surgical approach using selective soft-tissue procedures.  

PubMed

This study reviews the surgical treatment of twenty-seven patients (thirty-nine feet) with cavovarus foot deformity. The patients' ages ranged from six months to fifteen years. Only those patients who had at least a two-year follow-up were selected for statistical analysis. This group comprised twenty patients (twenty-seven feet). A standardized treatment program was used, based on the flexibility of the deformity. A radical plantar or plantar medial release was employed as indicated, in combination with tendon transfers or osteotomy of the fore part of the foot, or both. All patients were available for follow-up examination and special roentgenograms of the hind part of the foot. Follow-up appraisal of the patients with more than two years' follow-up revealed more than 85 per cent acceptable results with no major complications. PMID:7430182

Paulos, L; Coleman, S S; Samuelson, K M

1980-09-01

141

Development of remote microsurgery robot and new surgical procedure for deep and narrow space  

Microsoft Academic Search

We developed both new operation procedure and new robot system for remote micro surgery at deep and narrow space of human body. This system allows us to operate a difficult microsurgery that conventional method cannot be achieved. Our system consists of flexible stem and slave micro manipulators which can enter deep site such as brain through narrow channel. The macro

Koji Ikuta; Keiichi Yamamoto; Keiji Sasaki

2003-01-01

142

Evaluation of, and Revision of Open Laboratory Procedures at the College Freshman Level.  

ERIC Educational Resources Information Center

This report focuses on the open laboratory procedures used in the freshman biology course at Hamline University. The study aimed to review a number of specific methods used in conducting the unstructured and unscheduled laboratory procedures and discover the most effective arrangement using those procedures. The report includes detailed…

Downing, William L.

143

Third molar surgical procedures: practices by maxillofacial and oral surgeons in South Africa.  

PubMed

An audit of the treatment procedures routinely adopted by maxillofacial and oral surgeons for the removal of impacted third molars under general anaesthesia was undertaken in South Africa. Most maxillofacial and oral surgeons agree on the method of bone removal, the prescribing of antibiotics, analgesic agents and mouthwashes, the suturing of the incision wound and the post-operative review of patients. The results were compared to a similar study undertaken by Falcon and Roberts (1992) in the UK. With the exception of the method of bone removal, maxillofacial and oral surgeons in both groups share a similar approach to the treatment procedures adopted in the removal of impacted third molars. Some variability, however, existed in both studies with regard to the use of intra-operative local anaesthetic agents, the administration of peri-operative steroids and the use of non-steroidal anti-inflammatory agents. PMID:9461974

Naidoo, L C

1996-06-01

144

Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures  

PubMed Central

Objective To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period. Methods During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 54±19 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors. Results Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS) were uncommon (2 out of the 99 procedures/2%). Conclusions The rate of complications requiring reoperation after general thoracic surgery procedures is low and it is mainly related to technical issues from the initial surgery, the recent administration of antiplatelet drugs, the presence of advanced emphysema and surgery for infectious diseases. The need to proceed with completion pneumonectomy has serious risk for fatal outcome.

Foroulis, Christophoros N.; Kleontas, Athanasios; Karatzopoulos, Avgerinos; Nana, Chryssoula; Tagarakis, George; Tossios, Paschalis; Anastasiadis, Kyriakos

2014-01-01

145

A rapid and non-surgical procedure for jugular catheterization of pigs.  

PubMed

A rapid and non-surgical method for jugular catheterization in pigs was set up in 30 piglets of 6.2 kg, 23 pigs of 46 kg and 84 kg and two lactating multiparous sows. The animal was restrained on a V-shaped table (piglets) or with a rope around the mandible (slaughter pigs and sows). The vein was located with the Vacutainer system and a wire guide was inserted into the Vacutainer needle up to the vein lumen. When the needle was removed, the catheter was inserted over the wire guide and advanced until it penetrated the skin and thereafter, the vein wall. The catheter was fixed outside by a large tape and coiled inside a patch just behind the ears. The technique utilizes readily available material and is no more risky for the animal than a single blood sampling. Moreover, it can be performed within 15 to 20 min (including animal restraint) within pens. This new approach might have important implications not only for research purposes by facilitating repeated blood samplings but also for projects which require a rapid and easy method for testing of any kind of pharmaceutical or other type of products under husbandry conditions. PMID:10780845

Matte, J J

1999-07-01

146

Surgical procedures, complications, and prognosis for gastric cancer in the very elderly (>85): a retrospective study.  

PubMed

Many elderly individuals suffer from reduced functioning of major organs with cardiovascular and respiratory system comorbidity. Consequently, surgical stress and postoperative complications can be fatal. We investigated whether gastrectomy can safely improve the prognosis in very elderly (>85 years) patients with gastric cancer. We compared the clinical and pathological features of patients 85 years and older (Group A) with those 80- to 84-year-old (Group B) who underwent gastrectomy. We also compared the survival rates of Group A and Group B, and investigated the prognostic factors. Group A had a high incidence of patients with 3 or more comorbidities, but these did not influence postoperative complications or survival rate. Patients at stage I or II had a significantly higher survival rate than those who did not undergo surgery. However, there was no statistical difference in survival rate at stage III or IV. Our study results revealed that in the early stages (I and II) of well-differentiated gastric cancer with low risk of lymph node metastasis, surgery should consist of minimal lymphadenectomy and be minimally invasive. Further, treatments other than gastrectomy should be considered for patients in whom complete resection via reduction surgery is not possible. PMID:23823016

Isobe, Taro; Hashimoto, Kousuke; Kizaki, Junya; Miyagi, Motoshi; Aoyagi, Keishiro; Koufuji, Kikuo; Shirouzu, Kazuo

2012-01-01

147

Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open  

PubMed Central

Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) was introduced 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique has led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. However, only a minority of lobectomies are performed using the VATS technique, likely owing to concern for intraoperative complications. Optimal operative planning, including obtaining baseline pulmonary function tests with diffusion measurements, positron emission tomography and/or computed tomography scans, bronchoscopy, and endobronchial ultrasound or mediastinoscopy, can be used to anticipate and potentially prevent the occurrence of complications. With increasing focus on operative planning, as well as comfort and experience with the VATS technique, the indications for which this technique is used has grown. As such, the absolute contraindications have narrowed to inability to tolerate single lung ventilation, inability to achieve complete resection with lobectomy, T3 or T4 tumors, and N2 or N3 disease. However, as VATS lobectomy has been applied to more advanced stage disease, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon’s learning curve. Causes of conversion are generally classified into four categories: intraoperative complications, technical problems, anatomical problems, and oncological conditions. Though it is difficult to anticipate which patients may require conversion, it appears that these patients do not suffer from increased morbidity or mortality as a result of conversion to open thoracotomy. Therefore, with a focus on a safe and complete resection, conversion should be regarded as a means of completing resections in a traditional manner rather than as a surgical failure.

Hanna, Jennifer M.; Berry, Mark F.

2013-01-01

148

Open-loop recycling: Criteria for allocation procedures  

Microsoft Academic Search

If the aim of an LCA is to support decisions or to generate and evaluate ideas for future decisions, the allocation procedure\\u000a should generally be effect-oriented rather than cause-oriented. It is important that the procedure be acceptable to decision\\u000a makers expected to use the LCA results. It is also an advantage if the procedure is easy to apply. Applicability appears

Tomas Ekvall; Anne-Marie Tillman

1997-01-01

149

Dual mobility canine total hip prosthesis: implant characteristics and surgical procedure.  

PubMed

Prosthetic dislocation is one of the most common complications after canine hip replacement. The use of dual mobility acetabular components has been shown to reduce the rate of dislocation in first intent hip replacement in human patients who are at high risk for dislocation. In such implants, a mobile polyethylene liner articulates on one side with a metallic acetabular component and on the other side with a metallic prosthetic head. A dual mobility cemented acetabular component has been designed for use in dogs, and is available for use in association with a previously designed modular femoral component. This report describes the characteristics and the procedure for implantation of this implant combination. PMID:23111812

Guillaumot, P; Autefage, A; Palierne, S; Dembour, T; Chancrin, J-L

2012-11-14

150

Emergency treatment of complicated colorectal cancer in the elderly. Should the surgical procedure be influenced by the factor 'age'?  

PubMed

The complication rate in patients affected by colorectal cancer (CRC) is high and the prognosis especially in the elderly patients is poor. The aim of this retrospective study is to compare the complicated CRC outcome between elderly patients and a group of patients younger than 70 years old, treated at the same time period. Between 1997 and 2007, 24 patients older than 70 years old with CRC (Group A), in an emergency situation, were operated on by the same team of surgeons. During the same time period, 20 patients, aged less than 70 years (Group B), with similar clinical and surgical findings, were operated on. All patients had undergone emergency procedures for occlusion, perforation and haemorrhage. We compared both groups in terms of preoperative health status, morbidity and mortality rates. According to ASA classification, Group A was considered of greater intraoperative danger (P = 0.01). Despite the fact that there was no statistically significant difference between the two groups, patients aged > 70 years presented higher morbidity and mortality rates. This fact is probably due to their overall health status. The surgical approach of patients with complicated CRC should not be influenced by the patient's age. PMID:19832892

Kesisoglou, I; Pliakos, I; Sapalidis, K; Deligiannidis, N; Papavramidis, S

2010-11-01

151

Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis  

Microsoft Academic Search

Background  Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares\\u000a our experience with laparoscopic and open reversal of Hartmann’s procedure.\\u000a \\u000a \\u000a \\u000a Study design  All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients\\u000a with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open

Haggi Mazeh; Alexander J. Greenstein; Kristin Swedish; Scott Q. Nguyen; Aaron Lipskar; Kaare J. Weber; Edward H. Chin; Celia M. Divino

2009-01-01

152

Chronic instrumentation and longterm investigation in the fetal and maternal baboon: tether system, conditioning procedures and surgical techniques.  

PubMed

A tether system, conditioning procedures and surgical techniques were designed to maintain chronic catheters and electrodes in the pregnant baboon and her fetus. The tether system was comprised of a lightweight metal backpack containing catheters and electrodes, couplers, pressure transducers and electrical cabling. The backpack was held snugly in place by shoulder and body straps. A flexible metal tether connected the pack to a ball bearing assembly mounted on the top of the animal's home cage. Attached to the assembly were two infusion pumps, fluid reservoir and slip ring electrical connector. The entire system rotated freely with the movements of the animal; thus, the instrumentation and connectors were secure while access was maintained for continuous physiologic recording and intravascular infusion or intermittent blood sampling with minimal physical restraint. Animals were conditioned to accept the system prior to pregnancy and animals who demonstrated tolerance were bred. An initial group of 10 pregnant animals were sham tethered during pregnancy at 102 +/- 7 days with term gestation estimated at 180 days. Surgical procedures were done at 136 +/- 4 days with placement of catheters in the maternal femoral artery and vein, fetal carotid artery jugular vein and trachea, amniotic fluid cavity, and electrodes for fetal electrocardiogram and electroencephalogram. The mean fetal survival time was 9.3 (range 0 to 29) days. The major complications which led to early delivery were placental abruption and rupture of amniotic membranes. With ultrasonic localization of the placenta and determination of fetal position before surgery, these complications may be avoided.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2918681

Stark, R I; Daniel, S S; James, L S; MacCarter, G; Morishima, H O; Niemann, W H; Rey, H; Tropper, P J; Yeh, M N

1989-01-01

153

[Ulna impaction syndrome therapy: decompressive surgical procedures of the head of the ulna].  

PubMed

The ulnar impaction syndrome can be defined as the impaction of the ulnar head against the triangular fibrocartilage complex and ulnar carpus. As a result of this pattern, painful degeneration of the TFCC occurs. Wrist arthroscopy offers a certain diagnostic tool. In addition, arthroscopic debridement of the TFCC shows a high success rate of 70 to 80 percent. After failed arthroscopic debridement, ulnar shortening osteotomy reduces ulnar load significantly. Malunion of the radius resulting in posttraumatic ulna-plus variance should be treated by correction osteotomy with lengthening of the radius. If arthrosis of the distal radioulnar joint is combined with ulnar impaction syndrome, the hemiresection procedure of Bowers or the method of Kapandji-Sauvé are the methods of choice. PMID:9888007

Krimmer, H; Tränkle, M; Schober, F; van Schoonhoven, J

1998-11-01

154

Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure.  

PubMed

Total longitudinal disruptions of the interosseous membrane can allow proximal radius migration and are seen in Essex-Lopresti lesions. We propose an original technique of ligamentoplasty using the semitendinosus tendon. The graft corresponds to the forearm rotation axis for an optimized isometry and longitudinal stabilization. Our ligamentoplasty technique was performed on ten fresh frozen right forearms. We successively assessed the innocuousness, efficiency and resistance of the ligamentoplasty. The ligamentoplasty induced neither passive limitation of pronation-supination nor neurovascular lesions. It prevented from radius proximal migration. The mean load to failure was 28 kg at both ulnar and radial sides of the graft. Our technique is original for the type and position of the graft. It seems safe, efficient and resistant enough for in vivo procedures. This technique decreases longitudinal loads on the radius. It should be indicated in patients with Essex-Lopresti syndrome, in association with radial head internal fixation or arthroplasty. PMID:16474924

Soubeyrand, M; Oberlin, C; Dumontier, C; Belkheyar, Z; Lafont, C; Degeorges, R

2006-06-01

155

High condylectomy procedure: a valuable resource for surgical management of the mandibular condylar hyperplasia.  

PubMed

Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion. PMID:23851829

Pereira-Santos, Darklilson; De Melo, Willian Morais; Souza, Francisley Avila; de Moura, Walter Leal; Cravinhos, Julio César de Paulo

2013-07-01

156

Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management.  

PubMed

Leiomyomas are such common tumors of the uterus that at least two-thirds of women will have at least one by the age of 50. Despite this high incidence, we know relatively little about their cause, growth and development, and contribution to the genesis of reproductive disorders. The prevalence of lesions puts women with associated butun related symptoms at risk for unnecessary and/or unsuccessful interventions,especially if they have not been carefully evaluated and counseled. Indeed, because the majority of leiomyomas do not cause symptoms, when a woman presents with AUB, infertility, pelvic pain, or vague abdominal complaints, it is possible if not likely that the cause of the problem exists elsewhere. The other overwhelming impression that can be gleaned is this: when leiomyomas are the cause of the symptoms,particularly in women desiring to preserve fertility, the tumors have already and frequently induced irreparable harm, a circumstance that cries out for a strategy of early detection and interventions designed to minimize morbidity.Fortunately, because of the efforts of a few, we are just beginning to understand the potential molecular mechanisms by which leiomyomas may contribute to reproductive tract symptoms such as AUB, infertility, and pregnancy loss, work that may contribute to the development of more specific medical therapeutic techniques and strategies. The use of increasingly precise and accessible imaging for diagnosis,combined with the application of customized intrauterine drug-releasing systems or minimally invasive and highly accurate targeted ablative technologies that minimize collateral damage, may provide women the opportunity to avoid the mutilating,painful, expensive, and frequently unsuccessful surgical interventions of today that are applied to end-stage disease.For the present, clinicians should evaluate any woman with reproductive tract symptoms and leiomyomas carefully and with skepticism, ensuring that they have done all that is necessary to determine if the lesion or lesions are related to the problem. If leiomyomas are the suspected or known cause, clinicians must also be prepared to offer or otherwise provide access to the complete spectrum of care that the patient deserves, regardless of the limitations of the clinician’s training, experience,or institutional environment. Such an approach will limit the number of unnecessary and ineffective interventions and, it is hoped, minimize morbidity while optimizing quality of life for affected women. PMID:22134018

Munro, Malcolm G

2011-12-01

157

Surgical pitfalls of minimally invasive direct coronary artery bypass procedure from the viewpoint of a surgeon in the learning curve  

PubMed Central

Introduction Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers arterial revascularization of the left anterior descending (LAD) coronary artery especially in lesions unsuitable for percutaneous coronary interventions. By avoidance of sternotomy and cardiopulmonary bypass its invasiveness is less than that of conventional bypass surgery. Aim We in this study discuss our surgical experience in the MIDCAB procedure. Material and methods Thirteen patients were operated on with the MIDCAB procedure. The inclusion criteria for MIDCAB were pure LAD disease totally occluded or severely stenotic. Patient demographics and preoperative and postoperative data were analyzed. Results Mean age of the patients was 60.0 ±8.6 years. Patients’ preoperative and postoperative levels of cardiac CK-MB (creatine kinase MB) were not significantly different (p = 0.993). However, cardiac troponin I (p < 0.001), hemoglobin (p < 0.001) and hematocrit (p < 0.001) were significantly different. No perioperative myocardial infarctions or cerebrovascular accidents were seen. The patients were discharged at a mean day of 4.77 with oral antiaggregant therapy. No mortality was seen in the study population. Conclusions Minimally invasive direct coronary artery bypass is associated with few perioperative complications. Minimally invasive direct coronary artery bypass in our experience is a very good option for single vessel LAD disease.

Ozdemir, Ahmet Coskun

2012-01-01

158

Particle Swarm Procedure for the Capacitated Open Pit Mining Problem  

Microsoft Academic Search

In the Capacitated Open Pit Mining Problem, we consider the sequential extraction of blocks in order to maximize the total discounted profit under an extraction capacity during each period of the horizon. We propose a formulation closely related to the Resource-Constrained Project Scheduling Problem (RCPSP) where the genotype representation of the solution is based on a priority value encoding. We

Jacques A. Ferland; Jorge Amaya; Melody Suzy Djuimo

159

A pilot study to determine medical laser generated air contaminant emission rates for a simulated surgical procedure.  

PubMed

The U.S. Occupational Safety and Health Administration (OSHA) estimates that half a million health-care workers are exposed to laser surgical smoke each year. The purpose of this study was to establish a methodology to (1) estimate emission rates of laser-generated air contaminants (LGACs) using an emission chamber, and to (2) perform a screening study to differentiate the effects of three laser operational parameters. An emission chamber was designed, fabricated, and assessed for performance to estimate the emission rates of gases and particles associated with LGACs during a simulated surgical procedure. Two medical lasers (Holmium Yttrium Aluminum Garnet [Ho:YAG] and carbon dioxide [CO2]) were set to a range of plausible medical laser operational parameters in a simulated surgery to pyrolyze porcine skin generating plume in the emission chamber. Power, pulse repetition frequency (PRF), and beam diameter were evaluated to determine the effect of each operational parameter on emission rate using a fractional factorial design. The plume was sampled for particulate matter and seven gas phase combustion byproduct contaminants (benzene, ethylbenzene, toluene, formaldehyde, hydrogen cyanide, carbon dioxide, and carbon monoxide): the gas phase emission results are presented here. Most of the measured concentrations of gas phase contaminants were below their limit of detection (LOD), but detectable measurements enabled us to determine laser operation parameter influence on CO2 emissions. Confined to the experimental conditions of this screening study, results indicated that beam diameter was statistically significantly influential and power was marginally statistically significant to emission rates of CO2 when using the Ho:YAG laser but not with the carbon dioxide laser; PRF was not influential vis-a-vis emission rates of these gas phase contaminants. PMID:24498966

Lippert, Julia F; Lacey, Steven E; Lopez, Ramon; Franke, John; Conroy, Lorraine; Breskey, John; Esmen, Nurtan; Liu, Li

2014-01-01

160

Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures  

Microsoft Academic Search

Publications regarding anesthetic management for weight reduction surgery are scarce. We reviewed the records of 234 patients who underwent bariatric restrictive procedures (gastric bypass not included) from May 1999 to September 2000. Variables analyzed included demographics, anesthetic data and perioperative course. Patients were allocated into two groups: laparoscopic (LPG) and open procedures (OPG), comprising 167 and 67 patients respectively. Obstructive

T Ezri; G Muzikant; B Medalion; P Szmuk; I Charuzi; S Susmallian

2004-01-01

161

Students' Approaches to Open-Ended Science Investigation: The Importance of Substantive and Procedural Understanding  

ERIC Educational Resources Information Center

This paper investigates the respective roles of substantive and procedural understanding with regard to students' ability to carry out an open-ended science investigation. The research is a case study centred on an intervention in which undergraduate initial teacher training students are taught the basic building blocks of procedural

Roberts, Ros; Gott, Richard; Glaesser, Judith

2010-01-01

162

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: An analysis for Austria  

Microsoft Academic Search

PurposeTo examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB.

R. Gruber; E. Walter; T. H. Helbich

2010-01-01

163

Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe  

PubMed Central

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

Rech, Dino; Bertrand, Jane T.; Thomas, Nicholas; Farrell, Margaret; Reed, Jason; Frade, Sasha; Samkange, Christopher; Obiero, Walter; Agot, Kawango; Mahler, Hally; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

164

Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures.  

PubMed

This study examined variables predictive of pressure ulcers among patients undergoing urologic surgical procedures. Anesthesia duration and total time of the diastolic blood pressure was less than 50 Hgmm were statistically significant predictors. Dynamic pressure-relieving devices are recommended to reduce incidences of pressure ulcer incidence. PMID:21067094

Connor, Tom; Sledge, Jennifer A; Bryant-Wiersema, Laurel; Stamm, Linda; Potter, Patricia

2010-01-01

165

A review of surgical outcomes of the Lapidus procedure for treatment of hallux abductovalgus and degenerative joint disease of the first MCJ  

Microsoft Academic Search

BackgroundThe modified Lapidus procedure has been used to treat hallux abducto valgus and degenerative joint disease of the first metatarsocuneiform joint for many years. Historically, the Lapidus has been associated with poor satisfaction due to complications such as non-union. The aim of this study was to review the surgical outcomes of 18 patients using the validated Foot Health Status Questionnaire

Natalie G Taylor; Stuart A Metcalfe

2008-01-01

166

A comparison of stress distributions for different surgical procedures, screw dimensions and orientations for a Temporomandibular joint implant.  

PubMed

Finite element analysis is a useful analytical tool for the design of biomedical implants. The aim of this study was to investigate the behavior of temporomandibular joint implants with multiple design variables of the screws used for fixation of the implant. A commercially available implant with full mandible was analyzed using a finite element software package. The effects of different design variables such as orientation, diameter and stem length of the screws on the stress distribution in bone for two different surgical procedures were investigated. Considering the microstrain in bone as a principal factor, the acceptable ranges for screw diameter and length were determined. Parallel orientation of the screws performed better from a stress point of view when compared to the zig-zag orientation. Sufficient contact between the implant collar and mandibular condyle was shown to reduce the peak stresses which may lead to long term success. The distance between screw holes in the parallel orientation was much closer when compared to the zig-zag orientation. However, the stresses in bone near the screw hole area for the parallel orientation were within acceptable limits. PMID:21816398

Chowdhury, Amit Roy; Kashi, Ajay; Saha, Subrata

2011-09-23

167

Open surgical inferior vena cava filter retrieval for caval perforation and a novel technique for minimal cavotomy filter extraction.  

PubMed

Late complications of retrievable inferior vena cava (IVC) filters resulting from IVC perforation and erosion into adjacent structures is an increasingly frequent phenomena. We describe six cases of open filter explantation for IVC penetration and offer a novel technique for open filter removal without the need for an extensive cavotomy. All patients had radiographic evidence of filter erosion into pericaval structures requiring open surgical filter explant. Four of the six patients underwent minimal cavatomy filter extraction, eliminating the need for caval reconstruction. PMID:22503185

Connolly, Peter H; Balachandran, Vinod P; Trost, David; Bush, Harry L

2012-07-01

168

Mastectomy -- The Surgical Procedure  

MedlinePLUS Videos and Cool Tools

... the pocket of a special bra. Your health care provider can discuss breast prosthesis options with you ... financial assistance programs to help you with child care and elder care. Learn about transportation, lodging, child ...

169

Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients  

PubMed Central

Background Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications. Methods A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis. Results Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications. Conclusions The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration.

2014-01-01

170

Ten to 14Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis  

Microsoft Academic Search

Background: Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques.Hypothesis: Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up.Study Design: Case series; Level of evidence, 4.Methods: Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1

Jonathan H. Dunn; John J. Kim; Lonnie Davis; Robert P. Nirschl

2008-01-01

171

Three-dimensional reconstructed computed tomography-magnetic resonance fusion image-based preoperative planning for surgical procedures for spinal lipoma or tethered spinal cord after myelomeningocele repair.  

PubMed

Surgical procedures for spinal lipoma or tethered spinal cord after myelomeningocele (MMC) repair are often difficult and complicated, because the anatomical structures can be deformed in complex and unpredictable ways. Imaging helps the surgeon understand the patient's spinal anatomy. Whereas two-dimensional images provide only limited information for surgical planning, three-dimensional (3D) reconstructed computed tomography (CT)-magnetic resonance (MR) fusion images produce clearer representations of the spinal regions. Here we describe simple and quick methods for obtaining 3D reconstructed CT-MR fusion images for preoperative planning of surgical procedures using the iPlan(®) cranial (BrainLAB AG, Feldkirchen, Germany) neuronavigation software. 3D CT images of the vertebral bone were combined with heavily T(2)-weighted MR images of the spinal cord, lipoma, cerebrospinal fluid (CSF) space, and nerve root through a process of fusion, segmentation, and reconstruction of the 3D images. We also used our procedure called "Image Overlay" to directly project the 3D reconstructed image onto the body surface using an LED projector. The final reconstructed 3D images took 10-30 minutes to obtain, and provided the surgeon with a representation of the individual pathological structures, so enabled the design of effective surgical plans, even in patients with bony deformity such as scoliosis. None of the 19 patients treated based on our 3D reconstruction method has had neurological complications, except for CSF leakage. This 3D reconstructed imaging method, combined with Image Overlay, improves the visual understanding of complicated surgical situations, and should improve surgical efficiency and outcome. PMID:21613771

Bamba, Yohei; Nonaka, Masahiro; Nakajima, Shin; Yamasaki, Mami

2011-01-01

172

Preliminary Development of a Workstation for Craniomaxillofacial Surgical Procedures: Introducing a Computer-Assisted Planning and Execution System  

PubMed Central

Introduction Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation. Methods We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Results Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions The initial development of the CAPE workstation demonstrated integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution.

Gordon, Chad R.; Murphy, Ryan J.; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

2014-01-01

173

Incisional Surgical Site Infection after Elective Open Surgery for Colorectal Cancer  

PubMed Central

Background. The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer. Methods. We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development. Results. A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4). Conclusions. The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI.

Kusumi, Takaya; Hosokawa, Masao; Sumikawa, Sosuke; Furukawa, Hiroshi

2014-01-01

174

OCTYL2CYANOACRYLATE AS A ROUTINE DRESSING AFTER OPEN PEDIATRIC UROLOGICAL PROCEDURES  

Microsoft Academic Search

Purpose:Octyl-2-cyanoacrylate Dermabond, Ethicon, Inc., Sommerville, New Jersey is a synthetic tissue adhesive that has recently been used for skin closure in the treatment of minor lacerations. We assess its effectiveness as a sole dressing after open pediatric urological procedures.

ASHOK RAJIMWALE; BRIAN K. GOLDEN; SIAM OOTTOMASATHIEN; MINA KRISHNAMURTHY; NATHAN O. ULLRICH; MARTIN A. KOYLE

2004-01-01

175

Diffuse cavernous hemangioma of the rectosigmoid—CT scan, a new diagnostic modality, and surgical management using sphincter-saving procedures  

Microsoft Academic Search

Diffuse cavernous hemangioma of the rectosigmoid is a rare lesion. Preoperative recognition has been recorded but, because\\u000a of lack of awareness and inconsistent diagnoses inappropriate therapy still persists. Surgical therapy is the hallmark of\\u000a treatment. Abdominoperineal resection has been advocated. Three cases of diffuse cavernous hemangiomas of the rectosigmoid,\\u000a recognized preoperatively and treated successfully with sphincter-saving procedures, are reported. Use

Carol Ann Aylward; Guy R. Orangio; George W. Lucas; Victor W. Fazio

1988-01-01

176

The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation  

PubMed Central

Abstract: Background: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67). Twenty six patients were men (4patients with type B and 22 patients with type C fracture) and 12 women (7 patients with type B and 5 patients with type C fracture). The commonest cause was a road traffic accident (N=37, about 97%). Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. Results: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months).The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005). Conclusions: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks.

Mardanpour, Keykhosro; Rahbar, Mahtab

2013-01-01

177

Outcomes of Critical Pathway in Laparoscopic and Open Surgical Treatments for Gastric Cancer Patients: Patients Selection for Fast-Track Program through Retrospective Analysis  

PubMed Central

Purpose The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. Materials and Methods In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. Results The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. Conclusions We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.

Choi, Ji Woo; Xuan, Yi; Byun, Cheul Su; Han, Sang-Uk; Cho, Yong Kwan

2013-01-01

178

Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis  

PubMed Central

AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome. METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 ± 3.9 vs 12.6 ± 4.7, P = 0.9) or in the mean CTP (7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP: 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3). CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Hoteit, Maarouf A; Ghazale, Amaar H; Bain, Andrew J; Rosenberg, Eli S; Easley, Kirk A; Anania, Frank A; Rutherford, Robin E

2008-01-01

179

The cumulative analgesic consumption score (CACS): evaluation of a new score to describe postsurgical analgesic consumption as a surrogate parameter for postoperative pain and invasiveness of surgical procedures.  

PubMed

Objective: To validate and evaluate the applicability of a new score to describe postsurgical analgesic consumption in urological and surgical patients across different categories of pain medications and the invasiveness of medical interventions. Materials and Methods: The cumulative analgesic consumption score (CACS) was determined for two cohorts of patients split into three groups with surgeries involving clinically distinct levels of invasiveness (n = 2 x 60). Nonparametric statistical analyses were performed to determine differences between the CACS among the different groups and to assess the correlation between CACS and numeric rating scale (NRS) values for pain intensity. Results: The score was determined for postoperative days 1 and 2 and revealed median scores of 0 (0-11), 3 (0-22) and 10 (6-17) for UA (urological patients from group A), UB (group B) and UC (group C), respectively, and 4 (0-20), 8 (0-38) and 17 (7-68) for SA (surgical patients from group A, SB (group B) and SC (group C), respectively. CACS enabled reliable differentiation between groups involving different levels of invasiveness (p < 0.001). CACS and peak NRS values showed variable degrees of correlation, as expressed by levels of significance ranging from p < 0.001 to p = 0.34 (NS). Conclusions: The CACS is a valid and easily applicable tool to describe postsurgical analgesic consumption in urological and surgical patients. It can be used as a surrogate parameter to assess postsurgical pain and the invasiveness of surgical procedures. These aspects may be measured to compare surgical procedures, in both clinical trials and clinical practice settings. PMID:25010299

Schoenthaler, Martin; Miernik, Arkadiusz; Offner, Klaus; Karcz, Wojciech Konrad; Hauschke, Dieter; Sevcenco, Sabina; Kuehhas, Franklin Emmanuel; Bach, Christian; Buchholz, Noor; Wilhelm, Konrad

2014-01-01

180

A double blind randomized comparison of oral trimeprazine-methadone and ketamine-midazolam for sedation of pediatric dental patients for oral surgical procedures.  

PubMed Central

The safety and efficacy of an oral sedation technique for children having minor oral surgical procedures under local anesthesia were studied. One hundred healthy children between the ages of 2 and 7 yr received either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) (Group A), or a combination of trimeprazine (3 mg/kg) and methadone (0.2 mg/kg) (Group B) 30 min preoperatively. Hemodynamic parameters, adverse reactions, postoperative recovery, and behavior were evaluated. More children were asleep, but rousable to verbal commands, 30 min after drug administration in Group A (40%) than in Group B (8%). Immediately before the dental procedure, 46% of children in Group A were asleep in contrast to 8% of children in group B. Significantly more children in Group A were awake, coughing, crying, and moving purposefully 30 and 60 min after admission to the recovery room. Two children (4%) in Group A vomited. Ten (20%) children in Group A hallucinated compared to none in Group B. The surgeon rated the procedure as good or very good in 94% of children in Group A compared to 78% in Group B. Our results show that the combination of midazolam and ketamine, administered orally, is a safe, effective, and practical approach to managing children for minor oral surgical procedures under local anesthesia.

Roelofse, J. A.; Louw, L. R.; Roelofse, P. G.

1998-01-01

181

Evolution of Image-Guided Liver Surgery: Transition from Open to Laparoscopic Procedures  

PubMed Central

Indications for liver surgery to treat primary and secondary hepatic malignancies are broadening. Utilizing data from B-mode or 2-dimensional intraoperative ultrasound, it is often challenging to replicate the findings from preoperative CT or MRI scans. Additional data from more recently developed image-guidance technology, which registers preoperative axial imaging to a 3-dimensional real-time model, may be used to improve operative planning, locate difficult to find hepatic tumors, and guide ablations. Laparoscopic liver procedures are often more challenging than their open counterparts. Image-guidance technology can assist in overcoming some of the obstacles to minimally invasive liver procedures by enhancing ultrasound findings and ablation guidance. This manuscript describes a protocol that evaluated an open image-guidance system, and a subsequent protocol that directly compared, for validation, a laparoscopic with an open image-guidance system. Both protocols were limited to ablations within the liver. The laparoscopic image-guidance system successfully creates a 3-D model at both 7 and 14 mm Hg that is similar to the open 3-D model. Ultimately, improving intraoperative image guidance can help expand the ability to perform both laparoscopic and open liver surgeries.

Kingham, T. Peter; Jayaraman, Shiva; Clements, Logan W.; Scherer, Michael A.; Stefansic, James D.; Jarnagin, William R.

2013-01-01

182

The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.  

PubMed

This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible. PMID:20231048

Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph

2010-06-01

183

An integrated visualization system for surgical planning and guidance using image fusion and an open MR  

Microsoft Academic Search

A surgical guidance and visualization system is presented, which uniquely integrates capabilities for data analysis and on-line interventional guidance into the setting of interven- tional MRI. Various pre-operative scans (T1- and T2-weighted MRI, MR angiography, and functional MRI (fMRI)) are fused and automatically aligned with the operating field of the interventional MR system. Both pre-surgical and intra-oper- ative data may

David T. Gering; Arya Nabavi; Ron Kikinis; Noby Hata; Lauren J. O'Donnell; W. Eric L. Grimson; Ferenc A. Jolesz; Peter M. Black; William M. Wells

2001-01-01

184

A novel low-fidelity simulator for both mitral valve and tricuspid valve surgery: the surgical skills trainer for classic open and minimally invasive techniques†  

PubMed Central

OBJECTIVES Simulators have been proven to equip trainee surgeons with better skills than the traditional, standard approach to skill development. The purpose of this study was to develop a low-fidelity, low-cost, reusable and portable simulation device, which could provide training in nearly the full range of mitral valve surgery techniques, in both the classic, open approach as well as the minimally invasive approach. METHODS This novel simulator is made up of commonly available components. The basic elements are a classic baby bottle, with the associated feeding teat and screw ring, in combination with a sheet of dental dam. The detailed process for making this simulator is outlined in this article. Maximum suture tensile strength on the different components was tested with a digital force gauge. Reusability and the rate of wear as a result of suturing were documented. Total cost was calculated in euros (€). RESULTS This study resulted in a simulation model very similar in size to the actual anatomical dimensions of the mitral valve. Various pathological conditions, according to Carpentier's Functional Classification, could be simulated. This led to the possibility of providing training in several mitral valve surgical techniques. As the model developed, it became clear that it could also be used to practice tricuspid valve surgery techniques. Maximum mean suture tensions on the silicone teat and dental dam were 42.11 and 11.15 N/m2, respectively. The feeding teat started wearing after approximately 45 suture placements. Total cost of the study model was €5.14. CONCLUSIONS This relatively simple, low-cost, low-fidelity model can provide simulation training in nearly the full range of mitral valve and tricuspid valve surgical techniques, in both the classic open approach and the minimally invasive approach—and do so almost anywhere. Especially when used by young cardiothoracic surgeons in training, this model may contribute to the development of technical skills and procedural knowledge required for adequate performance in the operating room.

Verberkmoes, Niels J.; Verberkmoes-Broeders, Elizabeth M.P.C.

2013-01-01

185

[The switch prophylaxis with levofloxacin in surgical procedures for prosthetic inguinal hernia repair in one day surgery].  

PubMed

The installation of synthetic prosthesis in the repair of the hernial defects of the inguinal region, though it is part of cleaned surgical operations, it needs of an antibacterial prophylaxis for the prevention of the septic complications of the surgical wound and these, compared with complications following hernioplasty by straight suture, have a meaningful morbidity that can outweigh social and economic advantages of the hernioplasties. The Authors' experience is relative to 112 patients submitted to prosthetic hernioplasty by anterior approach (94 cases) and by transabdominal preperitoneal laparoscopy (TAPP) (18 cases) and underwent to "switch prophylaxis" with Levofloxacin using this posologic scheme: 500 mg ev 30 m' before the surgical operation and 500 mg os in seven days following. The evaluation of the surgical wound has never evidenced septic and suppurative complications; only 11 of the 122 surgical wounds (9%) have documented light phlogosis never advanced to evident suppuration. No patients have showed signs of pharmacologic local intolerance; about collateral general effects as sick and diarrhoea are appeared in 5% of patients, but these have been of light entity; an increase of the transaminase, quickly reverted to the suspension of the therapy, has interested 4% of cases. On the basis of these satisfactory results about clinical efficacy on the prophylaxis of the phlogistic complications of the surgical wound, with reduction of the incidence and gravity and in relation to large and complete antibacterial spectrum included Staphylococcus aureus and epidermidis, and about excellent tolerability without collateral effects, the Authors consider to be important the standardized use of this prophylaxis in the prosthetic hernial surgery of the inguinal region. This choice is correlated to the typical pharmacologic characteristics of the Levofloxacin and particularly to the total bioequivalence between endovenous and oral formulation and besides in relation to perseverance, not inferior to 24 hours, of the plasmatic and tissutal concentrations above bactericide IMC on the most part of organic districts, included skin and soft tissue. The assurance of Levofloxacin's employment in the "switch prophylaxis" also is correlated to patient's elevated compliance, above all if he is operated on regimen of "one day surgery", and to a favorable relationship between costs and benefits. PMID:11682967

Angiò, L G; Versaci, A; Rivoli, G; Santagati, C; De Caridi, G; Pacilè, V

2001-01-01

186

Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database  

PubMed Central

Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR) and nurse-to-bed ratio (NBR) were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR) was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (?19.7 physicians per 100 beds) and high NBR (?77.0 nurses per 100 beds) was significantly lower than that in the group with low PBR (<19.7) and low NBR (<77.0) (9.2% vs. 14.5%; odds ratio, 0.76; 95% confidence interval, 0.68–0.86; p?surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

2012-01-01

187

Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation?  

Microsoft Academic Search

Objectives: Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. Methods: Retrospective review of all high-risk neonates (prematurity, low birth weight, associated genetic or co-morbid conditions) undergoing initial palliation

Christian Pizarro; Christopher D. Derby; Jeanne M. Baffa; Kenneth A. Murdison; Wolfgang A. Radtke

2008-01-01

188

Using Surgical Microscope for Sclera Buckling and Transscleral Cryopexy: An Alternative Procedure of Treatment for Rhegmatogenous Retinal Detachment  

PubMed Central

Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ? C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness.

Zhong, Liu-xue-ying; Liu, Wen; Huang, Su-Ying; Zhang, Shao-chong

2014-01-01

189

Using surgical microscope for sclera buckling and transscleral cryopexy: an alternative procedure of treatment for rhegmatogenous retinal detachment.  

PubMed

Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ? C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness. PMID:24790997

Zhong, Liu-Xue-Ying; Du, Yi; Liu, Wen; Huang, Su-Ying; Zhang, Shao-Chong

2014-01-01

190

The OPAL Project: Open source Procedure for Assessment of Loss using Global Earthquake Modelling software  

NASA Astrophysics Data System (ADS)

This paper provides a comparison between Earthquake Loss Estimation (ELE) software packages and their application using an "Open Source Procedure for Assessment of Loss using Global Earthquake Modelling software" (OPAL). The OPAL procedure has been developed to provide a framework for optimisation of a Global Earthquake Modelling process through: 1) Overview of current and new components of earthquake loss assessment (vulnerability, hazard, exposure, specific cost and technology); 2) Preliminary research, acquisition and familiarisation with all available ELE software packages; 3) Assessment of these 30+ software packages in order to identify the advantages and disadvantages of the ELE methods used; and 4) Loss analysis for a deterministic earthquake (Mw7.2) for the Zeytinburnu district, Istanbul, Turkey, by applying 3 software packages (2 new and 1 existing): a modified displacement-based method based on DBELA (Displacement Based Earthquake Loss Assessment), a capacity spectrum based method HAZUS (HAZards United States) and the Norwegian HAZUS-based SELENA (SEismic Loss EstimatioN using a logic tree Approach) software which was adapted for use in order to compare the different processes needed for the production of damage, economic and social loss estimates. The modified DBELA procedure was found to be more computationally expensive, yet had less variability, indicating the need for multi-tier approaches to global earthquake loss estimation. Similar systems planning and ELE software produced through the OPAL procedure can be applied to worldwide applications, given exposure data. Keywords: OPAL, displacement-based, DBELA, earthquake loss estimation, earthquake loss assessment, open source, HAZUS

Daniell, James

2010-05-01

191

Incontinence Treatment: Surgical Treatments  

MedlinePLUS

... Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding ... changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures or devices Tips ...

192

Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period  

PubMed Central

Background There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period. Methods Data were collected in the form of a prospective registry from a community hospital after specific Institutional Review Board approval was obtained. The analysis included consecutive adult patients being surgically treated for degenerative conditions of the lumbar spine, with either an MIS or open approach for two-level instrumented lumbar fusion. Patient outcomes and costs were collected for the perioperative period. Hospital operating costs were grouped by hospitalization/operative procedure, transfusions, reoperations, and residual events (health care interactions). Results One hundred and one open posterior lumbar interbody fusion (Open group) and 109 MIS patients were treated primarily for stenosis coupled with instability (39.6% and 59.6%, respectively). Mean total hospital costs were $27,055.53 for the Open group and $24,320.16 for the MIS group. This represents a statistically significant cost savings of $2,825.37 (10.4% [95% confidence interval: $522.51–$5,128.23]) when utilizing MIS over traditional Open techniques. Additionally, residual events, complications, and blood transfusions were significantly more frequent in the Open group, compared to the MIS group. Conclusions/level of evidence Utilizing minimally invasive techniques for instrumented spinal fusion results in decreased hospital operating costs compared to similar open procedures in the early perioperative period. Additionally, patient benefits of minimally invasive techniques include significantly less blood loss, shorter hospital stays, lower complication rate, and a lower number of residual events. Long-term outcome comparisons are needed to evaluate the efficacy of the two treatments. Level of evidence: III Clinical relevance This work represents a true cost-of-operating comparison between open and MIS approaches for lumbar spine fusion, which has relevance to surgeons, hospitals and payers in medical decision-making.

Lucio, John C; VanConia, R Brent; DeLuzio, Kevin J; Lehmen, Jeffrey A; Rodgers, Jody A; Rodgers, WB

2012-01-01

193

Usefulness of infrared thermal imaging camera for screening of postoperative surgical site infection after the nuss procedure.  

PubMed

Introduction and Objective. The Nuss procedure is widely used in the treatment of pectus excavatum worldwide. Postoperative pectus bar infection is one of the most serious complications associated with this procedure. Therefore, early detection of signs of implant infection is very important. However, this is difficult, and effective methods have yet to be established. Methods. We use a handheld infrared thermal imaging camera to screen patients for postoperative infection following the Nuss procedure. Here, we report a 28-year-old man with recurrent postoperative (Ravitch procedure) pectus excavatum. Results. Infrared thermography camera clearly indicated slight cellulitis in the right chest. Conclusion. Our technique may assist in preventing postoperative bar infection and removal caused by severe bar infection. Furthermore, this camera is potentially suitable for many situations in infection monitoring following subcutaneous implant surgery. PMID:23878757

Fujita, Kenya; Noguchi, Masahiko; Yuzuriha, Shunsuke; Yanagisawa, Daisuke; Matsuo, Kiyoshi

2013-01-01

194

Laparoscopic Versus Open Pyeloplasty: Comparison of Two Surgical Approaches- A Single Centre Experience of Three Years  

Microsoft Academic Search

UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard\\u000a against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized\\u000a prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic\\u000a and 34 open

Punit Bansal; Aman Gupta; Ritesh Mongha; Srinivas Narayan; Ranjit K. Das; Malay Bera; Sudip C. Chakraborty; Anup K. Kundu

195

Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy  

PubMed Central

Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1–17.9 years). Results: The mean preoperative total Mallet score was 14.8 (range, 10–20), and active abduction was 84° (range, 20°–140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13–25, P < .0001), and the mean active abduction improved to 132° (range, 40°–180°, P < .0003). Conclusion: The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder.

Nath, Rahul K.; Somasundaram, Chandra

2012-01-01

196

Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.  

PubMed

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations. PMID:24001332

Pokrywka, Marian; Byers, Karin

2013-06-01

197

The Childhood Adenotonsillectomy Trial (CHAT): Rationale, Design, and Challenges of a Randomized Controlled Trial Evaluating a Standard Surgical Procedure in a Pediatric Population  

PubMed Central

Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used “standard practice” surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions. Citation: Redline S; Amin R; Beebe D; Chervin RD; Garetz SL; Giordani B; Marcus CL; Moore RH; Rosen CL; Arens R; Gozal D; Katz ES; Mitchell RB; Muzumdar H; Taylor HG; Thomas N; Ellenberg S. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. SLEEP 2011;34(11):1509-1517.

Redline, Susan; Amin, Raouf; Beebe, Dean; Chervin, Ronald D.; Garetz, Susan L.; Giordani, Bruno; Marcus, Carole L.; Moore, Renee H.; Rosen, Carol L.; Arens, Raanan; Gozal, David; Katz, Eliot S.; Mitchell, Ronald B.; Muzumdar, Hiren; Taylor, H.G.; Thomas, Nina; Ellenberg, Susan

2011-01-01

198

Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know?  

Microsoft Academic Search

Objective: Due to the combination of local trauma, extracorporeal circulation (ECC), and pulmonary and myocardial reperfusion, cardiac surgery leads to substantial changes in the immune system and possibly to post-operative complications. Procedures without ECC, however, have failed to demonstrate clear advantages. We hypothesized that ECC is far less important in this context than the reperfusion\\/reventilation of the lung parenchyma and

Axel Franke; Wolfgang Lante; Volker Fackeldey; Horst P. Becker; Edmond Kurig; Lothar G. Zöller; Christian Weinhold; Andreas Markewitz

2005-01-01

199

Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration.  

PubMed

A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake. PMID:24136476

Kawamoto, Ai; Katori, Yukio; Honkura, Yohei; Kakuta, Risako; Higashi, Kenjiro; Ogura, Masaki; Miyazaki, Makiko; Arakawa, Kazuya; Kashima, Kazutaka; Asada, Yukinori; Matsuura, Kazuto

2014-05-01

200

Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift procedure.  

PubMed

The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented. PMID:21360218

Bartelink, Lidewij R; Feitz, Wouter F; Kluivers, Kirsten B; Withagen, Mariella I J; Vierhout, Mark E

2011-07-01

201

Duhamel procedure: a comparative retrospective study between an open and a laparoscopic technique  

PubMed Central

Background Few studies are available comparing open with laparoscopic treatment of Hirschsprung’s disease. This study compares a laparoscopic series of 30 patients with a historical open series of 25 patients. Methods The charts of all patients having had a Duhamel procedure in the period from June 1987 through July 2003 were retrospectively reviewed. Open procedures were performed until March 1994. Patients with extended aganglionosis, pre-Duhamel ostomy, or syndrome were excluded from the study. End points were intraoperative complications, postoperative complications, time to first feeding, hospital stay, and outcome at follow-up such as stenosis, enterocolitis, constipation, fecal incontinence, and enuresis. Results Twenty-five patients had an open Duhamel (OD) and 30 had a laparoscopic one (LD). There were no differences in patient characteristics and there were no intraoperative complications in either group. Time to first oral feeds was significantly longer in the OD group as was the duration of hospital stay. No significant differences at follow-up were observed but there was a tendency for a higher enterocolitis rate in the LD group. In contrast, the adhesive obstruction and enuresis rates were higher in the OD group. Cosmetic results were superior in the LD group. Conclusions Except for a significantly shorter hospital stay and shorter time to first oral feeds in favor of LD, no significant differences could be observed. The cosmetic result was not an end point but there was no doubt that it was better in the LD group. Although not statistically significant different, there were no adhesive bowel obstructions in the LD group compared with 3 of 25 in the OD group. Fecal incontinence was not encountered in either group.

Bax, N. M. A.; Van der Zee, D. C.

2007-01-01

202

Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures  

PubMed Central

Background Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively. Patients and methods We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003–2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006–2009 (group B). Results In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner. Interpretation Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center.

2013-01-01

203

Open Source Procedure for Assessment of Loss using Global Earthquake Modelling software (OPAL)  

NASA Astrophysics Data System (ADS)

This paper provides a comparison between Earthquake Loss Estimation (ELE) software packages and their application using an "Open Source Procedure for Assessment of Loss using Global Earthquake Modelling software" (OPAL). The OPAL procedure was created to provide a framework for optimisation of a Global Earthquake Modelling process through: 1. overview of current and new components of earthquake loss assessment (vulnerability, hazard, exposure, specific cost, and technology); 2. preliminary research, acquisition, and familiarisation for available ELE software packages; 3. assessment of these software packages in order to identify the advantages and disadvantages of the ELE methods used; and 4. loss analysis for a deterministic earthquake (Mw = 7.2) for the Zeytinburnu district, Istanbul, Turkey, by applying 3 software packages (2 new and 1 existing): a modified displacement-based method based on DBELA (Displacement Based Earthquake Loss Assessment, Crowley et al., 2006), a capacity spectrum based method HAZUS (HAZards United States, FEMA, USA, 2003) and the Norwegian HAZUS-based SELENA (SEismic Loss EstimatioN using a logic tree Approach, Lindholm et al., 2007) software which was adapted for use in order to compare the different processes needed for the production of damage, economic, and social loss estimates. The modified DBELA procedure was found to be more computationally expensive, yet had less variability, indicating the need for multi-tier approaches to global earthquake loss estimation. Similar systems planning and ELE software produced through the OPAL procedure can be applied to worldwide applications, given exposure data.

Daniell, J. E.

2011-07-01

204

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair  

Microsoft Academic Search

  Abstract\\u000a \\u000a Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique,\\u000a which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective\\u000a study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias.\\u000a Patients underwent either (a) transabdominal preperitoneal

E. A. Papachristou; M. F. Mitselou; N. Finokaliotis

2002-01-01

205

Operative Stress Response Is Reduced After Laparoscopic Compared toOpen Cholecystectomy  

Microsoft Academic Search

Our objective was to determine the least invasive surgical procedure; to do this we compared postoperative pain, duration of ileus, and level of neurohormonal stress response after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). Postoperative recovery of patients was faster after LC than OC but comparison of the neurohormonal stress response after laparoscopic and open surgical procedures revealed conflicting results.

Isabelle Le Blanc-Louvry; Antoine Coquerel; Edith Koning; Cécile Maillot; Philippe Ducrotté

2000-01-01

206

Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift™ procedure  

Microsoft Academic Search

The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse\\u000a may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift™\\u000a procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented.

Lidewij R. Bartelink; Wouter F. Feitz; Kirsten B. Kluivers; Mariella I. J. Withagen; Mark E. Vierhout

2011-01-01

207

Remote Microsurgery System for Deep and Narrow Space - Development of New Surgical Procedure and Micro-robotic Tool  

Microsoft Academic Search

We developed a new medical operation procedure and robotic tool of microsurgery in deep and narrow site. It enables us to\\u000a operate a difficult microsurgery that conventional method can’t be achieved. Our system consists of flexible slave micro manipulators\\u000a which can enter deep site of human body like a flexible catheter and master manipulators. Owing to difference of their sizes,

Koji Ikuta; Keiji Sasaki; Keiichi Yamamoto; Takayuki Shimada

2002-01-01

208

Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.  

PubMed

We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/?l. PMID:24293603

Howard, N E; Phaff, M; Aird, J; Wicks, L; Rollinson, P

2013-12-01

209

A non-terminal surgical procedure for chronic collection of exocrine pancreatic secretions from unrestrained dogs (Canis familiaris).  

PubMed

The ability of dogs to adaptively modulate secretion by the exocrine pancreas to match changes in the amounts and sources of macronutrients is poorly understood. We evaluated the use of re-entrant pancreatic catheters as a non-terminal, temporary approach for the chronic collection of exocrine pancreatic secretion using unrestrained dogs fed diets differing in composition. Re-entrant catheters were surgically placed in the accessory pancreatic duct of two adult mongrel dogs. Secretions were collected for 40 days, during which the dogs were fed three diets with different amounts and sources of macronutrients. The volume of secretion was recorded, protein content was measured, and the activities of trypsin, chymotrypsin, amylase, and lipase were assayed. Inter-dog variation was detected for the volume of secretion (ml/h) but not for protein content (mg/ml) or activities (U/ml) of the enzymes. The volume and composition of the secretion differed among diets. The responses were delayed about 4 days, were transient, and did not coincide with the changes in diet composition. We found that the re-entrant catheters were suitable for studying the exocrine pancreatic secretion of dogs. Our findings were inconclusive about the influence of diet but suggested that adult dogs have a limited and nonspecific response of pancreatic secretion. PMID:11860256

Buddington, Karyl K; Cooper, Robert C; Pierzynowski, Stefan; Lehman, Keri; Swaggart, Glenn; Donahoo, Jillian; Buddington, Randal K

2002-01-01

210

Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence.  

PubMed

Objectives. To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. Study design. A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard midurethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. Results. In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Conclusions. Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques. PMID:24841685

Leanza, V; Intagliata, E; Leanza, A; Ferla, F; Leanza, G; Vecchio, R

2014-01-01

211

Midterm Outcomes of Open Surgical Repair Compared with Thoracic Endovascular Repair for Isolated Descending Thoracic Aortic Disease  

PubMed Central

Objective This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. Materials and Methods From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. Results The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). Conclusion Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.

Lee, Seung Hyun; Chung, Cheol Hyun; Jung, Sung Ho; Lee, Jae Won; Shin, Ji Hoon; Ko, Ki young; Yoon, Hyun Ki

2012-01-01

212

Laparoscopic versus open pyeloplasty: Comparison of two surgical approaches- a single centre experience of three years  

PubMed Central

BACKGROUND: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We compared laparoscopic (LP) and open pyeloplasty (OP) in a randomized prospective trial. MATERIALS AND METHODS: A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at three months and IVP at six months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. RESULTS: Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in OP group. Compared to OP group, the post operative diclofenac requirement was significantly less in LP group (mean 107.14 mg) and OP group required mean of (682.35 mg). The duration of analgesic requirement was also significantly less in LP group. The postoperative hospital stay in LP was mean 3.14 Days (2-7 days) significantly less than the open group mean of 8.29 days (7-11 days). CONCLUSION: LP has a minimal level of morbidity and short hospital stay compared to open approach. Although, laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.

Bansal, Punit; Gupta, Aman; Mongha, Ritesh; Narayan, Srinivas; Kundu, A K; Chakraborty, S C; Das, R K; Bera, M K

2008-01-01

213

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

PubMed

The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In this study, we evaluated the suitability of both a macroporous poly(L-lactide-co-caprolactone) and a porous collagen type I/III scaffold for this purpose. Surprisingly, cell attachment was rapid (?10?min) and sequestered the majority of adipose stem cells, as deduced from colony-forming unit assays. Proliferation occurred in both polymeric scaffolds. Upon chondrogenic induction, up-regulation of chondrogenic genes, production of glycosaminoglycans, and accumulation of collagen type II was observed, indicating differentiation of scaffold-attached SVF cells along the chondrogenic lineage. Osteogenic differentiation was achieved in both scaffold types, as visualized by up-regulation of osteogenic genes, increase of alkaline phosphatase production over time, and accumulation of bone sialoprotein and osteonectin. In conclusion, this study identifies both poly(L-lactide-co-caprolactone) and collagen type I/III as promising scaffold materials for rapid attachment of adipose stem cell-like (stromal) cells, enhancing the development of one-step surgical concepts for cartilage and bone tissue engineering. PMID:21246614

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

2011-06-01

214

Influence of Obesity on Short-term Surgical Outcome of the Transobturator Tape Procedure in Patients with Stress Urinary Incontinence  

PubMed Central

Purpose The purpose of our study was to evaluate the influence of obesity on clinical characteristics, quality of life (QoL), and outcomes in patients with stress urinary incontinence (SUI) who underwent the transobturator tape (TOT) surgery. Materials and Methods The medical records of SUI patients who underwent the TOT operation from January 2007 to February 2009 were retrospectively reviewed. Patients with any neurologic diseases that affect the voiding pattern were excluded, and 107 patients were enrolled. The patients were divided into nonobese (BMI<25) and obese (BMI?25) groups. The preoperative evaluation consisted of history taking, physical examination, cystometrography, 3-day frequency-volume chart, King's Health Questionnaire (KHQ), and symptom perception scale questionnaires. Results The nonobese group consisted of 55 (51.4%) patients and the obese group of 52 (48.6%). The median age was 49.0 (range, 30.8-73.5) years in the nonobese group and 52.7 (range, 35.5-73.5) years in the obese group (p>0.05). The obese group showed a higher SUI symptom grade, urethral hypermobility, urgency, and urge incontinence scale than did the nonobese group (each p<0.05). Neither the domains of the KHQ nor the items on the 3-day frequency-volume chart differed between the two groups (each p>0.05). After the operation, the symptom scales and parameters in the 3-day frequency-volume chart of the obese group were similar to those of the nonobese group (each p>0.05). The objective success, recurrence, and complication rates at 1year were similar in the two groups (each p>0.05). Conclusions Obese SUI patients had worse SUI symptom grade, urgency, and urge incontinence symptoms than did nonobese patients. However, surgical correction by the TOT operation could restore the symptoms and voiding parameters as effectively in obese patients as in nonobese patients.

Tchey, Dong-Un; Kim, Won-Tae; Kim, Yong-June; Lee, Sang-Cheol; Kim, Wun-Jae

2010-01-01

215

Flexible delivery of Er:YAG radiation at 2.94 µm with negative curvature silica glass fibers: a new solution for minimally invasive surgical procedures.  

PubMed

We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm(2). Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures. PMID:23413120

Urich, A; Maier, R R J; Yu, Fei; Knight, J C; Hand, D P; Shephard, J D

2013-02-01

216

Flexible delivery of Er:YAG radiation at 2.94 um with negative curvature silica glass fibers: a new solution for minimally invasive surgical procedures  

PubMed Central

We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm2. Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures.

Urich, A.; Maier, R. R. J.; Yu, Fei; Knight, J. C.; Hand, D. P.; Shephard, J. D.

2012-01-01

217

Comparison of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study  

PubMed Central

Background: We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Materials and Methods: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. Results: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H2O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable. Conclusion: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H2O were more in PLMA group which indicates its better suitability for controlled ventilation.

Kini, Gurudas; Devanna, Gopalkrishna Mettinadka; Mukkapati, Koteswara Rao; Chaudhuri, Souvik; Thomas, Daniel

2014-01-01

218

A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow  

Microsoft Academic Search

We conducted a prospective, randomised, controlled trial of 45 patients (47 elbows), with tennis elbow, who underwent either a formal open release or a percutaneous tenotomy. All patients had pre- and post-operative assessment using the Disability of Arm, Shoulder and Hand (DASH) scoring system. Both groups were followed up for a minimum of 12 months. Statistical analyses using the Mann-Whitney

P. D. Dunkow; M. Jatti; B. N. Muddu

2004-01-01

219

Open triple-branched stent graft placement for the surgical treatment of acute aortic arch dissection  

PubMed Central

Background The primary experience of open triple-branched stent graft placement for acute aortic arch dissection was reported. Methods Between January 2011 and October 2011, 13 well-selected patients (mea age, 46±8.2 years; approximate range, 30~58 years) with acute aortic arch dissection underwent open triple-branched stent graft placement for total arch reconstruction. The triple-branched stent graft was a branched 1-piece graft consisting of a self-expandable nitinol stent and polyester vascular graft fabric (Yuhengjia Sci Tech Corp Ltd, Beijing, China).During hypothermic circulatory arrest, through the transverse incision of the ascending aorta, the main graft of the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta, and then each sidearm graft was positioned one by one into the aortic branch. Once the main graft and sidearm grafts were properly positioned, the restraining strings were withdrawn and then the main graft and sidearm grafts were deployed. Enhanced electric beam computed tomography was performed in each patient before discharge to evaluate the postoperative time course of the residual false lumen. Results Open triple-branched stent graft placement was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and arrest time were 138.40±47.75 min, 70.60±28.94 min and 28.60±12.48 min, respectively. All patients were discharged from hospital. Their computed tomographic scans postoperatively showed that all stent grafts were fully opened and not kinked, there was no blood flow surrounding the triple-branched stent graft. Conclusion Open triple-branched stent graft placement is a new effective technique for total arch reconstruction in acute arch dissection.

2012-01-01

220

A Novel Surgical Technique for Patellar Fracture: Application of Extra-articular Arthroscopy With Hanger-Lifting Procedure.  

PubMed

We describe a novel operative technique for patellar fracture. The patient is placed in the supine position for setup of both an image intensifier and arthroscopy. After routine intra-articular inspection with an arthroscope, an extra-articular space including the prepatellar bursa is developed. The space is created with a lifting hanger applied from a portal wherein an arthroscope can then afford both intra- and extra-articular observation of the articular and bony surface of the patella. By use of an image intensifier, the fracture can be treated and fixed in percutaneous fashion with the aid of an arthroscope. This new technique offers surgeons a magnified view of the patella, both intra- and extra-articularly, through a minimally invasive procedure. Although it includes inherent risks and limitations, this new application of arthroscopy would certainly help surgeons to treat patellar fracture. PMID:24265998

Maeno, Shinichi; Hashimoto, Daijo; Otani, Toshiro; Masumoto, Ko; Fujita, Nobuyuki; Saito, Seiji

2013-01-01

221

DeloRes trial: study protocol for a randomized trial comparing two standardized surgical approaches in rectal prolapse - Delorme's procedure versus resection rectopexy  

PubMed Central

Background More than 100 surgical approaches to treat rectal prolapse have been described. These can be done through the perineum or transabdominally. Delorme’s procedure is the most frequently used perineal, resection rectopexy the most commonly used abdominal procedure. Recurrences seem more common after perineal compared to abdominal techniques, but the latter may carry a higher risk of peri- and postoperative morbidity and mortality. Methods/Design DeloRes is a randomized, controlled, observer-blinded multicenter trial with two parallel groups. Patients with a full-thickness rectal prolapse (third degree prolapse), considered eligible for both operative methods are included. The primary outcome is time to recurrence of full-thickness rectal prolapse during the 24?months following primary surgery. Secondary endpoints are time to and incidence of recurrence of full-thickness rectal prolapse during the 5-year follow-up, duration of surgery, morbidity, hospital stay, quality of life, constipation, and fecal incontinence. A meta-analysis was done on the basis of the available data on recurrence rates from 17 publications comprising 1,140 patients. Based on the results of a meta-analysis it is assumed that the recurrence rate after 2?years is 20% for Delorme’s procedure and 5% for resection rectopexy. Considering a rate of lost to follow-up without recurrence of 30% a total of 130 patients (2 x 65 patients) was calculated as an adequate sample size to assure a power of 80% for the confirmatory analysis. Discussion The DeloRes Trial will clarify which procedure results in a smaller recurrence rate but also give information on how morbidity and functional results compare. Trial registration German Clinical Trial Number DRKS00000482

2012-01-01

222

The painful scapulothoracic articulation: surgical management.  

PubMed

To clarify the indications and effectiveness of surgical decompression for scapulothoracic bursitis, 16 patients were evaluated, who during a 5-year period, had surgical treatment of refractory pain and snapping in the scapulothoracic region. Twelve women and four men with a mean age of 41 years had one of five methods of surgical decompression of the scapulothoracic articulation. Six patients had an open resection of the scapulothoracic bursa with excision of the superomedial portion of the scapula, two had this procedure using an arthroscopic method, and six had a combined approach with arthroscopic scapulothoracic bursectomy and open resection of the superomedial scapula through a small incision. One patient had an arthroscopic and one an open scapulothoracic bursectomy only. At final followup of an average of 36 months (range, 24-69 months), 81% of patients reported satisfaction with the procedure and indicated they would have it again based on the relief they obtained from pain. The Simple Shoulder Test was 9.8 (range, 2-12). Although there was no statistical difference in the success using any given technique, we thought that the combined open and arthroscopic approach was the most effective, and surgical treatment is an acceptable method for treatment of refractory painful scapulothoracic bursitis. PMID:15232433

Lehtinen, Janne T; Macy, John C; Cassinelli, Ezequiel; Warner, Jon J P

2004-06-01

223

Surgical tool alignment guidance by drawing two cross-sectional laser-beam planes.  

PubMed

Conventional surgical navigation requires for surgeons to move their sight and conscious off the surgical field when checking surgical tool's positions shown on the display panel. Since that takes high risks of surgical exposure possibilities to the patient's body, we propose a novel method for guiding surgical tool position and orientation directly in the surgical field by a laser beam. In our navigation procedure, two cross-sectional planar laser beams are emitted from the two laser devices attached onto both sides of an optical localizer, and show surgical tool's entry position on the patient's body surface and its orientation on the side face of the surgical tool. In the experiments, our method gave the surgeons precise and accurate surgical tool adjusting and showed the feasibility to apply to both of open and percutaneous surgeries. PMID:22736629

Nakajima, Yoshikazu; Dohi, Takeyoshi; Sasama, Toshihiko; Momoi, Yasuyuki; Sugano, Nobuhiko; Tamura, Yuichi; Lim, Sung-hwan; Sakuma, Ichiro; Mitsuishi, Mamoru; Koyama, Tsuyoshi; Yonenobu, Kazuo; Ohashi, Satoru; Bessho, Masahiko; Ohnishi, Isao

2013-06-01

224

Surgical helmet systems.  

PubMed

A surgical helmet system (SHS) is either a loose-fitting hood or a hood combined with an integral gown (called a toga system). SHSs are used during orthopedic procedures to decrease the patient's risk of deep wound infection by keeping skin and other particles from the surgeon's face from falling into the open surgical site. They are also used to protect surgical staff from infectious blood splashes and potentially infectious aerosols generated by power tools during orthopedic procedures - and it is this aspect of SHS use that has attracted particular attention, given the intensified interest in healthcare worker (HCW) protection (e.g., against human immunodeficiency virus [HIV], tuberculosis [TB], and hepatitis C virus [HCV]) in hospitals today. Ironically, the very factors that have led to SHSs' recent popularity may limit the need for their use, inasmuch as facilities have instituted so many other effective infection control methods against bloodborne and airborne pathogens. Although SHSs do provide splash protection against bloodborne pathogens, institutions may already by adequately protecting their staff against this hazard. In addition, they may be using SHSs to provide other types of patient and HCW protection that are already being provided by existing infection control measures. SHSs are available in a wide variety of configurations. We evaluated a total of six SHSs: one hood and one toga system each from three manufacturers. The units we tested were among each manufacturer's bestselling systems. We examined how well they would protect patients against deep wound infections and HCWs against splashes and aerosolized particles. We also evaluated their comfort and ease of use for wearers. We found that all of the SHSs provided sufficient patient protection against particles shed by the surgeon. We also found that the hood-only units and the hood components of the toga units provided sufficient HCW splash protection. (The gown portion of the toga systems failed our fluid-resistance criterion. However, we did not test the separate surgical gowns that are used with the hood-only units, and we do not know if they provide any greater level of protection than the toga fabric does). We rated all hood-only units Acceptable. We rated all toga units Acceptable-Not Recommended because the level of patient and HCW protection provided by the toga systems did not justify their significantly higher cost. We did find differences in the level of HCW respiratory protection these systems provided against aerosols. However, we do not believe that this should be a significant selection consideration because there is no established need for respiratory protection during orthopedic procedures. (Respiratory protection is needed against TB aerosols, but hip and knee arthroplasty procedures are usually elective and would be delayed on any active or suspected TB patient until the patient is noninfectious). To establish the context for this study, we first present a Guidance Section, "Do You Need Surgical Helmet Systems for Orthopedic Procedures?" In this section, we discuss the infection risks present during orthopedic procedures. We also outline the protective measures that institutions may already have in place to reduce these risks. We then discuss how SHSs fit into the infection control picture. Supplementary material in this section includes a discussion of the respiratory protection needed against Mycobacterium tuberculosis and a table of factors affecting the choice among SHSs, respirator masks, and surgical masks for patient and HCW protection. Ultimately, the choice to use SHSs may be dictated by the training and preference of the surgical staff. But this Evaluation will help facilities to (1) make this decision and, if appropriate, (2) select the best system for their needs... PMID:8722101

1996-04-01

225

Relation of Surgical Volume to Outcome in Eight Common Operations  

PubMed Central

Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.

Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W.; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

1999-01-01

226

[The development of pelviscopic (laparoscopic) surgical procedures in former East Germany--statistics from 1986-1988 inclusive].  

PubMed

The fourth German pelviscopy/laparoscopy statistical report includes survey data on a total of 219,314 laparoscopies from 354 clinics and 40,892 laparoscopies from 161 private practices. Clinics' response rate was 44.7%, 98.9% of them reported performing laparoscopies; and the number of serious complications requiring laparotomy or control laparoscopy was 492 (2.2/1,000). For private practices, the comparable figures were 66%, 90.8% and 123 (3/1,000), respectively. Compared with data from the third laparoscopy statistical survey, the data show a slight increase in serious complications, most of which were mechanical lesions of blood vessels in the abdominal wall or in the mesosalpinx, followed by mechanical lesions of the intestine. As shown by the previous survey, 16.5% of the complications were burns. For tubal sterilization, bipolar techniques were still predominant; approximately equal numbers of departments used this method, with or without subsequent transsection of the tubes. Endocoagulation by the method of Semm was the second most popular procedure; the use of clips and rings was of little significance. Monopolar high-frequency (HF) current was still used with transsection by 4.1% of clinics (4.7% of private practices) and without transsection by 2.5% (5.3%). Sterilization failure rates remained the same as those previously reported (2.5/1,000 in clinics, 2.8/1,000 in private practices), the highest rates were observed after the use of monopolar HF techniques. Sixty-six percent of the clinics and 41% of the private practices reported their intention to increase the use of endoscopic operational methods. PMID:8517079

Riedel, H H; Lehmann-Willenbrock, E; Semm, K

1993-01-01

227

A Staged Surgical Treatment Outcome of Type 3 Open Tibial Fractures  

PubMed Central

Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport.

Uysal, Emin; Ozmeric, Ahmet

2014-01-01

228

Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma  

Microsoft Academic Search

Background  The role of laparoscopic total gastrectomy (LTG) in the treatment of gastric cancer is controversial. The present study analyzed\\u000a the morbidity and adequacy of resection in LTG versus open total gastrectomy (OTG) for gastric adenocarcinoma.\\u000a \\u000a \\u000a \\u000a Methods  Between 2003 and 2006, clinical data of 38 consecutive patients who underwent LTG for gastric adenocarcinoma were collected\\u000a prospectively. The same data-entry form was used

B. Topal; E. Leys; N. Ectors; R. Aerts; F. Penninckx

2008-01-01

229

Ramirez's abdominoplasty technique combined with intraperitoneal chemohyperthermia after surgical cytoreductive procedures for the treatment of advanced intraperitoneal cancer in patients with ventral hernia.  

PubMed

Patients affected by peritoneal carcinomatosis are frequently submitted to repeated laparotomies to reduce intra-abdominal bulky lesions and to enhance the systemic chemotherapeutic action. Aim of our study is to evaluate feasibility and results of cytoreductive surgery and intraperitoneal chemohypertermic (IPCH) perfusion combined with Ramirez's abdominoplastic technique in selected patients with voluminous ventral hernias.At the same time, we support the hypothesis that Ramirez' technique would allow a normal intra-abdominal pressure leading to an optimal capability of penetration of chemotherapeutic agents in IPCH.From January 1998 to December 2003, 30 patients were submitted to a surgical debulking and IPCH through a laparotomic approach involving a ventral hernia. After extensive cytoreductive surgery, we closed the large abdominal wall damage with Ramirez's abdominoplasty technique, followed by IPCH. The technique described by Ramirez uses bilateral muscle flap complexes transposed medially to reconstruct the central abdominal wall without using meshes to supply or reinforce the abdominal reconstruction.A total of 23 patients (76.7%) were completely cytoreducted and subjected to IPCH. Postoperative mortality was 1/30 (3.3%). Major morbidity was 5/30 (16.7%). After a mean follow-up of 3 years, no sign of recurrent ventral hernia was noted in the survivors.This study suggests that surgical debulking combined with IPCH is feasible in patients with a previously large abdominal wall defect using the functional Ramirez's abdominoplasty technique. The reconstructive technique allows a regular IPCH procedure without recurrence of the ventral hernia confirmed by clinical examination and abdominal computed tomography. PMID:20098105

Fraccalvieri, Marco; Simone, Paolo; Bruno, Francesco; Gaglia, Piero; Ribero, Franco; Scuderi, Stefano; Seghesio, Raffaele; Monni, Manuela; Zanon, Claudio

2010-02-01

230

Orthodontic and surgical perspectives in management of a severe skeletal open bite.  

PubMed

In orthognathic correction of skeletal discrepancy, different treatment options should be considered to give optimum results to the patient with minimal postoperative problems caused by extensive bi-jaw surgery. In a case of severe vertical dysplasia with a large open bite, the orthodontist with the help of advanced diagnostic tools such as imaging software had planned bi-jaw surgery. However, there was a difference in opinion with the oral surgeon who considered only single jaw surgery to get adequate results. The possibility of only maxillary Le Fort I surgery creating autorotation of the mandible was considered, as 0.5° of autorotation results with 1° of maxillary posterior segment clockwise rotation thus avoiding bi-jaw surgery. After performing the Le Fort I superior repositioning of maxilla, the mandibular autorotation was not adequate, so a mandibular bilateral sagittal split osteotomy (BSSO) for mandibular advancement had to be performed to achieve favourable results. PMID:24835800

Vadgaonkar, Vaishali; Gangurde, Parag; Deshmukh, Vijay; Shah, Alok

2014-01-01

231

Duke Surgery Patient Safety: an open-source application for anonymous reporting of adverse and near-miss surgical events  

PubMed Central

Background Studies have shown that 4% of hospitalized patients suffer from an adverse event caused by the medical treatment administered. Some institutions have created systems to encourage medical workers to report these adverse events. However, these systems often prove to be inadequate and/or ineffective for reviewing the data collected and improving the outcomes in patient safety. Objective To describe the Web-application Duke Surgery Patient Safety, designed for the anonymous reporting of adverse and near-miss events as well as scheduled reporting to surgeons and hospital administration. Software architecture DSPS was developed primarily using Java language running on a Tomcat server and with MySQL database as its backend. Results Formal and field usability tests were used to aid in development of DSPS. Extensive experience with DSPS at our institution indicate that DSPS is easy to learn and use, has good speed, provides needed functionality, and is well received by both adverse-event reporters and administrators. Discussion This is the first description of an open-source application for reporting patient safety, which allows the distribution of the application to other institutions in addition for its ability to adapt to the needs of different departments. DSPS provides a mechanism for anonymous reporting of adverse events and helps to administer Patient Safety initiatives. Conclusion The modifiable framework of DSPS allows adherence to evolving national data standards. The open-source design of DSPS permits surgical departments with existing reporting mechanisms to integrate them with DSPS. The DSPS application is distributed under the GNU General Public License.

Pietrobon, Ricardo; Lima, Raquel; Shah, Anand; Jacobs, Danny O; Harker, Matthew; McCready, Mariana; Martins, Henrique; Richardson, William

2007-01-01

232

Surgical rasping systems and methods  

US Patent & Trademark Office Database

A surgical rasping system functional in multiple orthopedic applications, including but not limited to shoulder, knee, hip, wrist, ankle, spinal, or other joint procedures. The system comprises a rasping head which may be low profile and offer a flat cutting/rasping surface, and is configured to be driven by an attached hub that translates a rotational movement into a reciprocating motion. Suction for removal of bone fragments or other tissues is provided through an opening spaced apart from or adjacent to the rasping surface.

2013-12-31

233

Conscious sedation for surgical procedures  

MedlinePLUS

Anesthesia - conscious ... have, what medicines you are taking, and what anesthesia or sedation you have had before. You may ... Eriksson LI, Fleisher LA, et al., eds. Miller's Anesthesia. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009: ...

234

Laboratory procedure for determining percent ash and percent weight loss of solid wastes on heating at 600°C. Open-file report  

Microsoft Academic Search

A variety of analytical procedures have been employed for the determination of the volatile solids in solid wastes. Researchers, such as Kaiser, have adapted the ASTM standard procedure for coal to the analysis of refuse and residue. Other investigators, such as Schoenberger and Wiley and Spillane, have attained more complete oxidations by utilizing open-crucible techniques. A modification of the procedure

Ulmer

1971-01-01

235

Surgically Assisted Rapid Palatal Expansion  

Microsoft Academic Search

This study aimed to evaluate the effect of surgically assisted rapid palatal expansion on the skeletal structures of the midface. Ten patients (mean age 28.5 years) were investigated by means of acoustic rhinometry, study model analysis and sonography before and after the procedure of surgically assisted rapid palatal expansion. The measurements revealed that surgically assisted rapid palatal expansion not only

Susanne Wriedt; Martin Kunkel; Andrej Zentner; Ulrich.-W. Wahlmann

2001-01-01

236

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

Microsoft Academic Search

Post-surgical adhesion formation has numerous deleterious side effects in a wide variety of surgical settings. Physical barriers used together with laparoscopy were developed to reduce tissue trauma seen with open procedures. However, despite surgeons' meticulous techniques and the use of such barriers, adhesion formation remains a serious clinical problem, creating complications that cost the health care system over 1 billion

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

2009-01-01

237

Randomised clinical trial of Hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds.  

PubMed

This prospective, randomised clinical trial compared pain, comfort, exudate management, wound healing and safety with Hydrofiber dressing with ionic silver (Hydrofiber Ag dressing) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds. Patients were treated with Hydrofiber Ag dressing or povidone-iodine gauze for up to 2 weeks. Pain severity was measured with a 10-cm visual analogue scale (VAS). Other parameters were assessed clinically with various scales. Pain VAS scores decreased during dressing removal in both groups, and decreased while the dressing was in place in the Hydrofiber Ag dressing group (n = 35) but not in the povidone-iodine gauze group (n = 32). Pain VAS scores were similar between treatment groups. At final evaluation, Hydrofiber Ag dressing was significantly better than povidone-iodine gauze for overall ability to manage pain (P < 0.001), overall comfort (P < or = 0.001), wound trauma on dressing removal (P = 0.001), exudate handling (P < 0.001) and ease of use (P < or = 0.001). Rates of complete healing at study completion were 23% for Hydrofiber Ag dressing and 9% for povidone-iodine gauze (P = ns). No adverse events were reported with Hydrofiber Ag dressing; one subject discontinued povidone-iodine gauze due to adverse skin reaction. Hydrofiber Ag dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an antimicrobial dressing. PMID:17425549

Jurczak, Florent; Dugré, Thierry; Johnstone, Alison; Offori, Theodor; Vujovic, Zorica; Hollander, Dirk

2007-03-01

238

The Canaletto®™ implant for reconstructing transverse carpal ligament in carpal tunnel surgery. Surgical technique and cohort prospective study about 400 Canaletto cases versus 400 cases with open carpal tunnel surgery.  

PubMed

The techniques used for carpal tunnel release are open surgery, endoscopy and retinaculum repair. Postoperative outcome, however, is often altered by pain, weakness, insufficient sensory or motor recovery and recurrences. We propose, since March 2001, a new surgical technique based on the reconstruction of the flexor retinaculum using the Canaletto®™ implant. The present study consists in a comparative prospective analysis of 400 patients with a Canaletto®™ implant versus 400 patients having undergone open surgery without Canaletto. The average follow-up was 31 months (1-72 months). The rate of carpal tunnel syndrome recovery (suppression of diurnal and nocturnal paraesthesia) was 97.25% in the Canaletto group and 96.11% in the group without Canaletto. The quality of healing was better in the Canaletto group, with a reduced rate of postoperative oedema. Strength recovery defined as a postoperative strength between 80 and 100% of preoperative strength, as assessed by Jamar, was obtained in 67% of patients in the Canaletto group vs. 33% in the group without Canaletto at 1 month of follow-up. There were still some early strength failures in 226 patients (56.5%) of the group without Canaletto and 31 patients (7.75%) of the Canaletto group. In the long term, patients of the Canaletto group displayed strength between 120 and 200% of preoperative strength. Sensory recovery measured by visual analogic scale in patients with preoperative loss of sensitivity was better in the Canaletto group with an average of 8.9/10 vs. 5.8/10 in the group without Canaletto. No recurrence of carpal tunnel was observed in the Canaletto group whereas four recurrences occurred in the group without Canaletto. Mean duration of sick leave decreased from 5 weeks in the group without Canaletto to 3 weeks in the Canaletto group. Such mechanical and biological properties made this implant becoming part of our surgical armamentum; we use it in about 25% of our surgical procedures for carpal tunnel syndromes. There is some limitations regarding the results of this study due to: (1) a potential selection bias between the two cohorts related to Canaletto indication, and (2) one of the authors is also the designer of the implant (the other one has no conflict of interest). PMID:21067958

Duché, R; Trabelsi, A

2010-12-01

239

Surgical correction of bladder neck contracture following prostate cancer treatment.  

PubMed

The surgical and non-surgical treatment of localised prostate cancer may be complicated by bladder neck contractures, prostatic urethral stenoses and bulbomembranous urethral strictures. In general, such complications following radical prostatectomy are less extensive, easier to treat and associated with a better outcome and more rapid recovery than the same complications following radiotherapy, high-intensity focussed ultrasound and cryotherapy. Treatment options range from minimally invasive endoscopic procedures to more complex and specialised open surgical reconstruction.In this chapter the surgical management of bladder neck contractures following the treatment of prostate cancer is described together with the management of prostatic urethral stenoses and bulbomembranous urethral strictures, given the difficulty in distinguishing them from one another clinically. PMID:24531675

Bugeja, Simon; Andrich, Daniela E; Mundy, Anthony R

2014-01-01

240

Surgical Approaches and Outcomes  

Microsoft Academic Search

Weight-loss surgery is the only effective treatment for severe, medically complicated, and refractory obesity. It reverses,\\u000a eliminates, or significantly ameliorates numerous life-threatening medical comorbidities that occur as part of the pathophysiology\\u000a of obesity. Rapid changes in surgical technology and in demand for weight-loss surgery have made the field one of medicine’s\\u000a most dynamic. This chapter reviews available surgical procedures, their

George L. Blackburn; Vivian M. Sanchez

241

Thoracoscopic enucleation of esophageal leiomyomas: a feasible and safe procedure.  

PubMed

In recent years, minimally invasive approaches have been introduced, providing thoracoscopic/laparoscopic techniques in the treatment of esophageal leiomyomas. We determined the technical feasibility and patient safety of thoracoscopic enucleation of esophageal leiomyomas by evaluation of 10 consecutive patients undergoing this procedure. For the surgical approach, a four-trocar access via the right pleural cavity in single-lung ventilation was chosen. All minimally invasive procedures were successfully completed without conversion to open surgery. Every tumor was completely resected without opening of the mucosa. No relevant intra- or postoperative complications were detected. These data suggest that thoracoscopic enucleation is a feasible and safe procedure for esophageal leiomyomas. PMID:18072062

Vallböhmer, D; Hölscher, A H; Brabender, J; Bollschweiler, E; Gutschow, C

2007-12-01

242

[Relation between the status of central hemodynamics in the monkey in the postoperative period and the conditions of its maintenance prior to the surgical procedure].  

PubMed

The pumping and contractile cardiac function of monkeys was examined at different time intervals after electrode and transducer implantation. The study was carried out using 26 rhesus monkeys under ketalar anesthesia. The effect this surgical intervention on intracardiac hemodynamics depended on the initial health state of the animals. Prior to operation the pumping function declined due to diminished motor activity of the animals. It remained decreased to a greater extent 10-15 days after operation. When normal motor activity was allowed even for a short time before surgical implantation, this was sufficient for the normalization of the cardiovascular function. In view of these observations, we should be very cautious to expose monkeys to diminished motor activity for long periods of time. PMID:3560849

Kazakova, R T; Krotov, V P; Giriaeva, I O

1987-01-01

243

A procedure for tissue freezing and processing applicable to both intra-operative frozen section diagnosis and tissue banking in surgical pathology  

Microsoft Academic Search

Different methods for snap freezing surgical human tissue specimens exist. At pathology institutes with higher work loads,\\u000a solid carbon dioxide, freezing sprays, and cryostat freezing are commonly used as coolants for diagnosing frozen tissue sections,\\u000a whereas for tissue banking, liquid nitrogen or isopentane cooled with liquid nitrogen is preferred. Freezing tissues for diagnostic\\u000a and research purposes are therefore often time

Susanne Steu; Maya Baucamp; Gabriela von Dach; Marion Bawohl; Susanne Dettwiler; Martina Storz; Holger Moch; Peter Schraml

2008-01-01

244

Cost Comparison of Laparoscopic versus Open Procedures at the Sydney Women's Endosurgery Centre  

PubMed Central

Objectives: The objective of this study was to provide a cost comparison between laparoscopic surgery and open surgery from January 1996 to January 1998. The setting for this study was three private hospitals and one public hospital associated with the Sydney Women's Endosurgery Centre. Cost analysis was done using the costing provided by the private and public hospitals representing the total amount charged to the patient or the fund for their entire stay including disposable laparoscopic instruments and miscellaneous charges. We looked at laparoscopic hysterectomy, abdominal hysterectomy, vaginal hysterectomy, laparoscopic Burch colposuspension and open Burch colposus-pension. Despite the difficulties and limitations using our method of cost analysis, it appears that laparoscopic surgery is a less costly alternative to open abdominal surgery, particularly where the amount of disposable instruments are kept to a minimum. When the added advantages of early return to normal activities, family and workplace are added in, it is clear that providers of health care in the public and private sector will see laparoscopic surgery as an increasingly desirable option.

Chou, Danny; Cario, Gregory

1998-01-01

245

Surgical Options  

MedlinePLUS

... Treatments for Spinal Pain Surgical Options Anterior Cervical Fusion Artificial Disc Replacement Bone Graft Alternatives Bone Morphogenetic ... Discectomy Percutaneous Vertebral Augmentation Posterior Cervical Foraminotomy Spinal Fusion ... Medicine Surgical Options Anterior Cervical ...

246

Open door expansive laminoplasty and postoperative axial symptoms: a comparative study between two different procedures.  

PubMed

Study design:?Retrospective cohortObjective:?To determine if there are differences in important clinical outcomes between patients treated with a "preservation of the unilateral posterior muscular-ligament complex (PMLC) procedure" and a "hinge side anchoring procedure (HSAP)" for the treatment of cervical spondylotic myelopathy (CSM).Methods:?Nine hundred and forty-six patients underwent the above procedures for treatment of CSM between January 2006 and December 2009. Five hundred and fifty-two (58%) subjects met study criteria and 136 were analyzed (76% unavailable for follow-up). One group (70 patients) received a "preservation of unilateral PMLC procedure" and another group (66 patients) received an HSAP. The rate and severity of postoperative axial symptoms were assessed, and the changes of cervical-spine curvature and postoperative decompression were measured.Results:?The mean time to follow-up in the preservation of unilateral PMLC group was 6.9 months (range, 6-8 months) and the HSAP group was 6.4 months (6-8 months). The overall rate of any axial symptoms (AS) among all subjects was 35%. No AS was reported in 45.7% of the preservation of unilateral PMLC group and 23.8% of the HSAP group (P?=?.008). Severe AS was reported in 4.3% and 11.1% of patients per group, respectively (P?=?.14). Cervical spinal lordosis was improved in the unilateral PMLC group and decreased in the HSAP group. The risk of losing lordosis was more than two times higher in the HSAP group compared with the unilateral PMLC group (70% and 34%, respectively; P?

Sun, Yu; Zhang, Fengshan; Wang, Shaobo; Zhang, Li; Pan, Shengfa; Yu, Miao; Qiu, Sujun

2010-12-01

247

A fast numerical procedure for steady capillary flow in open channels  

Microsoft Academic Search

The surface evolver (SE) algorithm is a valued numerical tool for computations of complex equilibrium interfacial phenomena.\\u000a In this work, an iterative procedure is implemented such that SE can be employed to predict steady-state flows along capillary\\u000a channels of arbitrary cross-section. As a demonstration, a one-dimensional stream filament flow model is solved that approximates\\u000a the pressure changes inside the channel.

J. Klatte; D. Haake; M. M. Weislogel; M. Dreyer

2008-01-01

248

Validation Tests of Open-Source Procedures for Digital Camera Calibration and 3d Image-Based Modelling  

NASA Astrophysics Data System (ADS)

Among the many open-source software solutions recently developed for the extraction of point clouds from a set of un-oriented images, the photogrammetric tools Apero and MicMac (IGN, Institut Géographique National) aim to distinguish themselves by focusing on the accuracy and the metric content of the final result. This paper firstly aims at assessing the accuracy of the simplified and automated calibration procedure offered by the IGN tools. Results obtained with this procedure were compared with those achieved with a test-range calibration approach using a pre-surveyed laboratory test-field. Both direct and a-posteriori validation tests turned out successfully showing the stability and the metric accuracy of the process, even when low textured or reflective surfaces are present in the 3D scene. Afterwards, the possibility of achieving accurate 3D models from the subsequently extracted dense point clouds is also evaluated. Three different types of sculptural elements were chosen as test-objects and "ground-truth" data were acquired with triangulation laser scanners. 3D models derived from point clouds oriented with a simplified relative procedure show a suitable metric accuracy: all comparisons delivered a standard deviation of millimeter-level. The use of Ground Control Points in the orientation phase did not improve significantly the accuracy of the final 3D model, when a small figure-like corbel was used as test-object.

Toschi, I.; Rivola, R.; Bertacchini, E.; Castagnetti, C.; Dubbini, M.; Capra, A.

2013-07-01

249

Surgical management of upper tract urothelial carcinoma  

PubMed Central

Upper tract urothelial cell carcinoma accounts for 5% of all urothelial tumors. Compared to lower urinary tract tumors, upper tract urothelial carcinoma is diagnosed more frequently at advanced stages. Open radical nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, with the advancement of minimally invasive techniques and the benefits of these procedures regarding perioperative morbidity, cosmesis, and earlier convalescence, these options have shown promise in managing the patients with upper tract urothelial carcinoma. Despite the perioperative advantages, concerns exist on the oncological safety after minimally invasive surgery. In this article, we provide a comprehensive overview of the surgical management of upper tract urothelial carcinoma.

Bird, Vincent G.; Kanagarajah, Prashanth

2011-01-01

250

Surgically Controlled, Transpedicular Methyl Methacrylate Vertebroplasty with Fluoroscopic Guidance  

Microsoft Academic Search

Summary  ?The authors report a series of 13 patients with osteoporotic vertebral fractures treated by transpedicular vertebroplasty.\\u000a Because of a neurological complication due to posterior leakage of acrylic cement the classical percutaneous approach was\\u000a converted to an open surgical procedure. The latter allows direct visual control of neural structures and immediate removal\\u000a of spilled cement, thus eliminating the danger of compressive,

M. Wenger; T.-M. Markwalder

1999-01-01

251

Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25 cmH2O: Prospective, Blind, and Randomised Study  

PubMed Central

To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60?cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25?cmH2O, L group) and high (at 60?cmH2O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25?cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

Kang, Joo-Eun; Choi, Jae Won; Son, Il Soon

2014-01-01

252

Utilizing reamer irrigator aspirator (RIA) autograft for opening wedge high tibial osteotomy: A new surgical technique and report of three cases?  

PubMed Central

INTRODUCTION The lateral closing wedge high tibial osteotomy (HTO) was popularized by Coventry in the 1960s. In the 1990s the medial opening wedge osteotomy gained popularity because it could achieve greater valgus correction and it did not require dissociation of the fibula from the tibia, an important consideration when treating varus knees with lateral and posterolateral ligament deficiencies (Noyes’ double-varus and triple-varus knees). However, it has the disadvantage of requiring bone graft to fill bony defects. Recently, the reamer-irrigator-aspirator (RIA; Synthes, Paoli, PA) system was developed, and as a result of this procedure, a large amount of usable autogenous bone graft can be collected safely for use. To our knowledge, there is no published series combining opening wedge HTO with the use of RIA obtained autogenous bone graft. PRESENTATION OF CASE We present a novel technique in which a series of three patients underwent opening wedge HTO using ipsilateral, retrograde femur RIA graft to fill the bone defect. All patients had satisfactory clinical and radiologic outcomes following the new technique at latest follow up. DISCUSSION Opening wedge high tibial osteotomy is a well-documented and accepted orthopedic procedure, however, has the disadvantage of requiring varying amounts of bone graft. Traditionally, iliac crest or tricortical allograft have been the grafting modalities of choice, however both have inherent drawbacks to their use. In our series, the use of RIA autograft is a safe and reliable harvest technique for high tibial osteotomy, providing abundant and quality autogenous bone graft. CONCLUSION All three of our patients achieved radiographic union with high clinical patient satisfaction without any major complications. We feel this novel technique is a safe and acceptable operative solution grafting opening wedge osteotomies about the knee.

Seagrave, Richard A.; Sojka, John; Goodyear, Adam; Munns, Stephen W.

2013-01-01

253

Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies  

PubMed Central

Objectives To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA). Background Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes. Methods A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied. Results Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05]. Conclusion This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

Gurgel, Sanderland J. T.; El Dib, Regina; do Nascimento, Paulo

2014-01-01

254

Comparison of the health related quality of life of patients following mitral valve surgical procedures in the 6-months follow-up: a prospective study.  

PubMed

Purpose: The aim of the present study is to evaluate the health-related quality of life of the patients who underwent mitral valve repair (MvRp) and mitral valve replacement (MVR).Methods: Within the scope of this prospective study design, 56 patients who had mitral valve operation between the years of 2011-2012 were enrolled in the study. 24 (42.8%) of these patients had MVR while 32 (57.1%) of them had MvRp. The health-related quality of life was evaluated according to the Turkey norms of Short Form 36 Quality-Of-Life Measures (SF-36), which were filled in by the patients before and 6 months after the operation. Moreover, preoperative risk factors affecting the quality of life (age, gender, functional capacity, rhythm, hypertension, diabetes, applied surgical method and echocardiographic results) were investigated for all the patients (n = 56) by using independent sample t test analysis.Results: When the pre and postoperative changes were compared between the two groups, it was found out that there were no significant difference between the groups in terms of restraints on physical role functioning (PR), and the social role functioning values (SF) (respectively; p = 0.097, p = 0.105). However, in the comparison of pre-/postoperative changes between the groups, the changes in physical functioning (PF), bodily pain (BP), general health (GH), vitality (VT) and restraints on emotional role functioning (RE) and mental health (MH) values were found out to be significantly superior in the MvRp group than in the MVR group (respectively; p <0.01, p <0.05, p <0.01, p <0.01, p <0.05 and p <0.01). It was also confirmed that female gender, atrial fibrillation (AFR), and MVR method negatively affected the physical and mental components (respectively; p = 0.033, p = 0.003, p = 0.015).Conclusion: Results of the SF-36 quality of life measures show that quality of life may be better in patients that have had MvRp. It should be considered that the planned surgical treatment method can affect the patient's quality of life, and this effect can indicate the success of the surgical treatment. PMID:23558228

Ay, Yasin; Kara, Ibrahim; Aydin, Cemalettin; Ay, Nuray Kahraman; Inan, Bekir; Basel, Halil; Zeybek, Rahmi

2013-04-19

255

Madelung's deformity: radial opening wedge osteotomy and modified Darrach procedure using the ulnar head as trapezoidal bone graft.  

PubMed

Surgery may be indicated in treating Madelung's deformity and numerous techniques have been described. This study reports the early clinical and radiological results of a radial biplanar opening wedge osteotomy and modified Darrach procedure, using the excised ulnar head as a trapezoidal bone graft. Between 2000 and 2008, five adult wrists with symptomatic Madelung's deformity underwent surgery. All patients were female, with an average age at surgery of 34 years. Assessment included range of movement, grip strength, DASH scores and radiological imaging. All patients improved both subjectively and objectively with regards to pain, functional range of movement, and appearance at mean follow-up of 55 months (range 14-113). All osteotomies united. One patient required removal of hardware for restricted rotation. This technique provided satisfactory results that are comparable to other studies, and avoids the use of iliac crest bone graft. PMID:20621940

Kampa, R; Al-Beer, A; Axelrod, T

2010-11-01

256

Surgical wound infection surveillance.  

PubMed

Measuring the frequency of a defined outcome flaw for a series of patients undergoing operative procedures generates information for performance evaluation. Such data influence decisions to improve care if used responsibly. Wound infection (WI), bacterial invasion of the incision, is the most common infectious complication of surgical care and WI prevention has value because the complication affects economic, patient satisfaction, and patient functional status outcomes. WI frequency, one kind of surgical outcome flaw rate, is traditionally used to judge one aspect of surgical care quality. At the author's institution, global WI surveillance was conducted without interruption for 20 years. Results for 85,260 consecutive inpatient operations performed during the period showed that secular changes in infection rates occurred but were not necessarily caused by surgical care quality decrements. PMID:14750065

Lee, J T

2003-12-01

257

Impact of the introduction of drug eluting stents on clinical outcomes in patients undergoing percutaneous and surgical coronary artery revascularisation procedures in Western Australia  

PubMed Central

Background Increasing rates of percutaneous coronary intervention (PCI) and decreasing rates of coronary artery bypass graft (CABG) surgery followed the introduction of drug eluting stents in Western Australia in 2002. We assessed the impact of these changes on one-year outcomes for the total population of patients undergoing coronary artery revascularisation procedures (CARP) in Western Australia between 2000-2004. Methods Clinical and linked administrative data (inpatient admissions and death) were merged for all patients who had their first CARP with stent or CABG in Western Australia between 2000-2004. The clinical data were collected from all hospitals in Western Australia where CARP procedures are performed. We calculated the unadjusted (Kaplan-Meier) and adjusted (Cox) risks for one-year death (all-cause), death (all-cause) or admission for myocardial infarction (MI), target vessel revascularisation (TVR) and the composite outcome of death/MI/TVR (major adverse cardiac events, MACE). Results Over the study period, there were 14,118 index CARPs. The use of drug eluting stents increased from 0% to 95.8% of PCI procedures, and PCI procedures increased from 61.1% to 74.4% of all CARPS. There were no temporal changes in adjusted one-year mortality or death/MI. Overall, adjusted one-year MACE fell from 11.3% in 2000 to 8.5% in 2004 (p<0.0001) due to a significant reduction in TVR in the PCI group. Conclusion The introduction of drug eluting stents and resulting changes in coronary revascularisation strategies were not associated with changes in the one-year risk of major clinical endpoints (death or death/MI), but were associated with a significant reduction in the risk of MACE, driven entirely by a reduction in TVR after PCI. This real world study supports the effectiveness of drug eluting stents in reducing repeat procedures in the total CARP population without increasing the risk of death or MI.

2013-01-01

258

Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: A meta-analysis  

PubMed Central

AIM: To evaluate the feasibility and safety of laparoscopic distal pancreatectomy (LDP) compared with open distal pancreatectomy (ODP). METHODS: Meta-analysis was performed using the databases, including PubMed, the Cochrane Central Register of Controlled Trials, Web of Science and BIOSIS Previews. Articles should contain quantitative data of the comparison of LDP and ODP. Each article was reviewed by two authors. Indices of operative time, spleen-preserving rate, time to fluid intake, ratio of malignant tumors, postoperative hospital stay, incidence rate of pancreatic fistula and overall morbidity rate were analyzed. RESULTS: Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria. LDP was performed in 501 (37.4%) patients, while ODP was performed in 840 (62.6%) patients. There were significant differences in the operative time, time to fluid intake, postoperative hospital stay and spleen-preserving rate between LDP and ODP. There was no difference between the two groups in pancreatic fistula rate [random effects model, risk ratio (RR) 0.996 (0.663, 1.494), P = 0.983, I2 = 28.4%] and overall morbidity rate [random effects model, RR 0.81 (0.596, 1.101), P = 0.178, I2 = 55.6%]. CONCLUSION: LDP has the advantages of shorter hospital stay and operative time, more rapid recovery and higher spleen-preserving rate as compared with ODP.

Xie, Kun; Zhu, Yi-Ping; Xu, Xiao-Wu; Chen, Ke; Yan, Jia-Fei; Mou, Yi-Ping

2012-01-01

259

Arthroscopic repair of the posterior horn of the medial meniscus with opening wedge high tibial osteotomy: surgical technique.  

PubMed

Simultaneous repair of a radial tear at the tibial attachment site of the posterior horn of the medial meniscus under special circumstances requiring tibial valgus osteotomy is technically difficult. First, most patients who need an osteotomy have a narrowed medial tibiofemoral joint space. In such a situation, the pull-out suture technique is more difficult to perform than in a normal joint space. Second, pulling out suture strands that penetrate the posterior horn of the medial meniscus to the anterior tibial cortex increases the risk of transection during osteotomy. We performed a meniscus repair combined with an opening wedge tibial valgus osteotomy without complications and present our technique as a new method for use in selective cases necessitating both meniscus repair of a complete radial tear and opening wedge tibial osteotomy. PMID:19634730

Jung, Kwang Am; Kim, Sung Jae; Lee, Su Chan; Jeong, Jae Hoon; Song, Moon Bok; Lee, Choon Key

2009-07-01

260

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.  

PubMed

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population. PMID:15454594

Pockney, Pete; George, Steve; Primrose, John; Smith, Helen; Kinley, Helen; Little, Paul; Lattimer, Val; Lowy, Adam; Kneebone, Roger

2004-09-01

261

Surgical Outcomes of Congenital Atrial Septal Defect Using da VinciTM Surgical Robot System  

PubMed Central

Background Minimally invasive cardiac surgery has emerged as an alternative to conventional open surgery. This report reviews our experience with atrial septal defect using the da VinciTM surgical robot system. Materials and Methods This retrospective study included 50 consecutive patients who underwent atrial septal defect repair using the da VinciTM surgical robot system between October 2007 and May 2011. Among these, 13 patients (26%) were approached through a totally endoscopic approach and the others by mini-thoracotomy. Nineteen patients had concomitant procedures including tricuspid annuloplasty (n=10), mitral valvuloplasty (n=9), and maze procedure (n=4). The mean follow-up duration was 16.9±10.4 months. Results No remnant interatrial shunt was detected by intraoperative or postoperative echocardiography. The atrial septal defects were mainly repaired by Gore-Tex patch closure (80%). There was no operative mortality or serious surgical complications. The aortic cross clamping time and cardiopulmonary bypass time were 74.1±32.2 and 157.6±49.7 minutes, respectively. The postoperative hospital stay was 5.5±3.3 days. Conclusion The atrial septal defect repair with concomitant procedures like mitral valve repair or tricuspid valve repair using the da VinciTM system is a feasible method. In addition, in selected patients, complete port access can be helpful for better cosmetic results and less musculoskeletal injury.

Kim, Ji Eon; Jung, Sung-Ho; Kim, Gwan Sic; Kim, Joon Bum; Choo, Suk Jung; Chung, Cheol Hyun

2013-01-01

262

Rationale, scope, and 20-year experience of vascular surgical training with lifelike pulsatile flow models.  

PubMed

Vascular surgical training currently has to cope with various challenges, including restrictions on work hours, significant reduction of open surgical training cases in many countries, an increasing diversity of open and endovascular procedures, and distinct expectations by trainees. Even more important, patients and the public no longer accept a "learning by doing" training philosophy that leaves the learning curve on the patient's side. The Vascular International (VI) Foundation and School aims to overcome these obstacles by training conventional vascular and endovascular techniques before they are applied on patients. To achieve largely realistic training conditions, lifelike pulsatile models with exchangeable synthetic arterial inlays were created to practice carotid endarterectomy and patch plasty, open abdominal aortic aneurysm surgery, and peripheral bypass surgery, as well as for endovascular procedures, including endovascular aneurysm repair, thoracic endovascular aortic repair, peripheral balloon dilatation, and stenting. All models are equipped with a small pressure pump inside to create pulsatile flow conditions with variable peak pressures of ~90 mm Hg. The VI course schedule consists of a series of 2-hour modules teaching different open or endovascular procedures step-by-step in a standardized fashion. Trainees practice in pairs with continuous supervision and intensive advice provided by highly experienced vascular surgical trainers (trainer-to-trainee ratio is 1:4). Several evaluations of these courses show that tutor-assisted training on lifelike models in an educational-centered and motivated environment is associated with a significant increase of general and specific vascular surgical technical competence within a short period of time. Future studies should evaluate whether these benefits positively influence the future learning curve of vascular surgical trainees and clarify to what extent sophisticated models are useful to assess the level of technical skills of vascular surgical residents at national or international board examinations. This article gives an overview of our experiences of >20 years of practical training of beginners and advanced vascular surgeons using lifelike pulsatile vascular surgical training models. PMID:23601597

Eckstein, Hans-Henning; Schmidli, Jürg; Schumacher, Hardy; Gürke, Lorenz; Klemm, Klaus; Duschek, Nikolaus; Meile, Toni; Assadian, Afshin

2013-05-01

263

Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†  

PubMed Central

OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315).

Thimour-Bergstrom, Linda; Roman-Emanuel, Christine; Schersten, Henrik; Friberg, Orjan; Gudbjartsson, Tomas; Jeppsson, Anders

2013-01-01

264

One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR(R) vs. CureMesh(R)  

PubMed Central

Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures.

Joo, Young Min; Choe, Jin Ho

2010-01-01

265

[Surgical treatment of benign prostatic hypertrophy and Kelami syndrome].  

PubMed

The authors analyze a group of 116 consecutive patients treated with transvesical prostatic adenomectomy or transurethral prostatic resection for benign prostatic hypertrophy (BPH) isolated five of them with a Kelami syndrome. These patients, aged between 53 and 70 years old, had a relevant ventral penile deflection with severe sexual impairment postoperatively. Among them only one asked for a corrective surgical procedure. Aetiology, preventive measures and therapeutic choices are discussed. Authors pointed out that this syndrome is actually underestimated considering the high number of transurethral or open surgery procedures for BPH. PMID:8560354

Bodo, G; Casetta, G; Piana, P; Ghabin, H; Gamba, P; Tizzani, A

1995-06-01

266

Surgical Simulation  

PubMed Central

Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training.

Sutherland, Leanne M.; Middleton, Philippa F.; Anthony, Adrian; Hamdorf, Jeffrey; Cregan, Patrick; Scott, David; Maddern, Guy J.

2006-01-01

267

Giant paranasal sinus osteomas: surgical treatment options.  

PubMed

Giant paranasal sinus osteomas are rare tumors that may be very closely adherent to surrounding anatomical structures, and complete removal of these tumors may be very challenging. We report 6 cases of giant paranasal sinus osteomas that were removed completely and discussed their symptoms, diagnostic workup, and our surgical approach. We reviewed the patient files of our 6 cases with giant paranasal osteomas and summarized their history, symptoms, diagnosis, management, and follow-up. Three of our patients underwent endoscopic sinus surgery; the other 2 patients underwent open surgical approach (osteoplastic flap procedure with bicoronal incision), and 1 patient underwent both endoscopic and open approaches, all under general anesthesia. Mean patient age was 42.6 years (range, 18-54 years). Main symptoms were headache, proptosis, and diplopia. Physical examination findings include proptosis and frontal puffiness. Paranasal sinus computed tomography revealed larger than 3-cm-diameter tumors in the frontal and ethmoid sinuses. The surgical approach to each case was customized to the location, size, and presenting symptoms of the osteoma. Histopathology revealed osteoma in all cases. All patients were evaluated with paranasal sinus computed tomography scan postoperatively. At a mean follow-up of 15 months, complication was observed in 1 patient; no residual tumor or recurrence was detected following surgery. In symptomatic cases with huge tumors, open, endoscopic, or combined approaches could be applied because of the location and size of the tumor with successful outcomes. Both endoscopic and open approaches are safe and effective methods for removal of these tumors. PMID:24911601

Muderris, Togay; Sevil, Ergun; Bercin, Sami; Canda, Buket; Kiris, Muzaffer

2014-07-01

268

Evaluation of Changes in Tumor Shadows and Microcalcifications on Mammography Following KORTUC II, a New Radiosensitization Treatment without any Surgical Procedure for Elderly Patients with Stage I and II Breast Cancer  

PubMed Central

We introduced non-surgical therapy with a novel enzyme-targeting radiosensitization treatment, Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, Type II (KORTUC II) into early stages breast cancer treatment. The purpose of this study was to examine changes in tumor shadows and microcalcifications on mammography (MMG) following KORTUC II for elderly patients with breast cancer. We also sought to determine whether MMG was useful in evaluating the therapeutic effect of KORTUC II. In addition to MMG, positron emission tomography-computed tomography (PET-CT) was performed to detect both metastasis and local recurrence. In all 10 patients, tumor shadows on MMG completely disappeared in several months following the KORTUC II treatment. The concomitant microcalcifications also disappeared or markedly decreased in number. Disappearance of the tumors was also confirmed by the profile curve of tumor density on MMG following KORTUC II treatment; density fell and eventually approached that of the peripheral mammary tissue. These 10 patients have so far have also shown neither local recurrence nor distant metastasis on PET-CT with a mean follow-up period of approximately 27 months at the end of September, 2010. We conclude that breast-conservation treatment using KORTUC II, followed by aromatase inhibitor, is a promising therapeutic method for elderly patients with breast cancer, in terms of avoiding any surgical procedure. Moreover, MMG is considered to be useful for evaluating the efficacy of KORTUC II.

Tsuzuki, Akira; Ogawa, Yasuhiro; Kubota, Kei; Tokuhiro, Shiho; Akima, Ryo; Yaogawa, Shin; Itoh, Kenji; Yamada, Yoko; Sasaki, Toshikazu; Onogawa, Masahide; Yamanishi, Tomoaki; Kariya, Shinji; Nogami, Munenobu; Nishioka, Akihito; Miyamura, Mitsuhiko

2011-01-01

269

The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts--A Review of a Surgical Technique  

PubMed Central

Background. Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation. Aim. To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique. Methods. The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles. Results. A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies. Conclusion. All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed.

Riben, Christopher; Thor, Andreas

2012-01-01

270

Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance.  

PubMed

The authors report a series of 13 patients with osteoporotic vertebral fractures treated by transpedicular vertebroplasty. Because of a neurological complication due to posterior leakage of acrylic cement the classical percutaneous approach was converted to an open surgical procedure. The latter allows direct visual control of neural structures and immediate removal of spilled cement, thus eliminating the danger of compressive, chemical and thermal effects of methyl methacrylate on neural elements. By use of this elegant technique primary stability of fractured vertebras is obtained leading to prompt pain relief in all patients. Surgically controlled vertebroplasty can be used in conjunction with internal fixation. By having studied the different ways of cement escape in their patients, the authors are convinced that surgically controlled vertebroplasty is safer than percutaneous vertebroplasty. PMID:10929728

Wenger, M; Markwalder, T M

1999-01-01

271

Surgical proctoring for gynecologic surgery.  

PubMed

Surgical proctoring allows a hospital's credentialing committee to objectively monitor, regulate, or oversee surgical privileging for its medical staff to ensure the safety and quality of care for its patients. The surgical proctor does not participate directly in patient care and does not establish a patient-physician relationship before the procedure and therefore is under no obligation to intervene if an intraoperative complication occurs or substandard care is witnessed. Good Samaritan legislation enacted in every state should provide immunity for the proctoring physician if intervention is necessary. Teleproctoring may become the most cost-effective method for institutions that are unable to identify a local proctor for surgical privileging. PMID:24402592

Heit, Michael

2014-02-01

272

Photodigitizing procedures  

NASA Astrophysics Data System (ADS)

This report documents procedures and programs for efficiently running the Photo Digitizing System at the Naval Biodynamics Laboratory. Procedures have been tested and have been found to be effective. Any future acquisitions of programs or changes to current programs should be incorporated in these procedures. On-going research programs use high speed instrumentation cameras to record the motion of test subjects during biodynamic experiments. The films are digitized and the 3-dimensional motion is reconstructed and analyzed. Experimental research is performed to determine the effects of aircraft crashes, ship motion, vibration, aircraft ejection and parachute opening forces on the health and performance of Navy personnel.

Kilgore, P. D.; Gottbrath, J. H.

1984-02-01

273

Neurological recovery and its influencing factors in thoracic and lumbar spine fractures after surgical decompression and stabilization  

Microsoft Academic Search

Surgical decompression and internal fixation of the injured spine have become standard procedures in the management of thoracic and lumbar spine fractures, but their effectiveness on neurological recovery remains controversial. We report on 169 consecutive patients with thoracic and lumbar spine fractures who were treated by reduction, fusion, and internal fixation using transpedicular screw-rod systems. Open decompression was carried out

Stefan Arthur Rath; John Festo Kahamba; Thomas Kretschmer; Ulrich Neff; Hans-Peter Richter; Gregor Antoniadis

2005-01-01

274

Surgical treatment for women with breast cancer in relation to socioeconomic and insurance status.  

PubMed

Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes. PMID:24164659

Azzopardi, Jonathan; Walsh, David; Chong, Chilton; Taylor, Corey

2014-01-01

275

Periodontal Treatments and Procedures  

MedlinePLUS

... Procedures Periodontists are dentistry's e?xperts in treating periodontal disease. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal ...

276

A prospective, randomized controlled trial comparing n-butyl cyanoacrylate tissue adhesive (LiquiBand) with sutures for skin closure after laparoscopic general surgical procedures.  

PubMed

The aim of this study was to compare the efficacy of n-butyl-cyanoacrylate tissue adhesive (Liquiband) with nonabsorbable monofilament sutures for laparoscopic port site closure. Adult patients having elective laparoscopic procedures were randomly allocated to wound closure with sutures or tissue adhesive. End points included skin closure time, wound dressing requirements, wound complications, and cosmesis, assessed at discharge, 4 to 6 weeks and 3 months. Seventy-eight patients randomized to receive sutures and 76 to receive tissue adhesive were eligible for final analysis. Mean closure time was significantly longer for sutures (220 vs. 125 s, P < 0.001). Fewer dressings were required in the tissue adhesive group immediately postoperatively (21% vs. 97%, P < 0.001) and at discharge (24% vs. 82%, P < 0.001). There were no significant differences in wound complications or in cosmesis at either 4 to 6 weeks or at 3 months. Tissue adhesive for laparoscopic port site closure offers potential savings with respect to time and has comparable wound complication rates and cosmetic outcomes when compared with nonabsorbable monofilament sutures. PMID:16804456

Dowson, Charlotte C; Gilliam, Andrew D; Speake, William J; Lobo, Dileep N; Beckingham, Ian J

2006-06-01

277

Surgical management of gastrointestinal stromal tumors: a single center experience  

PubMed Central

Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.

Petrik, Pavel; Petrik, Egle; Lipnickas, Vytautas; Stanaitis, Juozas; Strupas, Kestutis

2014-01-01

278

Surgical bleeding in microgravity  

NASA Technical Reports Server (NTRS)

A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

1993-01-01

279

A comparison of 30 day outcomes after non-lap Band primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery (LABS) study  

PubMed Central

Background The goals were to compare morbidity and mortality between primary and revisional bariatric surgery and to identify clinical predictors of adverse outcome among patients undergoing revisional surgery in the LABS consortium. Setting University hospitals, United States Methods Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. There were 3802 LABS-1 patients included: 3577 primary surgery and 225 revisional surgery patients. Demographic, clinical, operative, and 30-day outcome data were compared between groups. A non-linear mixed effects logit model was used to identify independent risk factors for adverse outcome (death, DVT, PE, reintubation, reoperation, or discharge after day 30). Results Compared to those undergoing revisional surgery, primary surgery patients were younger (median age 44 vs. 49 years, p<0.0001), more likely to be male (20.5 vs. 12.7%, p=0.006), heavier (median BMI 47.3 vs. 41.2 kg/m2, p<0.0001), and had more co-morbidities (p<0.0001), including hypertension (56.0 vs. 46.0%, p=0.0044), diabetes (35.7 vs. 20.0%, p<0.0001) and sleep apnea (50.3 vs. 27.2%, p<0.0001). Revisional procedure operative time was longer (median 181 vs. 135 min, p<0.0001) and associated with greater blood loss (median 100 vs. <50 ml, p<0.0001). Adverse outcome was more likely after revisional surgery (15.1 vs. 5.3%, p<0.0001, OR 2.4, 95% CI 1.6–3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcome, this difference remained statistically significant (OR = 2.3, 95% CI 1.5–3.8). Thirty day mortality was similar in the two groups (0.4%). Conclusions Revisional surgery was performed without substantial mortality but with greater incidence of adverse outcome than primary bariatric surgery.

Inabnet, William Barry; Belle, Steven H.; Bessler, Marc; Courcoulas, Anita; Dellinger, Patchen; Garcia, Luis; Mitchell, James; Oelschlager, Brant; O'Rourke, Robert; Pender, John; Pomp, Alfons; Pories, Walter; Ramanathan, Ramesh; Wahed, Abdus; Wolfe, Bruce

2010-01-01

280

Endoscopy-MR Image Fusion for Image Guided Procedures  

PubMed Central

Minimally invasive endoscope based abdominal procedures provide potential advantages over conventional open surgery such as reduced trauma, shorter hospital stay, and quick recovery. One major limitation of using this technique is the narrow view of the endoscope and the lack of proper 3D context of the surgical site. In this paper, we propose a rapid and accurate method to align intraoperative stereo endoscopic images of the surgical site with preoperative Magnetic Resonance (MR) images. Gridline light pattern is projected on the surgical site to facilitate the registration. The purpose of this surface-based registration is to provide 3D context of the surgical site to the endoscopic view. We have validated the proposed method on a liver phantom and achieved the surface registration error of 0.76 ± 0.11?mm.

Huang, Xishi; Ren, Jing

2013-01-01

281

Multi-site study of surgical practice in neurosurgery based on surgical process models.  

PubMed

Surgical Process Modelling (SPM) was introduced to improve understanding the different parameters that influence the performance of a Surgical Process (SP). Data acquired from SPM methodology is enormous and complex. Several analysis methods based on comparison or classification of Surgical Process Models (SPMs) have previously been proposed. Such methods compare a set of SPMs to highlight specific parameters explaining differences between populations of patients, surgeons or systems. In this study, procedures performed at three different international University hospitals were compared using SPM methodology based on a similarity metric focusing on the sequence of activities occurring during surgery. The proposed approach is based on Dynamic Time Warping (DTW) algorithm combined with a clustering algorithm. SPMs of 41 Anterior Cervical Discectomy (ACD) surgeries were acquired at three Neurosurgical departments; in France, Germany, and Canada. The proposed approach distinguished the different surgical behaviors according to the location where surgery was performed as well as between the categorized surgical experience of individual surgeons. We also propose the use of Multidimensional Scaling to induce a new space of representation of the sequences of activities. The approach was compared to a time-based approach (e.g. duration of surgeries) and has been shown to be more precise. We also discuss the integration of other criteria in order to better understand what influences the way the surgeries are performed. This first multi-site study represents an important step towards the creation of robust analysis tools for processing SPMs. It opens new perspectives for the assessment of surgical approaches, tools or systems as well as objective assessment and comparison of surgeon's expertise. PMID:23810856

Forestier, Germain; Lalys, Florent; Riffaud, Laurent; Louis Collins, D; Meixensberger, Jurgen; Wassef, Shafik N; Neumuth, Thomas; Goulet, Benoit; Jannin, Pierre

2013-10-01

282

Accounting for severity in surgical morbidity rates  

Microsoft Academic Search

Introduction: Because mortality is relatively rare for many procedures, there is growing interest in using morbidity rates to assess surgical quality. However, current measures, including those used in the National Surgical Quality Improvement Program (NSQIP), do not account for complication severity.Methods: Based on NSQIP definitions, postoperative complications were assessed prospectively in 11,169 consecutive patients undergoing general surgery procedures over a

Melissa A. Meyers; Nancy Birkmeyer; Christian M. Birkmeyer; Nancy M. Karon; Perri L. Maxham; Richard W. Dow; John D. Birkmeyer

2004-01-01

283

The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach  

Microsoft Academic Search

Introduction  Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction\\u000a (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus\\u000a decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for\\u000a ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT)

Panduranga Yenumula; Erick F. Rivas; Keith M. Cavaness; Ed Kang; Edward Lanigan

2011-01-01

284

[Update on special surgical approaches in the therapy for lymphedemas].  

PubMed

Despite recent medical progress primary and secondary lymphedemas still represent a therapeutic challenge and they often lead to a significant reduction in quality of life. Lymphedemas usually develop in the extremities, the male external genitals as well as the female breast as a consequence to the axial alignment of the lymphatic collectors. Early stages are characterized by an excess of lymph fluid increasing the volume of the affected part of the body whereas later stages represent an increasing amount of solid tissue. Thus therapeutic efforts can focus on the reduction of the surplus of liquid and/or solid components. Generally there are conservative and operative strategies. Conservative measures mainly focus on the improvement of fluid mobilization and drainage and comprise compression garments, manual lymphatic drainage, and apparative intermittent compression. Operative approaches comprise procedures for surgical tissue reduction (symptomatic/ablative approaches) and/or procedures with the intention of enhancing lymphatic transport (causal approaches). Surgical tissue reduction can be performed by open resection and/or liposuction. Traditional surgical causal techniques such as transposition of local flaps aim at leading lymph away from the congested region of the body. Modern microsurgical causal approaches contain methods of reconstruction of interrupted lymphatic pathways as well as techniques for the conduction of lymph into local veins. In this review we depict and discuss the features of the multiform spectrum of the surgical therapy of lymphedemas on the basis of literature as well as our own clinical and experimental experience. PMID:23093446

Wallmichrath, J; Baumeister, R; Giunta, R E; Notohamiprodjo, M; Frick, A

2012-12-01

285

Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction.  

PubMed

Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery. PMID:24744521

Thiruchelvam, Nikesh

2014-04-01

286

Surgical instruments  

US Patent & Trademark Office Database

A surgical instrument includes an elongated transmission waveguide defining a longitudinal axis. The transmission waveguide has a distal end and a proximal end. The at least one strike surface is formed on the proximal end and is configured to receive vibratory energy.

2012-07-24

287

Surgical Mesh  

MedlinePLUS

... complications associated with the mesh. The complications include adverse reactions to the mesh, adhesions (when the loops of ... continuing to analyze and evaluate incoming reports of adverse events, and are ... you’ve had a past reaction to materials used in surgical mesh or sutures, ...

288

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract  

Microsoft Academic Search

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open- angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined

Bradford Shingleton; Manfred Tetz; Norbert Korber

289

[Surgical treatment of Wolff-Parkinson-White syndrome: analysis of the methods and results].  

PubMed

The authors analyse the outcomes of surgical management in 400 patients with the Wolff-Parkinson-White syndrome who had been operated on in the All-Union Centre for Surgical treatment of Severe Cardiac Arrhythmias and Electrocardiostimulation. Unique surgical procedures were applied, which made it possible to perform cryodestruction of accessory atrioventricular pathways, without resorting to an extracorporeal circulation and without opening heart cavities. The procedures are demonstrated to be not inferior to operations using extracorporeal circulation. It is concluded that patients with the Wolff-Parkinson-White syndrome should be operated on under natural circulation, in particular if they have a concomitant abnormality as a risk factor for employing extracorporeal circulation. PMID:2087028

Bredikis, Iu Iu; Putialis, R A; Sakalauskas, Iu; Bredikis, A Iu; Sasnauskas, A

1990-11-01

290

Predictors of ARF after cardiac surgical procedures  

Microsoft Academic Search

Background: In a pilot study, a low preoperative serum ferritin level predicted increased risk for acute renal failure (ARF) after cardiopulmonary bypass. It was hypothesized that this may reflect a decreased ability to bind free iron and defend against oxidative stress. However, the pilot study was performed in a small number of patients (n = 30) operated on by a

Katherine R. Tuttle; Neil K. Worrall; Lynn R. Dahlstrom; Radha Nandagopal; Annamaria T. Kausz; Connie L. Davis

2003-01-01

291

The problem surgical colleague.  

PubMed

The surgical profession, more than any other medical specialty, is constantly in the limelight. Frequently, concerns are expressed about our colleagues. The concerns may be personality clashes rather than failure in behaviour or performance. Most concerns can be addressed locally with support from the Royal College Invited Review Mechanism of the National Clinical Assessment Service. Unfortunately, if the concern is sufficiently serious or repetitive it may warrant referral to the General Medical Council (GMC) who alone has the right to withdraw a surgeon's medical registration. The surgeon will then be unable to work in the medical profession in this country. The procedures the the surgeon must undergo if referred to the GMC are stressful and protracted. Even if successful the surgeon will probably be expected to undergo a period of retraining that will prove difficult to arrange. New proposals to modify the GMC procedures will reduce the standard of proof to one of 'balance of probabilities'. The surgical profession should be accountable to its patients and colleagues. Will our Royal College rise to the challenge to establish itself as the bulwark of the surgical profession? PMID:17688714

Mosley, John G

2007-07-01

292

Efficacy of surgical treatment of chronic otitis media.  

PubMed

This article presents our results of surgical treatment of chronic otitis media (COM) and discusses its efficacy regarding the control of disease and hearing results. A retrospective chart review of 84 ears was performed. Forty-one ears with noncholesteatomatous COM underwent tympanomastoidectomy, 43 ears with cholesteatoma were managed according to the extension of the disease, closed mastoidectomy was indicated in 19 cases, and open mastoidectomy was performed in 24 ears. In the group without cholesteatoma, a stable ear with closed tympanic membrane was obtained in 85% of cases after the first procedure. The speech response threshold before and after surgery was 38 and 26 dB. In patients with cholesteatoma, a dry ear was achieved in 79% of cases on both techniques after the first intervention. The recurrence rate of cholesteatoma was 10% for the closed technique and 4% for the open technique. The mean preoperative and postoperative SRTs for the closed technique were 30 and 29 dB and for the open technique were 50 and 54 dB. The surgical treatment for COM can be a rewarding procedure if a correct technique is indicated. The surgery should be tailored regarding the clinical stage and intraoperative findings in each case. PMID:12601324

Cruz, Oswaldo Laércio M; Kasse, Cristiane A; Leonhart, Fernando D

2003-02-01

293

Surgical management of ectopic pregnancy.  

PubMed

Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

Stock, Laura; Milad, Magdy

2012-06-01

294

Surgical management of presbyopia  

PubMed Central

Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.

Torricelli, Andre AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

2012-01-01

295

Endoscopic Plantar Fasciotomy: A Minimally Traumatic Procedure for Chronic Plantar Fasciitis  

PubMed Central

Endoscopic plantar fasciotomy (EPF) is a minimally invasive and minimally traumatic surgical treatment for the common problem of chronic plantar fasciitis. This procedure is indicated only for the release of the proximal medial aspect of the fascia in cases that do not respond to aggressive conservative, nonsurgical treatment. In the literature, an overall 87% success rate has been reported in 1228 procedures, in addition to an 83% success rate reported by Burke at the Northwest Podiatric Foundation Surgical Seminar in January 2000. The author's personal experience with 41 procedures over 5 years is consistent with an overall average success of 90%. EPF complications are reduced in comparison with traditional open procedures and can be avoided in many cases when identified early and treated properly. EPF is recommended as the procedure of choice when conservative treatment measures have been exhausted.

Hake, Daniel H.

2000-01-01

296

Surgical access to separate branches of the cat vestibular nerve  

NASA Technical Reports Server (NTRS)

A posteroventral approach for access to separate branches of the cat vestibular nerve is presented which permits simultaneous surgical access to the ampullary and otolithic nerves. Surgical procedures are discussed.

Radkevich, L. A.; Ayzikov, G. S.

1981-01-01

297

Surgical Techniques in the Study of Canine Fetal Physiology.  

National Technical Information Service (NTIS)

Surgical techniques for operating on the canine fetus together with pre- and postoperative management have been described. These principles have been developed during the course of over 500 surgical procedures performed on the pregnant dog. (Author)

R. L. Bernstine A. G. Coran

1972-01-01

298

Surgical management of urolithiasis in spinal cord injury patients.  

PubMed

Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications. PMID:24740271

Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J

2014-06-01

299

Lumbar (Open) Microscopic Discectomy  

MedlinePLUS

Open Discectomy Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall ... area and into one or both legs. Open discectomy uses surgery to remove part of the damaged ...

300

Surgical management of adrenocortical tumours.  

PubMed

The surgical treatment of adrenal tumours has evolved over the past century, as has our understanding of which hormones are secreted by the adrenal glands and what these hormones do. This article reviews the preoperative evaluation of patients with adrenal tumours that could be benign or malignant, including metastases. The biochemical evaluation of excess levels of hormones is discussed, as are imaging characteristics that differentiate benign tumours from malignant tumours. The options for surgical management are outlined, including the advantages and disadvantages of various open and laparoscopic approaches. The surgical management of adrenocortical carcinoma is specifically reviewed, including controversies in operative approaches as well as surgical management of invasive or recurrent disease. PMID:24637859

Miller, Barbra S; Doherty, Gerard M

2014-05-01

301

SURgical interventions with FEIBA (SURF): international registry of surgery in haemophilia patients with inhibitory antibodies.  

PubMed

Factor VIII Inhibitor Bypassing Activity (FEIBA) can effectively achieve haemostasis in haemophilia patients with inhibitors. Further evaluation of FEIBA in surgical settings is of significant interest considering the relatively limited prospective data published to date. The aim of the study is to evaluate the perioperative efficacy and safety of FEIBA in haemophilia patients with inhibitors. Haemophilia patients with inhibitors who underwent surgical procedures and received FEIBA for perioperative haemostatic control were prospectively enrolled in an open-label, noninterventional, postauthorization study [SURgical interventions with FEIBA (SURF)]. Outcome measures included haemostatic efficacy, safety, FEIBA exposure and blood loss associated with the perioperative use of FEIBA. Thirty-five surgical procedures were performed at 19 centres worldwide in patients with congenital haemophilia A, congenital haemophilia B, or acquired haemophilia A. Haemorrhagic risk was severe in 37.1% (13 of 35) of the procedures, moderate in 25.7% (9 of 35) and mild in 37.1% (13 of 35). One moderate risk surgery was excluded from the efficacy analyses because it did not meet all protocol requirements. Haemostasis was judged to be 'good' or 'excellent' in 91.2% (31 of 34) of surgical procedures and 'fair' in 8.8% (3 of 34). Among the 12 adverse events, three were serious adverse events (SAEs), two of which were unrelated to FEIBA therapy; one SAE, a clot in an arteriovenous fistula, was deemed to be possibly related to therapy. This prospective investigation confirms that FEIBA can be safely and effectively used when performing surgical procedures in haemophilia patients with inhibitors. PMID:23282031

Négrier, C; Lienhart, A; Numerof, R; Stephens, D; Wong, W Y; Baghaei, F; Yee, T T

2013-05-01

302

Recapturing the history of surgical practice through simulation-based re-enactment.  

PubMed

This paper introduces simulation-based re-enactment (SBR) as a novel method of documenting and studying the recent history of surgical practice. SBR aims to capture ways of surgical working that remain within living memory but have been superseded due to technical advances and changes in working patterns. Inspired by broader efforts in historical re-enactment and the use of simulation within surgical education, SBR seeks to overcome some of the weaknesses associated with text-based, surgeon-centred approaches to the history of surgery. The paper describes how we applied SBR to a previously common operation that is now rarely performed due to the introduction of keyhole surgery: open cholecystectomy or removal of the gall bladder. Key aspects of a 1980s operating theatre were recreated, and retired surgical teams (comprising surgeon, anaesthetist and theatre nurse) invited to re-enact, and educate surgical trainees in this procedure. Video recording, supplemented by pre- and post-re-enactment interviews, enabled the teams' conduct of this operation to be placed on the historical record. These recordings were then used to derive insights into the social and technical nature of surgical expertise, its distribution throughout the surgical team, and the members' tacit and frequently sub-conscious ways of working. While acknowledging some of the limitations of SBR, we argue that its utility to historians - as well as surgeons - merits its more extensive application. PMID:24331217

Kneebone, Roger; Woods, Abigail

2014-01-01

303

Open craniotomy for brain abscess: A forgotten experience?  

PubMed Central

Background: Brain abscess carries a high morbidity and mortality despite medical advances. In this paper, we present a single institution's experience with the surgical treatment of brain abscess. Methods: We retrospectively analyzed 33 cases of intracranial abscess who underwent surgical treatment between January 2001 and December 2009. Patients were treated with aspiration through a single burr hole, open aspiration with ultrasound guidance, or complete abscess resection. The medical records were analyzed for demographics, clinical presentation, predisposing factors, imaging, microbiological investigations, treatment, and outcomes. Results: There were 26 male and 7 female patients, aged between 12 and 78 years. The most common predisposing factor was head trauma. Surgical excision of the abscess was performed in 22 patients, open aspiration in 9 patients, and burr-hole aspiration in 2 patients. Repeat surgical procedure was required in six patients. Mortality in this series was 21%. A favorable outcome (Glasgow outcome scale 4 and 5) was achieved in 54%. There was no significant correlation between outcome and age, predisposing factor, treatment modality, or culture results. Conclusions: In this series, most patients were treated with an open technique, either by surgical excision or open aspiration of brain abscess. An open technique may reduce the need for additional imaging, surgical treatment, and length of antibiotic therapy. In resource-limited settings, excision of brain abscess may play a more important role in patient management while maintaining favorable outcomes.

Gadgil, Nisha; Patel, Akash J.; Gopinath, Shankar P.

2013-01-01

304

Technology Insight: surgical robots--expensive toys or the future of urologic surgery?  

PubMed

There is an increasing demand for minimally invasive surgery, despite any controversy over whether patients benefit from minimally invasive procedures rather than undergoing open surgery. In the field of urology, the performance of more complicated procedures is still a challenge even for experienced laparoscopic surgeons. Recently, robots have been introduced to enhance operative performance, increase applicability and precision of laparoscopy, and improve the learning curve for complicated minimally invasive procedures. With the introduction of master-slave systems where the surgeon is seated remotely from the robot and uses controls to maneuver the mechanical arms placed inside the patient, a new development in robot-assisted surgery has commenced. Several authors have suggested that surgical robots similar to the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA), which have three-dimensional (3D) vision and wristed instruments thus giving a greater degree of freedom than rigid laparoscopic instruments, will facilitate the outcome of these more challenging laparoscopic procedures. Whether these features will translate into better functional and oncological results remains to be evaluated. Data published so far clearly suggest that the patient will benefit from less postoperative pain, decreased bleeding and a shorter hospital stay compared with open surgery, and that the surgeon benefits from a faster learning curve than for conventional laparoscopy. For the benefit of our patients and for the development of urology it is vital that we understand both the limitations of telerobotics and when it is appropriate to incorporate these new techniques in day-to-day urologic surgery. PMID:16474522

Wiklund, N Peter

2004-12-01

305

STRES ?NKONT?NANS CERRAH? YAKLA?IMLARDAN VAJ?NAL DUVAR ASKI, TANS?YONSUZ VAG?NAL TAPE VE BURCH KOLPOSÜSPANS?YON YÖNTEM?N?N KL?N?K BA?ARI VE ÜROD?NAM?K BULGULAR AÇISINDAN KAR?ILA?TIRILMASI COMPARISON OF URODYNAMIC FINDINGS AND CLINICAL SUCCESS RATE OF SURGICAL PROCEDURES OF STRESS INCONTINENCE: VAGINAL WALL SLING, TENSION-FREE VAGINAL TYPE AND BURCH COLPOSUSPENSION  

Microsoft Academic Search

Introduction: The number of patients with stress urinary incontinence has inclined in recent years. However the gold standard surgical procedure for stress urinary incontinence is not certain yet. In this study, we evaluated urodynamic findings, clinical success and complication rates of pubovaginal vaginal wall sling procedures, namely tension free vaginal tape (TVT), vaginal wall sling (VWS) and retropubic cystourethropexy (Burch

Soner GÜNEY; Nurettin Cem SÖNMEZ; Serdar ARISAN; Ayhan DALKILIÇ; Erbil ERGENEKON

306

Is vasoplegic syndrome more prevalent with open-heart procedures compared with isolated on-pump CABG surgery?  

PubMed

Postoperative vasoplegic syndrome (PVS) is a frequent complication and can affect the early postoperative course. Our study investigated the incidence and risk factors of PVS after on-pump isolated coronary artery grafting bypass (CABG) and on-pump open-heart surgery. A total of 629 patients underwent on-pump cardiac surgery from November 21, 2005, to June 9, 2006, at our institution. Of those, 334 patients underwent on-pump isolated CABG and 295 patients had open-heart surgery. PVS was defined based on the recognized criteria. Multivariate logistic regression analysis was used to identify the risk factors for PVS. The overall incidence of PVS was 11.7%. The incidence in isolated on-pump CABG surgery was 6.9% and 17.0% in open-heart surgery (P<.01). In multivariate analysis, isolated CABG reduced by half the incidence of PVS [odds ratio (OR)=0.45, P=.02]; preoperative left ventricular ejection fraction (EF) <35% was identified as an independent predictor of PVS (OR=2.1, P=.01), and a protective effect of female gender for PVS was observed (OR=0.4, P=.01). The association between angiotensin-converting enzyme inhibitors and other preoperative medical treatments was not confirmed by our study. In conclusion, PVS occurred less often after isolated CABG surgery than after open-heart surgery. Advanced age and low preoperative EF strongly predicted PVS. PMID:21367673

Sun, Xiumei; Boyce, Steven W; Herr, Daniel L; Hill, Peter C; Zhang, Li; Corso, Paul J; Haile, Elizabeth; Lee, Anne T; Molyneaux, Robert E

2011-01-01

307

Learning surgical technical skills.  

PubMed

Training issues raised by the recent introduction of laparoscopic surgical techniques led to this analysis of motor-skill learning principles as they apply specifically to the learning of technical surgical skills. The most accepted theories of motor-skill learning are presented, not as opposing views, but as complementary constructs. The behaviourist school of thought's main contribution is the executive routine or knowledge of the steps of a procedure. Schmidt's schema theory and MacKay's node theory suggest that perceptual information may play an important role in the quality of the performance. The conclusions reached from neuropsychologic testing experiments on surgeons are that visuospatial perceptual skills (the ability to represent mentally the physical environment and the movement to be performed) are the major determinants of surgical technical performance. Learners should make use of learning strategies that improve mental representation of a skill and the corresponding anatomy. Specific strategies discussed include imagery, mental practice and a systematic review of performance that focuses on the perceptual feedback received by the learner. PMID:7882206

DesCôteaux, J G; Leclère, H

1995-02-01

308

Commercial fibrin sealants in surgical care  

Microsoft Academic Search

Fibrin sealants can be a valuable adjunct to surgical procedures. A variety of commercial products have been developed. Specific uses include hemostasis, tissue sealing, and even drug delivery. This review summarizes the components, mechanism of action, and clinical uses of fibrin sealants in modern surgical care.

William D Spotnitz

2001-01-01

309

Retained surgical sponges, needles and instruments  

PubMed Central

Introduction Retained sponges and instruments (RSI) due to surgery are a recognised medical ‘never event’ and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies. Methods A comprehensive literature search was performed on MEDLINE®, Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved. Results The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success. Conclusions Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.

Hariharan, D

2013-01-01

310

Severe plantar hyperhidrosis: an effective surgical solution.  

PubMed

Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life. PMID:23896256

Reisfeld, Rafael; Pasternack, Glenn A; Daniels, Parviz D; Basseri, Eraj; Nishi, Gregg K; Berliner, Karen I

2013-08-01

311

Open globe injuries: factors predictive of poor outcome  

Microsoft Academic Search

ObjectiveDespite advances in ocular and orbital imaging, instrumentation, materials, and surgical procedures, the management of open globe injuries continues to pose difficult management dilemmas. In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries presenting to a major UK centre.MethodOperating department records were reviewed to identify all patients who had undergone repair of

I Rahman; A Maino; D Devadason; B Leatherbarrow

2006-01-01

312

Procedures for restoring vestibular disorders  

PubMed Central

This paper will discuss therapeutic possibilities for disorders of the vestibular organs and the neurons involved, which confront ENT clinicians in everyday practice. Treatment of such disorders can be tackled either symptomatically or causally. The possible strategies for restoring the body's vestibular sense, visual function and co-ordination include medication, as well as physical and surgical procedures. Prophylactic or preventive measures are possible in some disorders which involve vertigo (bilateral vestibulopathy, kinetosis, height vertigo, vestibular disorders when diving (Tables 1 (Tab. 1) and 2 (Tab. 2)). Glucocorticoid and training therapy encourage the compensation of unilateral vestibular loss. In the case of a bilateral vestibular loss, it is important to treat the underlying disease (e.g. Cogan's disease). Although balance training does improve the patient's sense of balance, it will not restore it completely. In the case of Meniere's disease, there are a number of medications available to either treat bouts or to act as a prophylactic (e.g. dimenhydrinate or betahistine). In addition, there are non-ablative (sacculotomy) as well as ablative surgical procedures (e.g. labyrinthectomy, neurectomy of the vestibular nerve). In everyday practice, it has become common to proceed with low risk therapies initially. The physical treatment of mild postural vertigo can be carried out quickly and easily in outpatients (repositioning or liberatory maneuvers). In very rare cases it may be necessary to carry out a semicircular canal occlusion. Isolated disturbances of the otolith function or an involvement of the otolith can be found in roughly 50% of labyrinth disturbances. A specific surgical procedure to selectively block the otolith organs is currently being studied. When an external perilymph fistula involving loss of perilymph is suspected, an exploratory tympanotomy involving also the round and oval window niches must be carried out. A traumatic rupture of the round window membrane can, for example, also be caused by an implosive inner ear barotrauma during the decompression phase of diving. Dehiscence of the anterior semicircular canal, a relatively rare disorder, can be treated conservatively (avoiding stimuli which cause dizziness), by non-ablative „resurfacing" or by „plugging" the semicircular canal. A perilymph fistula can cause a Tullio-phenomenon resulting from a traumatic dislocation or hypermobility of the stapes, which can be surgically corrected. Vestibular disorders can also result from otosurgical therapy. When balance disorders persist following stapedectomy it is necessary to carry out a revision operation in order to either exclude a perilymph fistula or shorten the piston. Surgically reducing the size of open mastoid cavities (using for example porous hydroxylapatite or cartilage) can result in a reduction of vertiginous symptoms while nursing or during exposure to ambient air. Vestibular disturbances can occur both before and after vestibular nerve surgery (acoustic neuroma). Initially, good vestibular compensation can be expected after surgically removing the acoustic neuroma. An aberrant regeneration of nerve fibers of the vestibulocochlear nerve has been suggested as a cause for secondary worsening. Episodes of vertigo can be caused by an irritation of the vestibular nerve (vascular loop). Neurovascular decompression is generally regarded as the best surgical therapy. In the elderly, vestibular disturbances can severely limit quality of life and are often aggravated by multiple comorbidities. Antivertiginous drugs (e.g. dimenhydrinate) in combination with movement training can significantly reduce symptoms. Administering antivertiginous drugs over varying periods of time (e.g. transdermal scopolamine application via patches) as well as kinetosis training can be used as both prophylactically and as a therapy for kinetosis. Exposure training should be used as a prophylactic for height vertigo.

Walther, Leif Erik

2005-01-01

313

Procedures for restoring vestibular disorders.  

PubMed

This paper will discuss therapeutic possibilities for disorders of the vestibular organs and the neurons involved, which confront ENT clinicians in everyday practice. Treatment of such disorders can be tackled either symptomatically or causally. The possible strategies for restoring the body's vestibular sense, visual function and co-ordination include medication, as well as physical and surgical procedures. Prophylactic or preventive measures are possible in some disorders which involve vertigo (bilateral vestibulopathy, kinetosis, height vertigo, vestibular disorders when diving (Tables 1 (Tab. 1) and 2 (Tab. 2)). Glucocorticoid and training therapy encourage the compensation of unilateral vestibular loss. In the case of a bilateral vestibular loss, it is important to treat the underlying disease (e.g. Cogan's disease). Although balance training does improve the patient's sense of balance, it will not restore it completely.In the case of Meniere's disease, there are a number of medications available to either treat bouts or to act as a prophylactic (e.g. dimenhydrinate or betahistine). In addition, there are non-ablative (sacculotomy) as well as ablative surgical procedures (e.g. labyrinthectomy, neurectomy of the vestibular nerve). In everyday practice, it has become common to proceed with low risk therapies initially. The physical treatment of mild postural vertigo can be carried out quickly and easily in outpatients (repositioning or liberatory maneuvers). In very rare cases it may be necessary to carry out a semicircular canal occlusion.Isolated disturbances of the otolith function or an involvement of the otolith can be found in roughly 50% of labyrinth disturbances. A specific surgical procedure to selectively block the otolith organs is currently being studied. When an external perilymph fistula involving loss of perilymph is suspected, an exploratory tympanotomy involving also the round and oval window niches must be carried out. A traumatic rupture of the round window membrane can, for example, also be caused by an implosive inner ear barotrauma during the decompression phase of diving. Dehiscence of the anterior semicircular canal, a relatively rare disorder, can be treated conservatively (avoiding stimuli which cause dizziness), by non-ablative "resurfacing" or by "plugging" the semicircular canal. A perilymph fistula can cause a Tullio-phenomenon resulting from a traumatic dislocation or hypermobility of the stapes, which can be surgically corrected. Vestibular disorders can also result from otosurgical therapy. When balance disorders persist following stapedectomy it is necessary to carry out a revision operation in order to either exclude a perilymph fistula or shorten the piston. Surgically reducing the size of open mastoid cavities (using for example porous hydroxylapatite or cartilage) can result in a reduction of vertiginous symptoms while nursing or during exposure to ambient air. Vestibular disturbances can occur both before and after vestibular nerve surgery (acoustic neuroma). Initially, good vestibular compensation can be expected after surgically removing the acoustic neuroma. An aberrant regeneration of nerve fibers of the vestibulocochlear nerve has been suggested as a cause for secondary worsening. Episodes of vertigo can be caused by an irritation of the vestibular nerve (vascular loop). Neurovascular decompression is generally regarded as the best surgical therapy. In the elderly, vestibular disturbances can severely limit quality of life and are often aggravated by multiple comorbidities. Antivertiginous drugs (e.g. dimenhydrinate) in combination with movement training can significantly reduce symptoms. Administering antivertiginous drugs over varying periods of time (e.g. transdermal scopolamine application via patches) as well as kinetosis training can be used as both prophylactically and as a therapy for kinetosis. Exposure training should be used as a prophylactic for height vertigo. PMID:22073053

Walther, Leif Erik

2005-01-01

314

Teleoperation in surgical robotics--network latency effects on surgical performance.  

PubMed

A teleoperated surgical robotic system allows surgical procedures to be conducted across long distances while utilizing wired and wireless communication with a wide spectrum of performance that may affect the outcome. An open architecture portable surgical robotic system (Raven) was developed for both open and minimally invasive surgery. The system has been the subject of an intensive telesurgical experimental protocol aimed at exploring the boundaries of the system and surgeon performance during a series of field experiments in extreme environments (desert and underwater) teleportation between US, Europe, and Japan as well as lab experiments under synthetic fixed time delay. One standard task (block transfer emulating tissue manipulation) of the Fundamentals of Laparoscopic Surgery (FLS) training kit was used for the experimental protocol. Network characterization indicated a typical time delay in the range of 16-172 ms in field experiments. The results of the lab experiments showed that the completion time of the task as well as the length of the tool tip trajectory significantly increased (alpha< 0.02) as time delay increased in the range of 0-0.5 sec increased. For teleoperation with a time delay of 0.25s and 0.5s the task completion time was lengthened by a factor of 1.45 and 2.04 with respect to no time delay, whereas the length of the tools' trajectory was increased by a factor of 1.28 and 1.53 with respect to no time delay. There were no statistical differences between experienced surgeons and non-surgeons in the number of errors (block drooping) as well as the completion time and the tool tip path length at different time delays. PMID:19964184

Lum, Mitchell J H; Rosen, Jacob; King, Hawkeye; Friedman, Diana C W; Lendvay, Thomas S; Wright, Andrew S; Sinanan, Mika N; Hannaford, Blake

2009-01-01

315

Echols' Procedure for Treating Syringomyelia: Case Report and Historical Review  

PubMed Central

A 9 year-old girl with syringomyelia and scoliosis was treated with Echols’ procedure, a surgical technique that employs a metal stent to maintain drainage of fluid from the syrinx into the subarachnoid space. The patient presented to our institution 34 years later with a history of progressive myelopathy and surgically-treated deformities of the thoracic spine, lumbar spine, and right foot. Computer-assisted myelography indicated that the metal wire remained in place and that the syrinx had collapsed. Neurological examination and neurophysiological testing confirmed the presence of thoracic myelopathy, which may be due to the wire tethering the thoracic spinal cord to the dorsal dura. This is believed to be the sole long-term report of the effects of Echols’ procedure. The history of direct treatment of syringomyelia is reviewed and is contrasted with indirect treatment of syringomyelia, which relieves the condition by opening obstructed CSF pathways within the foramen magnum or spine.

Peterson, Matthew M.; Cracium, Liviu; Heiss, John D.

2009-01-01

316

Best surgical option for arch extension of type B dissection: the endovascular approach  

PubMed Central

Despite advances in surgical techniques and postoperative management, the in-hospital mortality rate for patients undergoing conventional open surgical repair for type B dissections is still significant. In light of this, the less invasive surgical procedure for acute type B aortic dissections, defined as thoracic endovascular aortic repair (TEVAR), was developed. Despite some controversy, the use of TEVAR for the management of type B aortic dissections has become commonplace. Generally, the main entry tear in type B aortic dissection is located in the vicinity of the orifice of the left subclavian artery (LSA). The proximal landing zone in the aortic arch must be secured as long as the aim of TEVAR for type B dissection is primary entry closure. This requires hybrid surgery that includes the use of open surgical procedures, such as debranching for revascularization of cervical branches. Despite the presence of challenging anatomic conditions in the aortic arch, hybrid repair has evolved as an increasingly viable alternative, and promising early and long-term results have been reported. As the next step, fenestrated and branched TEVAR techniques have recently been reported with satisfactory early results. In the coming years, there will be intense competition to develop the devices themselves, improve delivery systems, and supplement devices with auxiliary functions. Thus there is high expectations for the next generation and how they will improve and advance treatment methods of TEVAR for type B aortic dissections.

2014-01-01

317

Best surgical option for arch extension of type B dissection: the endovascular approach.  

PubMed

Despite advances in surgical techniques and postoperative management, the in-hospital mortality rate for patients undergoing conventional open surgical repair for type B dissections is still significant. In light of this, the less invasive surgical procedure for acute type B aortic dissections, defined as thoracic endovascular aortic repair (TEVAR), was developed. Despite some controversy, the use of TEVAR for the management of type B aortic dissections has become commonplace. Generally, the main entry tear in type B aortic dissection is located in the vicinity of the orifice of the left subclavian artery (LSA). The proximal landing zone in the aortic arch must be secured as long as the aim of TEVAR for type B dissection is primary entry closure. This requires hybrid surgery that includes the use of open surgical procedures, such as debranching for revascularization of cervical branches. Despite the presence of challenging anatomic conditions in the aortic arch, hybrid repair has evolved as an increasingly viable alternative, and promising early and long-term results have been reported. As the next step, fenestrated and branched TEVAR techniques have recently been reported with satisfactory early results. In the coming years, there will be intense competition to develop the devices themselves, improve delivery systems, and supplement devices with auxiliary functions. Thus there is high expectations for the next generation and how they will improve and advance treatment methods of TEVAR for type B aortic dissections. PMID:24967169

Kuratani, Toru

2014-05-01

318

Open-heart surgery in Jehovah's Witness patients  

Microsoft Academic Search

Open-heart surgery has been performed since 1975 on 25 patients who are Jehovah's Witnesses by religion. The patients' ages ranged from 6–60 years, and their body weights from 18–51 kg. Surgical procedures included correction of congenital heart disease in 14 patients and valve repair or replacement in 11. Six procedures were reoperations. The lowest mean haematocrits, during perfusion and the

M. Chikada; A. Furuse; Y. Kotsuka; K. Yagyu

1996-01-01

319

Biliary bypass surgery - Analysis of indications & outcome of different procedures  

PubMed Central

Objectives: This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. Methods: This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Results: Out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. The CBD stones were observed as the most common indication (25.3%), followed by CBD injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and CBD obstruction(14.46%) either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Conclusion: Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases.

Hussain Talpur, K.Altaf; Mahmood Malik, Arshad; Iqbal Memon, Amir; Naeem Qureshi, Jawed; Khan Sangrasi, Ahmed; Laghari, Abdul Aziz

2013-01-01

320

Design and implementation of a PC-based image-guided surgical system.  

PubMed

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery. PMID:12204449

Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

321

Surgical Therapy of Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) can be found in an increasing number of cardiac surgical patients due to a higher patient's age and comorbidities. Atrial fibrillation is known, however, to be a risk factor for a greater mortality, and one aim of intraoperative AF treatment is to approximate early and long-term survival of AF patients to survival of patients with preoperative sinus rhythm. Today, surgeons are more and more able to perform less complex, that is, minimally invasive cardiac surgical procedures. The evolution of alternative ablation technologies using different energy sources has revolutionized the surgical therapy of atrial fibrillation and allows adding the ablation therapy without adding significant risk. Thus, the surgical treatment of atrial fibrillation in combination with the cardiac surgery procedure allows to improve the postoperative long-term survival and to reduce permanent anticoagulation in these patients. This paper focuses on the variety of incisions, lesion sets, and surgical techniques, as well as energy modalities and results of AF ablation and also summarizes future trends and current devices in use.

Haensig, Martin; Rastan, Ardawan Julian; Holzhey, David Michael; Mohr, Friedrich-Wilhelm; Garbade, Jens

2012-01-01

322

Assessment of mouse anxiety-like behavior in the light-dark box and open-field arena: Role of equipment and procedure.  

PubMed

Light-dark box and open field are conventional tests for assessment of anxiety-like behavior in the laboratory mice, based on approach-avoidance conflict. However, except the basic principles, variations in the equipment and procedures are very common. Therefore, contribution of certain methodological issues in different settings was investigated. Three inbred strains (C57BL/6, 129/Sv, DBA/2) and one outbred stock (ICR) of mice were used in the experiments. An effect of initial placement of mice either in the light or dark compartment was studied in the light-dark test. Moreover, two tracking systems were applied - position of the animals was detected either by infrared sensors in square box (1/2 dark) or by videotracking in rectangular box (1/3 dark). Both approaches revealed robust and consistent strain differences in the exploratory behavior. In general, C57BL/6 and ICR mice showed reduced anxiety-like behavior as compared to 129/Sv and DBA/2 strains. However, the latter two strains differed markedly in their behavior. DBA/2 mice displayed high avoidance of the light compartment accompanied by thigmotaxis, whereas the hypoactive 129 mice spent a significant proportion of time in risk-assessment behavior at the opening between two compartments. Starting from the light side increased the time spent in the light compartment and reduced the latency to the first transition. In the open field arena, black floor promoted exploratory behavior - increased time and distance in the center and increased rearing compared to white floor. In conclusion, modifications of the apparatus and procedure had significant effects on approach-avoidance behavior in general whereas the strain rankings remained unaffected. PMID:24832050

Kulesskaya, Natalia; Voikar, Vootele

2014-06-22

323

Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient  

PubMed Central

Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ.

2013-01-01

324

Transcatheter aortic valve implantation with Core Valve: First Indian experience of three high surgical risk patients with severe aortic stenosis  

PubMed Central

The prevalence of aortic stenosis is increasing with aging population. However with multiple co-morbidities and prior procedures in this aging population, more and more patients are being declared unfit for the ‘Gold Standard’ treatment i.e. surgical aortic valve replacement (AVR). Among the patients who are unfit or high risk for aortic valve replacement (AVR) by open heart surgery, transcatheter aortic valve implantation (TAVI) has been proven to be a valuable alternative improving survival and quality of life. We report first Indian experience of Core Valve (Medtronic Inc.) implantation in three high surgical risk patients performed on 22nd and 23rd February 2012.

Seth, Ashok; Rastogi, Vishal; Kumar, Vijay; Maqbool, Syed; Mustaqueem, Arif; Sekar, V. Ravi

2013-01-01

325

Transcatheter aortic valve implantation with Core Valve: first Indian experience of three high surgical risk patients with severe aortic stenosis.  

PubMed

The prevalence of aortic stenosis is increasing with aging population. However with multiple co-morbidities and prior procedures in this aging population, more and more patients are being declared unfit for the 'Gold Standard' treatment i.e. surgical aortic valve replacement (AVR). Among the patients who are unfit or high risk for aortic valve replacement (AVR) by open heart surgery, transcatheter aortic valve implantation (TAVI) has been proven to be a valuable alternative improving survival and quality of life. We report first Indian experience of Core Valve (Medtronic Inc.) implantation in three high surgical risk patients performed on 22nd and 23rd February 2012. PMID:23993000

Seth, Ashok; Rastogi, Vishal; Kumar, Vijay; Maqbool, Syed; Mustaqueem, Arif; Sekar, V Ravi

2013-01-01

326

Pathogenesis of postoperative oral surgical pain.  

PubMed Central

Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain.

Ong, Cliff K. S.; Seymour, R. A.

2003-01-01

327

Contemporary open partial nephrectomy is associated with diminished procedure-specific morbidity despite increasing technical challenges: a single institutional experience  

Microsoft Academic Search

Objective  To review trends in open partial nephrectomy (OPN) at our center, concentrating on patient selection, technique and perioperative\\u000a complications.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A comprehensive database was developed by chart review of consecutive patients undergoing OPN for renal masses at our center.\\u000a Patient selection, technical modifications, perioperative morbidity, and histopathology were compared in patients undergoing\\u000a OPN between 1992–1999, 2000–2003, and 2004–2008. Complications were divided

Bruce R. Kava; Rosely De Los Santos; Rajinikanth Ayyathurai; Samir Shirodkar; Murugesan Manoharan; Raymond Leveillee; Vincent Bird; Gaetano Ciancio; Mark S. Soloway

2010-01-01

328

[Surgical treatment of hallux rigidus].  

PubMed

Hallux rigidus is a deformity of the first metatarsophalangeal joint. Symptoms include a painful reduction of mobility and increasing stiffness in the big toe. Only when conservative therapeutic methods have failed should surgical options be considered. The surgical technique depends on the stage of the deformity. For stadium I and II, the joint should be retained, for example by cheilectomy. In this case, a correction osteotomy of the phalanx or first metatarsus can follow. For stadium III and IV, the usual procedure is arthrodesis. Complications can involve an incorrect positioning of the big toe, pseudoarthrosis and arthrosis of the interphalangeal joint. For less active patients, a resection arthroplasty is also possible. PMID:16032427

Dereymaeker, G

2005-08-01

329

[Surgical therapy of liver echinococcosis].  

PubMed

There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube. PMID:4013541

Bähr, R; Gaebel, G

1985-01-01

330

Surgical Never Events should never happen...  

PubMed

Surgical procedures are intended to save lives and improve the quality of life, however omissions in essential practices (system and human error) contribute to unsafe surgical care, and cause significant harm to patients. For centuries it was believed that patients' co-morbidities and the surgeon's technical competence were the key determinants of surgical outcome; it is only within the last decade, that the relationship between failure to follow safety procedures, sub-optimal team work, poor communication and clinical outcomes has been appreciated (Vincent et al 2001). Recognition of the interdependencies for good surgical outcomes owes much to safety oriented research focusing on interpersonal behaviours and cognitive performance, the science of 'human factors', and the route cause analysis (RCA) of surgical harm. PMID:22165490

Reid, Jane H

2011-11-01

331

Guide to Surgical Specialists  

MedlinePLUS

... the surgical care and prevention of traumatic injuries); pediatric surgical oncology (knowledge of the diagnosis and surgical care of ... and disorders of the cranial and spinal nerves. Pediatric neurosurgeons manage ... care, oncology care, and primary health care for women. Specialty ...

332

[Multifactorial analysis of results of the open and endo-biliary surgical treatment of patients with obstructive jaundice due to the distal obstruction of the bile ducts].  

PubMed

The were analyzed the results of treatment of patients with the obstructive jaundice (OJ) due to obstruction of the biliary ducts distal part using surgical and endobiliary decompression using the variation statistics methods (distribution of patients on groups depending on the values of the investigated parameters, calculation of the mean values, evaluation of the authenticity of the indexes distinction), the multifactoral correlative-regressive analysis, the complex evaluation of indexes and probit-analysis. The dependence of results of treatment from value of clinical parameters was established, their prognostic significance was determined. The content of the bilirubin more than 300 mmol/l in distal level of affection of biliferous ducts cause high probability of the postoperative complications occurrence (coefficient of determination 34.8%), determining necessity of performance of draining endobiliary intervention on the first stage of surgical treatment. The dependence of lethality from age of patients and duration of the OJ was noted. PMID:12024709

Diachenko, V V

2002-03-01

333

Outcomes of surgical treatment of Peyronie's disease.  

PubMed

The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer-reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non-systematic review included 'Peyronie's disease', 'outcomes', 'complications', 'erectile dysfunction or ED', 'patient expectation', and 'patient satisfaction'; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty-one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non-surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug-resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long-term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence-based selection of the surgical approach. PMID:24219080

Carson, Culley C; Levine, Laurence A

2014-05-01

334

Utilization of Minimally Invasive Surgical Approach for Sacroiliac Joint Fusion in Surgeon Population of ISASS and SMISS Membership  

PubMed Central

Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their members to examine current preferences in surgeon practice of MIS SI fusion. Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and average length of stay for each approach. Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only available option. Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as possible increase in outcome quality.

Lorio, Morgan P.; Polly Jr., David W.; Ninkovic, Ivana; Ledonio, Charles G.T.; Hallas, Kelli; Andersson, Gunnar

2014-01-01

335

Skin Preparation for the Prevention of Surgical Site Infection: Which Agent Is Best?  

PubMed Central

Procedural and surgical site infections create difficult and complex clinical scenarios. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure critical. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcohol-based solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for longer open surgeries with the potential for irrigation or surgical spillage, such as cystoprostatectomy, radical prostatectomy, and retroperitoneal lymph node dissection.

Hemani, Micah L; Lepor, Herbert

2009-01-01

336

Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southamptonq  

Microsoft Academic Search

Objective: The most appropriate management of aortic stenosis (AS) in children remains controversial. The purpose of this study was to determine the outcome following open valvotomy for AS in children. Methods: Ninety-seven consecutive, unselected, children (mean age 3.2 ^ 3.6 years, 1 day-15 years) underwent an open valvotomy for criticalÖnà 36Ü or severeÖnà 61Ü AS between 1979 and 2000 in

Christos Alexiou; Qiang Chen; Stephen M. Langley; Anthony P. Salmon; Barry R. Keeton; Marcus P. Hawa; James L. Monro

337

Surgical smoke evacuation systems.  

PubMed

Surgical smoke evacuation systems are high-flow suction and filtering devices used to remove, or capture, the smoke generated at the surgical site during the use of lasers and electrosurgical units (ESUs). This process helps minimize patient and staff exposure to the aerosols and gases carried by the smoke. We originally evaluated smoke evacuators in our April 1997 issue (Health Devices 26[4]). For this Update Evaluation, we have tested seven additional units from seven suppliers, using the same criteria and test methods as in the earlier study. We also present update information for the previously evaluated units, along with comparative ratings for all the units we have evaluated to date. We rated nine units in our top group for general-purpose applications (in which a hand-held nozzle will be used for most or all procedures): the Buffalo Filter PlumeSafe 1202, PlumeSafe Whisper 602, PlumeSafe Whisper Turbo, and Porta PlumeSafe 602; the ConMed 1000 SES; the Niche Medical SmartVac; the Stackhouse AirSafe VersaVac2; and the Surgimedics Plume-inator and Surgi-Fresh Mini. We rated a 10th unit, the I.C. Medical Crystal Vision ICM-360, in our top group for applications in which the evacuator will be used only with an ESU-pencil-based wand. PMID:10489643

1999-09-01

338

Advanced Procedure for the Monitoring of Settlement and Open Space Development on Basis of Topographical Geodata Sets in the Ioer-Monitor  

NASA Astrophysics Data System (ADS)

Concept, Procedures and Results of the Monitor of settlement and open space development are presented. The monitoring system will describe the state and the development of land use especially in regard to its sustainability for the entire Federal Republic of Germany. To this end, for the first time ever it makes use of topographical geobasis data (digital landscape model of the Authoritative Topographic-Cartographic Information System, short ATKIS). These data allow for a more precise spatial and contentwise description of land use than that of the land register data, which serve as the basis for the official land use statistics. On the basis of the geobasis data an automatic calculation of indicators from the fields of settlement, open space, nature reserves, population, traffic occurs and landscape fragmentation. The indicators are depicted in thematic maps, thus allowing for spatial and chronological comparisons. In addition to administrative spatial units (federal state, region, district, municipality), the indicator values are also presented in scales of various cell widths. For calculating building-based settlement indicators, the patented program SEMENTA® is used, which is based on an automated evaluation of analogue maps.

Meinel, G.

2011-08-01

339

Effects, in the rat, of various stressing procedures on the jaw-opening reflex induced by tooth-pulp stimulation.  

PubMed

Jaw-opening reflex (JOR) induced by a repetitive tooth-pulp stimulation delivered at 1 Hz was observed in awake, freely-moving rats. Modifications of the reflex responses of the digastric muscle were produced by foot-shock stimulation, by an oesophageal administration of placebo and a subcutaneous injection of saline. Subcutaneous injection of saline evoked a total disappearance of the reflex which returned within 30 s. Foot shock delivered for 10 s and repeated twice a minute for 30 min of intensity, just below the vocalization threshold, evoked a marked decrease of the reflex to 60 +/- 6 per cent of the control value (n = 10). Administration of arabic gum by oesophageal tube gave either: the same transient disappearance as for the subcutaneous injection in 6 rats; a progressive 28 min +/- 11 (n = 6) return to the initial value; a progressive return to a subcontrol value of 52 +/- 4 per cent (n = 7). The application of two successive stimuli resulted in a more pronounced JOR decrease. The response to electrical foot shock can be explained by a central analgesia induced by stress. PMID:3459404

Vassel, A; Pajot, J; Aigouy, L; Rajaona, J; Woda, A

1986-01-01

340

Type II arch hybrid debranching procedure  

PubMed Central

Management of aortic arch aneurysm and dissection continues to evolve as endovascular options play an increasing role in treating thoracic aortopathies. Although conventional open treatment of aortic arch disease with total arch replacement still remains the gold standard, in patients with old age and/or high comorbid disease index, there is significant associated morbidity and mortality. The hybrid arch procedure, which aims to minimize cardiopulmonary bypass and circulatory arrest times, is a particularly appealing surgical option in this cohort of patients. The hybrid arch concept essentially entails three main principles: (I) open debranching of the great vessels; (II) creation of proper proximal (zone 0 landing) and distal landing zones, and; (III) concomitant or delayed endovascular stent grafting of the aortic arch. The classification scheme for hybrid arch debranching procedures is based on the extent of proximal and distal landing zone reconstruction required, and thus the need and extent of cardiopulmonary bypass and circulatory arrest management strategies to be employed. In this illustrated article, we describe the details of the type II hybrid arch debranching procedure, where the ascending aorta and aortic arch pathology is typically treated by reconstruction of ascending aorta ? arch vessel debranching, with concomitant antegrade stent grafting of the aortic arch.

Szeto, Wilson Y.; Desai, Nimesh; Komlo, Caroline; Bavaria, Joseph E.

2013-01-01

341

Ingrown toenail: results of surgical treatment.  

PubMed

When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment. PMID:3229700

Pettine, K A; Cofield, R H; Johnson, K A; Bussey, R M

1988-12-01

342

Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion.  

PubMed

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery-middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED. PMID:24835048

Abla, Adib A; Zaidi, Hasan A; Crowley, R Webster; Britz, Gavin W; McDougall, Cameron G; Albuquerque, Felipe C; Spetzler, Robert F

2014-07-01

343

Multimodal imaging and detection strategy with 124 I-labeled chimeric monoclonal antibody cG250 for accurate localization and confirmation of extent of disease during laparoscopic and open surgical resection of clear cell renal cell carcinoma.  

PubMed

Renal cell carcinoma (RCC) accounts for approximately 85% to 90% of all primary kidney malignancies, with clear cell RCC (ccRCC) constituting approximately 70% to 85% of all RCCs. This study describes an innovative multimodal imaging and detection strategy that uses (124)I-labeled chimeric monoclonal antibody G250 ((124)I-cG250) for accurate preoperative and intraoperative localization and confirmation of extent of disease for both laparoscopic and open surgical resection of ccRCC. Two cases presented herein highlight how this technology can potentially guide complete surgical resection and confirm complete removal of all diseased tissues. This innovative (124)I-cG250 (ie, (124)I-girentuximab) multimodal imaging and detection approach, which would be clinically very useful to urologic surgeons, urologic medical oncologists, nuclear medicine physicians, radiologists, and pathologists who are involved in the care of ccRCC patients, holds great potential for improving the diagnostic accuracy, operative planning and approach, verification of disease resection, and monitoring for evidence of disease recurrence in ccRCC patients. PMID:22455975

Povoski, Stephen P; Hall, Nathan C; Murrey, Douglas A; Sharp, David S; Hitchcock, Charles L; Mojzisik, Cathy M; Bahnson, Eamonn E; Knopp, Michael V; Martin, Edward W; Bahnson, Robert R

2013-02-01

344

Endoscopic cochlear implant procedure.  

PubMed

The objective was to asses the feasibility of the endoscopic technique for cochlear implant (CI) positioning avoiding mastoidectomy and to discuss the benefits and drawbacks of the technique. The study design is a surgical procedure description and prospective case series report. From December 2011 to October 2012, six patients underwent endoscopic CI. All cases were selected based on CT and MRI studies. All surgical steps were analyzed; intra-and post-operative complications were noted. The length of time for each surgical procedure was recorded. The surgical procedure was described step by step focusing on the anatomy of the round window (RW) niche, analyzing the critical point during the dissection. The timing of the surgical procedures was 120 ± 21 (mean ± SD) min. In 1/6 patients, intra-operative injury of the chorda tympani occurred. In all cases, an endoscopic identification was performed and the anatomical details of the RW niche were noted. In 6/6 cases, a RW niche magnification was performed endoscopically. 5/6 cases showed a normal conformation of the RW. In 1/6 patients, obliteration of the RW niche was found. In 4/6 patients, an endoscopic cochleostomy through the RW was performed. In 1/6 patients, a difficult insertion of the array was observed. The current follow-up is 7.3 months (SD ± 3.7). No post-operative short- or long-term complications were noted in this series. Endoscopic CI is a safe and viable technique with a low rate of complications and with good outcomes. PMID:23595616

Marchioni, Daniele; Grammatica, Alberto; Alicandri-Ciufelli, Matteo; Genovese, Elisabetta; Presutti, Livio

2014-05-01

345

Surgical planning of Isshiki type I thyroplasty using an open-source Digital Imaging and Communication in Medicine viewer OsiriX.  

PubMed

Abstract Conclusion: Preoperative surgical planning of Isshiki type I thyroplasty with the Digital Imaging and Communication in Medicine (DICOM) viewer OsiriX can be used for strategic and predictable type I thyroplasty. Objectives: The aim of this study was to determine the efficacy of the preoperative planning of type I thyroplasty using the DICOM viewer OsiriX. Methods: Five patients with unilateral vocal cord paralysis and severe breathy dysphonia were included in this study. Multidetector computed tomography (CT) DICOM data were obtained and breath holding was performed during image acquisition. Using three-dimensional multiplanar reconstruction, we outlined the optimal location for a window. Type I thyroplasty was performed using Isshiki's original method, and only the placement of the window was decided according to the preoperative simulation point. To verify the advantages of this method, we compared our data with the previous data for total operation time and voice quality at 3 months after the operation without the DICOM viewer planning. Results: All patients are free from dysphonia and their glottic closures have resolved satisfactorily. Postoperative CT revealed that appropriate implant positioning resulted in successful surgical intervention. The comparison of total operation time showed that with the new method, operation duration was shortened by 12 min. PMID:24646143

Hara, Hirotaka; Hori, Takeshi; Sugahara, Kazuma; Yamashita, Hiroshi

2014-06-01

346

Open rib biopsy guided by radionuclide technique  

SciTech Connect

When abnormally increased radioactivity is seen in a rib or ribs by bone imaging in a patient with suspected or known malignancy, it frequently is difficult to differentiate fracture from metastatic disease. Histological examination of the lesion is crucial for diagnosis, staging, and planning of therapy. To assess the value of external localization of the site or sites of abnormal uptake in a rib as a guide for open rib biopsy, 10 patients (7 men, 3 women; age range, 34 to 68 years) with known or suspected malignancy were studied. With reference to the oscilloscope image, a cobalt 57 marker was placed on the skin overlying the focus of increased uptake, and the area of increased activity was marked on the skin as a guide to surgical resection. Of ten resected ribs, four showed metastatic disease and five had fractures. (One patient underwent two external marking procedures and two surgical procedures.) Rib biopsy was not performed in 1 patient because prior to the surgical procedure, a small subcutaneous nodule adjacent to the skin marker was excised and confirmed to be carcinoma. Appropriate courses of management (operation, irradiation, chemotherapy) were taken after the biopsies. The surgeon responsible for the biopsy should be present during the skin-marking procedure, and the area beneath the scapula and the region adjacent to the spine should be avoided. Our results indicate that the technique is a very useful aid for approaching open rib biopsies more precisely.

Shih, W.J.; DeLand, F.H.; Domstad, P.A.; Magoun, S.; Dillon, M.L.

1984-07-01

347

Different surgical approaches for stress urinary incontinence in women.  

PubMed

Stress urinary incontinence (SUI) constitutes involuntary voiding as a consequence of rising intra-abdominal pressure caused by sphincter weakness. In recent years studies were published according to surgical SUI management evaluating and comparing therapy options and outcomes. Therapy options were evaluated using a Medline search, including only publications in English between 2000-2012. Key words used were: SUI, conservative and surgical treatment, midurethral sling, colposuspension. Surgical treatment options demonstrate significantly better results than conservative treatment. MUS demonstrate better subjective and objective cure rates than colposuspension; it is less invasive and more cost-effective. First line SUI therapy such as RP MUS and TVT seem to be favored when compared to transobturator techniques. Retropubic and transobturator MUS showed equivalent objective and subjective success rates. Open colposuspension is an effective treatment possibility for recurrent SUI after failed MUS. TVT, compared with other MUS, seems to show slightly better cure rates. but perioperative complications appear to be similar. Long-term results (>10 years) of repeated SUI surgery showed that the Burch procedure had the lowest 9-year cumulative incidence of repeat SUI surgery. Mini-sling techniques may be underestimated but long-time results are pending and closer monitoring of the adverse event profile must be carried out. MUS are first choice in the treatment of SUI, of which TVT, has the best cure rate. Colpussupension continues to have its place in recurrent SUI. The new mini-MUS needs a longer follow-up for final evaluation. PMID:23412017

Mischinger, J; Amend, B; Reisenauer, C; Bedke, J; Naumann, G; Germann, M; Kruck, S; Arenas Desilva, L F; Wallwiener, H; Koelbl, H; Nitti, V; Sievert, K D

2013-02-01

348

SELENA - An open-source tool for seismic risk and loss assessment using a logic tree computation procedure  

NASA Astrophysics Data System (ADS)

The era of earthquake risk and loss estimation basically began with the seminal paper on hazard by Allin Cornell in 1968. Following the 1971 San Fernando earthquake, the first studies placed strong emphasis on the prediction of human losses (number of casualties and injured used to estimate the needs in terms of health care and shelters in the immediate aftermath of a strong event). In contrast to these early risk modeling efforts, later studies have focused on the disruption of the serviceability of roads, telecommunications and other important lifeline systems. In the 1990s, the National Institute of Building Sciences (NIBS) developed a tool (HAZUS ®99) for the Federal Emergency Management Agency (FEMA), where the goal was to incorporate the best quantitative methodology in earthquake loss estimates. Herein, the current version of the open-source risk and loss estimation software SELENA v4.1 is presented. While using the spectral displacement-based approach (capacity spectrum method), this fully self-contained tool analytically computes the degree of damage on specific building typologies as well as the associated economic losses and number of casualties. The earthquake ground shaking estimates for SELENA v4.1 can be calculated or provided in three different ways: deterministic, probabilistic or based on near-real-time data. The main distinguishing feature of SELENA compared to other risk estimation software tools is that it is implemented in a 'logic tree' computation scheme which accounts for uncertainties of any input (e.g., scenario earthquake parameters, ground-motion prediction equations, soil models) or inventory data (e.g., building typology, capacity curves and fragility functions). The data used in the analysis is assigned with a decimal weighting factor defining the weight of the respective branch of the logic tree. The weighting of the input parameters accounts for the epistemic and aleatoric uncertainties that will always follow the necessary parameterization of the different types of input data. Like previous SELENA versions, SELENA v4.1 is coded in MATLAB which allows for easy dissemination among the scientific-technical community. Furthermore, any user has access to the source code in order to adapt, improve or refine the tool according to his or her particular needs. The handling of SELENA's current version and the provision of input data is customized for an academic environment but which can then support decision-makers of local, state and regional governmental agencies in estimating possible losses from future earthquakes.

Molina, S.; Lang, D. H.; Lindholm, C. D.

2010-03-01

349

Computer-assisted planning of stereotactic neurosurgical procedures.  

PubMed

To extend the advantages of stereotactic localization to open procedures, a computational device with a graphic output is introduced. It is designed to be used in the operating room, where it processes neuroradiological information (CT, MR, and angiography) acquired under stereotactic conditions. The surgeon can interact with neuroanatomical data, extracting borders of structures of surgical relevance. The resulting sets of outlines, shown tridimensionally within the reference of a stereotactic head holder, are presented with respect to the planned approaching trajectory. Color-coded high-resolution graphics show the relationship between lesions and normal brain structures and guide the surgeon's access to deep-seated lesions through small exposures. PMID:2680080

Giorgi, C; Casolino, S D; Franzini, A; Servello, D; Passerini, A; Broggi, G; Pluchino, F

1989-10-01

350

Laparoscopic cholecystectomy with an ultrasound surgical aspirator.  

PubMed

Laparoscopic cholecystectomy using an ultrasound surgical aspirator has been performed in our department since March 1991. The horn cover was altered in order to be inserted through a trocar 10 mm in diameter. The main purpose of this device is to explore Calot's triangle by fragmentation and aspiration of the fatty tissue without damaging the nerves, vessels, and cystic duct. First the serosa of the Calot's triangle is cut via electrocautery with the sharp-angle hook dissector we designed. Then the cystic duct and cystic artery are efficiently exposed by the ultrasound surgical aspirator. This procedure is perfectly adapted for laparoscopic cholecystectomy. We obtained favorable results with the ultrasound surgical aspirator in 135 cases including 40 cases with a negative gallbladder, as evaluated by endoscopic retrograde cholangiography. In conclusion, the ultrasound surgical aspirator is suitable for skeletonizing the cystic duct and cystic artery, and the procedure is perfectly safe. PMID:7725224

Murai, R; Ando, H; Hirohara, S; Okui, S; Kusuyama, A; Sasaki, T; Watanabe, N; Sasaya, K; Komuro, K; Itsubo, K

1995-01-01

351

Intermuscular pterygoid-temporal abscess following inferior alveolar nerve block anesthesia-A computer tomography based navigated surgical intervention: Case report and review  

PubMed Central

Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated.

Wallner, Jurgen; Reinbacher, Knut Ernst; Pau, Mauro; Feichtinger, Matthias

2014-01-01

352

Prospective cost analysis of laparoscopic vs. open pyeloplasty in children: Single centre contemporary evaluation comparing two procedures over a 1-year period  

PubMed Central

Introduction: Laparoscopy in pediatric urological surgery continues to gradually gain acceptance. Since economic implications are of increasing importance in our cost-containment environment, few studies have compared the expense associated with open to laparoscopic approaches. We present a prospective comparative cost-analysis between the laparoscopic (LP) and open pediatric pyeloplasty (OP). Methods: Over a period of a year (2007–2008), 54 consecutives pyeloplasties were performed. The “traditional” OP was performed in 33 patients and the remaining 21 children underwent LP. Costs were prospectively collected for each group and divided based on amounts incurred by all different departments involved: nursing, laboratory, diagnostic imaging, pharmacy and operative room. Results: Overall, the average cost for a LP was CDN$6240 compared to CDN$5079 for an OP with a median hospital stay of 2 days (range OP: 1–18, LP: 1–7). The main difference was found in operative room expenses (OP: $2508 vs. LP: $3925). The higher cost could not be solely explained by the use of disposable items, which only subtracts $335 per procedure (23.6% of the cost difference between OP and LP). Length of time spent in the operating room was 1.2 hours longer for the LP and appears to be the main factor explaining the cost difference. Conclusion: Our findings show that at our institution, pediatric LP is more expensive than OP. This cost difference is mainly due to operating room time. For cost-containment purposes, efforts aimed at increasing efficiency in the operating room may help equalize both approaches.

Moore, Katherine; Lorenzo, Armando J.; Turner, Suzanne; Bagli, Darius J.; Pippi Salle, Joao L.; Farhat, Walid A.

2013-01-01

353

Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis  

PubMed Central

Introduction Antifibrinolytic agents are commonly used during cardiac surgery to minimize bleeding. Because of safety concerns, aprotinin was withdrawn from the market in 2007. Since then, tranexamic acid (TXA) has become the antifibrinolytic treatment of choice in many heart centers. The safety profile of TXA has not been extensively studied. Therefore, the aim of this study was to evaluate safety and efficiency of TXA compared with aprotinin in cardiac surgery. Methods Since July 1, 2006, TXA has been administered at a dose of 50 mg/kg tranexamic acid before cardiopulmonary bypass (CPB) and 50 mg/kg into the priming fluid of the CPB. Prior to this, all patients were treated with aprotinin at a dose of 50,000 KIU per kilogram body weight. Safety was evaluated with mortality, biomarkers, and the diagnosis of myocardial infarction, ischemic stroke, convulsive seizures, and acute renal failure in the intensive care unit (ICU), intermediate care unit (IMCU), and hospital stay. Efficiency was evaluated by the need for transfusion of blood products and total postoperative blood loss. Results After informed consent, 893 patients were included in our database (557 consecutive patients receiving aprotinin and 336 patients receiving TXA). A subgroup of 320 patients undergoing open-heart procedures (105 receiving TXA and 215 receiving aprotinin) was analyzed separately. In the aprotinin group, a higher rate of late events of ischemic stroke (3.4% versus 0.9%; P = 0.02) and neurologic disability (5.8% versus 2.4%; P = 0.02) was found. The rate of postoperative convulsive seizures was increased in tendency in patients receiving TXA (2.7% versus 0.9%; P = 0.05). The use of TXA was associated with higher cumulative drainage losses (PANOVA < 0.01; Ptime < 0.01) and a higher rate of repeated thoracotomy for bleeding (6.9% versus 2.4%; P < 0.01). In the subgroup of patients with open-chamber procedures, mortality was higher in the TXA group (16.2% TXA versus 7.5% aprotinin; P = 0.02). Multivariate logistic regression identified EURO score II and CPB time as additional risk factors for this increased mortality. Conclusions The use of high-dose TXA is questioned, as our data suggest an association between higher mortality and minor efficiency while the safety profile of this drug is not consistently improved. Further confirmatory prospective studies evaluating the efficacy and safety profile of TXA are urgently needed to find a safe dosage for this antifibrinolytic drug.

2010-01-01

354

Operative surgical yield from general surgical outpatient clinics; time to change the way we practice?  

PubMed

The aim of this study was to compare the number of patients attending surgical outpatient clinics in a general hospital to the number of resulting elective procedures scheduled in a single year. Patients initially assessed at private consulting rooms are not included in this study. The number of surgical outpatient appointments issued in 2011 totalled 6503 with non-attendances running at 1489 (22.9%). The number of elective surgical theatre cases performed in 2011 (i.e. the surgical yield from that period) came to 1078 with an additional 1470 patients referred for endoscopy and 475 patients referred for minor operations. Operative surgical yield from the currently structured outpatient clinic model is low, with the number of theatre cases coming to only 16.58% of the original number of outpatient appointments issued. Recommendations for the improvement of outpatient services are made. These findings are relevant in the context of streamlining access to surgical services. PMID:24218748

Irfan, M; McGovern, M; Robertson, I; Waldron, R; Khan, I; Khan, W; Barry, K

2013-01-01

355

Patient profile and results of percutaneous transvenous mitral commissurotomy in mitral restenosis following prior percutaneous transvenous mitral commissurotomy vs surgical commissurotomy  

PubMed Central

Background Patients with mitral restenosis who have undergone prior PTMC or surgical commissurotomy have increased. Predictors of outcome of repeat PTMC in either subgroup of patients may be different. Aims and objectives Aim was to assess and compare the immediate results of PTMC in patients who had undergone a prior PTMC or surgical commissurotomy. Methods and results This is a single center, prospective, open label study. Of 70 patients in study, 44 (62.85%) patients had prior history of PTMC and 26 (37.15%) had prior surgical commissurotomy (closed/open). Average time from the initial procedure was 8.88 ± 5.36 years overall, 6.75 ± 3.38 for patients with prior PTMC and 16.73 ± 3.67 for patients with prior surgical commissurotomy. Prior PTMC group had 75% female, patients with prior surgical commissurotomy were older (44 ± 7 vs 33.57 ± 9.1 years, p = 0.001), had higher NYHA class (III/IV in100% vs 86.36%, p = 0.006.), higher atrial fibrillation (73.1% vs 25% p < 0.0001) and higher Wilkins' score (>8 in 88.46% vs 68.18%, p = 0.05). Successful PTMC was lower (65.4% vs 84.1%) in patients with prior surgical commissurotomy, though statistically not significant (p = 0.07). After PTMC, mitral valve area, PA systolic pressure, LA mean pressure and trans-mitral gradient were similar. Post procedure complications were not different in both the groups. Conclusion PTMC for mitral restenosis in patients with prior surgical valvotomy is as effective as in patients with prior PTMC despite older age, higher NYHA class, higher Wilkins score and atrial fibrillation and can be considered in all patients with restenosis irrespective of the type of past procedures done.

Sharma, Kamal H.; Jain, Sharad; Shukla, Anand; Bohora, Shomu; Roy, Bhavesh; Gandhi, Gaurav D.; Ashwal, A.J.

2014-01-01

356

Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital  

PubMed Central

Background: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital. Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times. Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%), and none were directly related to the robotic system. Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot.

Sait, Khalid H

2011-01-01

357

Reducing Surgical Site Infections: A Review  

PubMed Central

Infection at or near surgical incisions within 30 days of an operative procedure contributes substantially to surgical morbidity and mortality each year. The prevention of surgical site infections encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures aimed at neutralizing the threat of bacterial, viral, and fungal contamination posed by operative staff, the operating room environment, and the patient’s endogenous skin flora. It is the latter aspect of contamination, and specifically mechanical methods of prevention, on which this review focuses.

Reichman, David E; Greenberg, James A

2009-01-01

358

The role of simulation in surgical training.  

PubMed Central

Surgical training has undergone many changes in the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. Simulation of surgical procedures and human tissue, if perfect, would allow complete transfer of techniques learnt in a skills laboratory directly to the operating theatre. Several techniques of simulation are available including artificial tissues, animal models and virtual reality computer simulation. Each is discussed in this article and their advantages and disadvantages considered. Images Figure 1 Figure 2 Figure 3 Figure 4

Torkington, J.; Smith, S. G.; Rees, B. I.; Darzi, A.

2000-01-01

359

Topical hemostatic agents in surgical practice.  

PubMed

Hemostasis is of critical importance in achieving a positive outcome in any surgical intervention. Different hemostatic methods can be employed and topical hemostatic agents are used in a wide variety of surgical settings. Procoagulation agents have different hemostatic properties and the choice of a specific one is determined by the type of surgical procedure and bleeding. Hemostatic treatments include fibrin sealants, microfibrillar collagen, gelatin hemostatic agents, oxidized regenerated cellulose and cyanoacrylates adhesives. Surgeons should be familiar with topical hemostatics to ensure an appropriate use. Our purpose is to illustrate the currently available agents, their mechanism of action and their effective applications, in order to ensure an optimal use in operating room. PMID:22040778

Emilia, Masci; Luca, Santoleri; Francesca, Belloni; Luca, Bottero; Paolo, Stefanini; Giuseppe, Faillace; Gianbattista, Bertani; Carmela, Montinaro; Luigi, Mancini; Mauro, Longoni

2011-12-01

360

A computerized bioskills system for surgical skills training in total knee replacement.  

PubMed

Although all agree that the results of total knee replacement (TKR) are primarily determined by surgical skill, there are few satisfactory alternatives to the 'apprenticeship' model of surgical training. A system capable of evaluating errors of instrument alignment in TKR has been developed and demonstrated. This system also makes it possible quantitatively to assess the source of errors in final component position and limb alignment. This study demonstrates the use of a computer-based system to analyse the surgical skills in TKR through detailed quantitative analysis of the technical accuracy of each step of the procedure. Twelve surgeons implanted a posterior-stabilized TKR in 12 fresh cadavers using the same set of surgical instruments. During each procedure, the position and orientation of the femur, tibia, each surgical instrument, and the trial components were measured with an infrared coordinate measurement system. Through analysis of these data, the sources and relative magnitudes of errors in position and alignment of each instrument were determined, as well as its contribution to the final limb alignment, component positioning and ligament balance. Perfect balancing of the flexion and extension gaps was uncommon (0/15). Under standardized loading, the opening of the joint laterally exceeded the opening medially by an average of approximately 4 mm in both extension (4.1 +/- 2.1 mm) and flexion (3.8 +/- 3.4 mm). In addition, the overall separation of the femur and the tibia was greater in flexion than extension by an average of 4.6 mm. The most significant errors occurred in locating the anterior/posterior position of the entry point in the distal femur (SD = 8.4 mm) and the correct rotational alignment of the tibial tray (SD = 13.2 degrees). On a case-by-case basis, the relative contributions of errors in individual instrument alignments to the final limb alignment and soft tissue balancing were identified. The results indicate that discrete steps in the surgical procedure make the largest contributions to the ultimate alignment and laxity of the prosthetic knee. Utilization of this method of analysis and feedback in orthopaedic training is expected rapidly to enhance surgical skills without the risks of patient exposure. PMID:17315769

Conditt, M A; Noble, P C; Thompson, M T; Ismaily, S K; Moy, G J; Mathis, K B

2007-01-01

361

Surgical rehearsal platform: potential uses in microsurgery.  

PubMed

Surgical training has remained remarkably similar in many respects since the early days of halstedian training. Neurosurgery is a demanding field that requires extensive cognitive, perceptive, and technical training. Surgical simulation is a promising approach to facilitate acquiring proficiency in neurosurgical procedures. Simulation can permit mentoring trainees in a "safe" environment. By incorporating images that depict specific abnormalities in actual patients, simulation can provide realistic rehearsal for any given case for both novice and experienced surgeons in much the same way that data acquired from drones can be used to allow pilots to rehearse mission-critical maneuvers in a simulator before taking flight. Most neurosurgical simulators to date have focused on endovascular procedures, spinal procedures, temporal bone dissection, and stereotactic procedures. The use of simulator technology for microsurgery is in its infancy. This article describes a novel simulator technology developed by Surgical Theater LLC (http://www.surgicaltheater.net/home.html) called the Selman Surgical Rehearsal Platform. The platform shows promise for use in intracranial microvascular procedures, which require experience that is becoming increasingly limited for trainees who have to become proficient in more procedures in much less time than ever before. PMID:24051875

Bambakidis, Nicholas C; Selman, Warren R; Sloan, Andrew E

2013-10-01

362

The endocrine and metabolic response to surgical stress in the neonate  

Microsoft Academic Search

This study was conducted to investigate the newborn's response to surgical trauma. Ten newborns and 10 infants as a control group undergoing similar surgical procedures were studied. All patients had moderate surgical stress, and there was no difference between the groups regarding the degree of surgical trauma. Alterations in the serum cortisol and growth hormone levels were investigated as parameters

Hamit Okur; Mustafa Küçükaydin; K. Muzaffer Üstdal

1995-01-01

363

Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893  

PubMed Central

Background Extended systemic lymphadenectomy (D2) is standard procedure for surgical treatment of advanced gastric cancer (AGC) although less extensive lymphadenectomy (D1) can be applied to early gastric cancer. Complete D2 lymphadenectomy is the mandatory procedure for studies that evaluate surgical treatment results of AGC. However, the actual extent of D2 lymphadenectomy varies among surgeons because of a lacking consensus on the anatomical definition of each lymph node station. This study is aimed to develop a consensus for D2 lymphadenectomy and also to qualify surgeons that can perform both laparoscopic and open D2 gastrectomy. Methods/Design This (KLASS-02-QC) is a prospective, observational, multicenter study to qualify the surgeons that will participate in the KLASS-02-RCT, which is a prospective, randomized, clinical trial comparing laparoscopic and open gastrectomy for AGC. Surgeons and reviewers participating in the study will be required to complete a questionnaire detailing their professional experience and specific gastrectomy surgical background/training, and the gastrectomy metrics of their primary hospitals. All surgeons must submit three laparoscopic and three open D2 gastrectomy videos, respectively. Each video will be allocated to five peer reviewers; thus each surgeon’s operations will be assessed by a total of 30 reviews. Based on blinded assessment of unedited videos by experts’ review, a separate review evaluation committee will decide whether or not the evaluated surgeon will participate in the KLASS-02-RCT. The primary outcome measure is each surgeon’s proficiency, as assessed by the reviewers based on evaluation criteria for completeness of D2 lymphadenectomy. Discussion We believe that our study for standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC) will guarantee successful implementation of the subsequent KLASS-02-RCT study. After making consensus on D2 lymphadenectomy, we developed evaluation criteria for completeness of D2 lymphadenectomy. We also developed a unique surgical standardization and quality control system that consists of recording unedited surgical videos, and expert review according to evaluation criteria for completeness of D2 lymphadenectomy. We hope our systematic approach will set a milestone in surgical standardization that is essential for surgical clinical trials. Additionally, our methods will serve as a novel system for educating surgeons and assessing surgical proficiency. Trial registration NCT01283893.

2014-01-01

364

Mycotic carotid pseudoaneurysm: staged endovascular and surgical repair.  

PubMed

Mycotic carotid pseudoaneurysms are rare and challenging to manage. Traditional surgical approaches are technically demanding and can be associated with a high morbidity and mortality. The use of endovascular stents in infected fields remains controversial, and long-term efficacy has not been fully clarified. We describe a case where a combined staged endovascular and open surgical approach was used to successfully manage a mycotic carotid pseudoaneurysm that developed following dental extraction. A covered endovascular stent was used to temporarily exclude the infected pseudoaneurysm, before proceeding to early definitive surgical management. We suggest that staged endovascular therapy followed by early surgical repair should be considered for this difficult surgical problem. PMID:19906550

Wales, L; Kruger, A J; Jenkins, J S; Mitchell, K; Boyne, N S; Walker, P J

2010-01-01

365

American Pediatric Surgical Association  

MedlinePLUS

... May 2014 issue Stay current with APSA and pediatric surgery news. Read current issue | Archives Locum Tenens ... for Children’s Surgical Care Assuring Access to Quality Pediatric Surgical Subspecialty Care in the Accountable Care Organization ( ...

366

Surgical treatment of cerebellar metastases  

PubMed Central

Background: Cerebral metastases are a common neurosurgical finding. Surgery confers several advantages to other therapies, including immediate symptomatic improvement, diagnosis, and relief from corticosteroid dependence. Here we evaluate patients with cerebellar metastases who underwent surgery and compare their findings to those in the literature, and address the benefit of avoiding ventriculo-peritoneal shunting in patients undergoing surgery. Methods: We performed a retrospective analysis involving 50 patients with cerebellar metastases who underwent surgical resection. Ventriculo-peritoneal shunts were placed in patients necessitating permanent CSF drainage. We evaluated presentation, diagnosis, complications, and outcome. Results: Our review included 21 males and 29 females, 29 to 82 years of age. Primary tumors included lung (48%), breast (14%), GI (14%), endometrial/ovarian (6%), melanoma (6%), sarcoma (4%), lymphoma (4%), laryngeal (2%), and other (2%). Clinical symptoms at presentation commonly were those secondary to elevated intracranial pressure and were the initial complaint in 34% of patients. Preoperatively, 29 patients were noted to have hydrocephalus. Importantly, 76% of these patients were able to avoid placement of a ventriculo-peritoneal shunt following surgery. Only two complications were noted in our series of 50 patients, including a symptomatic pseudomeningocele and a wound infection. No symptomatic postoperative hematoma developed in any surgical case. Conclusion: A review of the literature has shown a high complication rate in patients undergoing surgical resection of cerebellar metastases. We have shown that surgical resection of cerebellar metastases is a safe procedure and is effective in the treatment of hydrocephalus in the majority of patients harboring cerebellar lesions.

Ghods, Ali J.; Munoz, Lorenzo; Byrne, Richard

2011-01-01

367

Surgical treatment of hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome).  

PubMed

The surgical management of the Lynch syndrome patient with colorectal cancer needs to be individualized. Because of the increased incidence of synchronous and metachronous colorectal neoplasms, most favor an extended resection at the time of diagnosis of colorectal cancer. Age of diagnosis, stage of the tumor, co-morbidities, surgical expertise, surgical morbidity, and patient wishes should be taken into account when considering a surgical procedure. There are no prospective randomized trials or retrospective trials suggesting that patients undergoing an extended procedure have a survival advantage compared to those undergoing segmental resection. In retrospective studies it has been demonstrated that patients undergoing extended procedures will develop less metachronous colorectal neoplasms and will undergo less subsequent surgical procedures related to colorectal cancer. In females abdominal hysterectomy and bilateral salpingoophorectomy should be considered at the time of surgery for colorectal cancer. PMID:23508345

Rodriguez-Bigas, Miguel A; Möeslein, Gabriela

2013-06-01

368

Surgical treatment of vaginal apex prolapse.  

PubMed

Pelvic organ prolapse is a common problem in women that increases with age and adversely affects quality of life and sexual function. If conservative treatments fail, surgery becomes the main option for symptom abatement. For uterovaginal prolapse, treatment with or without hysterectomy can be offered, and operations must include a specific apical support procedure to be effective. Operations for apical prolapse include transvaginal, open, and laparoscopic or robotic options; few clinical trials have compared the effectiveness and risk of these various surgeries. Grafts can be used selectively for apical suspensions and may improve cure rates but also increase risk of some complications. Slings should be added selectively to reduce postoperative stress incontinence. For women interested in future sexual activity who require apical prolapse surgery, we suggest using transvaginal apical repairs for older patients, those with primary or less severe prolapse, and those at increased surgical risk. We recommend sacral colpopexy with polypropylene mesh (preferably by minimally invasive route) in younger women, those with more severe prolapse or recurrences after vaginal surgery, and women with prolapsed, short vaginas. In older women with severe prolapse who are not interested in sexual activity, obliterative operations are very effective and have high satisfaction rates. An interactive consent process is mandatory, because many decisions-about route of surgery; use of hysterectomy, slings, and grafts; and vaginal capacity for sexual intercourse-require an informed patient's input. Selective referral to specialists in Female Pelvic medicine and Reconstructive Surgery can be considered for complex and recurrent cases. PMID:23344287

Walters, Mark D; Ridgeway, Beri M

2013-02-01

369

Changing surgical aspects of urinary stone disease.  

PubMed

Surgical management of urinary calculous disease has changed dramatically in the past decade. The development of percutaneous nephrostomy techniques has allowed new access to upper tract stones. Percutaneous removal of large calculi was made possible by the development of ultrasonic and electrohydraulic lithotripsy. All upper tract calculi can now be removed in 70 to 100 per cent of cases with minimal complications. Nephrostolithotomy has reduced transfusion rates and hospitalization costs and has markedly shortened convalescence periods compared with open surgery. Ureteroscopy followed nephrostolithotomy as advanced fiberoptic technology allowed the development of the small-caliber instruments required for this procedure. With experience, successful stone retrieval has occurred in 90 per cent or more of cases, again with minimal complications. As nephrostolithotomy and ureteroscopy have become available, the subspecialty of endourology has emerged and significantly changed the management of urinary tract calculi. Perhaps the most significant advance in stone therapy has been the design and implementation of extracorporeal shock wave lithotripsy. With this noninvasive technique, most renal and proximal ureteral calculi can be effectively treated with minimal morbidity and convalescence. Research in lithotripter design is continuing, with more advanced and effective machines on the horizon. The applicability of extracorporeal therapy for the treatment of biliary tract calculi is currently under investigation. Finally, one should not disparage medical therapy for recurrent nephrolithiasis. A comprehensive metabolic evaluation combined with selective medical therapy provides almost complete relief from recurrent stone formation and makes medical therapy an integral component of treating the patient with renal or ureteral calculi. PMID:3051454

Brown, R D; Preminger, G M

1988-10-01

370

Surgical treatment of GERD: where have we been and where are we going?  

PubMed

Surgical management of gastroesophageal reflux disease has evolved from relatively invasive procedures requiring open laparotomy or thoracotomy to minimally invasive laparoscopic techniques. Although side effects may still occur, with careful patient selection and good technique, the overall symptomatic control leads to satisfaction rates in the 90% range. Unfortunately, the next evolution to endoluminal techniques has not been as successful. Reliable devices are still awaited that consistently produce long-term symptomatic relief with correction of pathologic reflux. However, newer laparoscopically placed devices hold promise in achieving equivalent symptomatic relief with fewer side effects. Clinical trials are still forthcoming. PMID:24503364

Kim, David; Velanovich, Vic

2014-03-01

371

Surgical Management for Peyronie's Disease  

PubMed Central

Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations.

Segal, Robert L.

2013-01-01

372

Surgical Management of Hidradenitis Suppurativa  

PubMed Central

Background: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Method: This study reviewed 54 sites in 27 patients with moderate to extensive chronic inflammatory skin lesions treated surgically in our hospital from 2004 through 2009, with a follow-up of at least 6 months. Result: A total number of 54 operative procedures were performed during the study period with 42% (23 sites) involving the axilla, 20% (11 sites) involving the gluteal area, %24 (13 sites) involving the perineal area and 12% (7 sites) involving the inguinal region. Conclusion: Conservative treatment methods have little or no effects especially on gluteal, perineal/perianal, axillary hidradenitis suppurativa. The morbidity associated with the established form of this disease is significant, and the only successful treatment is wide surgical excision.

Menderes, Adnan; Sunay, Ozgur; Vayvada, Haluk; Yilmaz, Mustafa

2010-01-01

373

Results of open pararenal abdominal aortic aneurysm repair: Tabular review of the literature.  

PubMed

Open surgical repair of complex abdominal aortic aneurysms requires more extensive dissection and aortic clamping above the renal or mesenteric arteries. Although results of open surgical series have shown variation, morbidity and mortality is higher compared with infrarenal aortic aneurysm repair. Potential complications include renal insufficiency, mesenteric ischemia, multisystem organ failure, and death. Although endovascular treatment with fenestrated and branched endografts might potentially decrease the risk of complications and mortality, its role is not yet defined and the technology is not widely available. Issues related to durability of the procedure and secondary interventions might limit its application to patients with higher risk or those with hostile anatomy. This article summarizes the clinical results of open surgical repair of pararenal abdominal aortic aneurysms to provide a benchmark for comparison with results of endovascular treatment, using fenestrated and branched techniques. PMID:21172590

Tallarita, Tiziano; Sobreira, Marcone L; Oderich, Gustavo S

2011-01-01

374

Craniosynostosis: Esthetic protocol in open technique  

PubMed Central

Introduction: The past two decades have seen advances relative to the treatment of patients with craniosynostosis in the areas of resorbable fixation, imaging, and both intraoperative and perioperative management. The purpose of this study is to present open cranial vault reshaping techniques and anesthetic protocol used at Louisiana State University Health - Shreveport, USA. Materials and Methods: The surgical procedure of choice was single-stage open cranial vault reshaping with barrel-staving and orbital bandeau advancement as needed for supra-orbital rim deficiencies. Results: The outcomes of single-stage cranial vault reshaping with selective postoperative dynamic orthotics yielded symmetrical and consistent clinical results with only three children out of over 100 cases requiring later surgical correction. Discussion: Our review of techniques provides a safe protocol for management of craniosynostosis with symmetrical clinical head shape. The techniques presented here are aimed at improving the multidisciplinary management of these patients.

Ghali, Ghali E.; Zakhary, George

2013-01-01

375

VATS Lobectomy: Surgical Evolution from Conventional VATS to Uniportal Approach  

PubMed Central

There is no standardized technique for the VATS lobectomy, though most centres use 2 ports and add a utility incision. However, the procedure can be performed by eliminating the two small ports and using only the utility incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resection, the technique has been spreading worldwide. The single-port technique provides a direct view to the target tissue. The conventional triple port triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. The parallel instrumentation achieved during single-port approach mimics inside the maneuvers performed during open surgery. Furthermore, it represents the less invasive approach possible, and avoiding the use of trocar, we minimize the compression of the intercostal nerve. Further development of new technologies like sealing devices for all vessels and fissure, robotic arms that open inside the thorax, and wireless cameras will facilitate the uniportal approach to become the standard surgical procedure for pulmonary resection in most thoracic departments.

Gonzalez-Rivas, Diego

2012-01-01

376

[Acute paraproctitis: choice of surgical treatment].  

PubMed

Experience in surgical treatment of more than 16 thousand patients with acute paraproctitis is discussed. In most cases the distal part of the main purulent passage comes out of the cavity of the abscess into the rectal lumen inside the sphincter. This makes possible in most cases simultaneous elimination of the inner opening of the paraproctitis in the anal canal. PMID:7723254

Alf, I M; An, V K; NIkolina, E M; Studenkova, A V; Polukarov, V A; Chakhvashvili, R I

1994-10-01

377

Management of petrous bone cholesteatoma: open versus obliterative techniques.  

PubMed

The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on obliterative or closed techniques in large cholesteatomas. A retrospective study was performed from July 1977 to September 2007 at the Tertiary referral cranial base center. Thirty-five patients were treated for PBC through different surgical approaches, and in 25 cases (72%) the surgical cavity was obliterated with a muscle flap. Four patients (11%) had a long-term recurrence. These patients received an open technique and after surgical re-exploration using a closed technique they had no recurrence. There were no recurrences in patients who underwent an obliterative technique and they received periodic MRI controls. The facial function after surgery was acceptable (71% of patients had House-Brackmann grades I to III). PBC is a complex pathology and presents difficulties in its diagnosis and treatment. Surgical technique should be suitable for removing the pathology and preventing damage to structures such as the facial nerve or great vessels. Obliterative techniques, where possible, are at least as safe as open cavity procedures and they have fewer postoperative complications; however, regular follow-up with CT and MRI is mandatory. PMID:20680639

Alvarez, Fernando López; Gómez, Justo R; Bernardo, Ma Jesús; Suárez, Carlos

2011-01-01

378

Surgical management of severe rigid tuberculous kyphosis of dorsolumbar spine  

Microsoft Academic Search

To assess the effectiveness of deformity correction and safety of the two major corrective spinal surgical procedures, 35\\u000a patients, aged 14–47 years, were placed into two groups according to procedures performed. Sixteen patients (group A) had\\u000a four-stage procedures including initial halo-pelvic distraction after anterior release and a subsequent three procedural steps\\u000a plus brace. Nineteen patients (group B) had one-set two-stage procedures:

Myung-Sang Moon; Sung-Soo Kim; Bong-Jin Lee; Jeong-Lim Moon; Young-Wan Moon

2011-01-01

379

Surgical treatment of primary headaches.  

PubMed

Neuromodulation for the treatment of drug-refractory cranial neuralgias constitutes an exciting field of research for physicians; in the last decade, several methodologies have been described which could help many patients to exit such desperate conditions; although the exact mechanisms of action of these techniques are still matter of debate, several experimental and neuroradiological modalities can help us to get near the concept of understanding them. In this paper, the authors summarize the most recent surgical procedures used to treat severe and pharmaco-resistant cranial painful conditions, along with brief descriptions of the results obtained in the several published so far. PMID:22644188

Franzini, Angelo; Messina, Giuseppe; Cordella, Roberto; Proietti Cecchini, Alberto; Leone, Massimo; Bussone, Gennaro

2012-05-01

380

Surgical approaches to the treatment of obesity  

Microsoft Academic Search

Bariatric surgery, through its efficacy and improved safety, is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Established procedures, such as Roux-en-Y gastric bypass and adjustable gastric banding, account for more than 80% of bariatric surgical procedures globally. Sleeve gastrectomy has emerged as a stand-alone

Nora E. Straznicky; Elisabeth A. Lambert; Markus P. Schlaich; Gavin W. Lambert; John B. Dixon

2011-01-01

381

Preventing surgical site infections: a surgeon's perspective.  

PubMed Central

Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. National studies have defined the patients at highest risk for infection in general and in many specific operative procedures. Advances in risk assessment comparison may involve use of the standardized infection ratio, procedure-specific risk factor collection, and logistic regression models. Adherence to recommendations in the 1999 Centers for Disease Control and Prevention guidelines should reduce the incidence of infection in surgical patients.

Nichols, R. L.

2001-01-01

382

Retained surgical swabs in 13 dogs.  

PubMed

To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats that were referred to four referral centres were reviewed. Cases in which a retained surgical swab was identified during surgery at the referral hospital were selected for further study. The signalment, history, clinical signs, diagnostic and surgical findings and outcome in these cases were reviewed. Thirteen dogs with retained surgical swabs were included in the study. Bodyweight ranged from 9 to 45 kg. The initial surgery was a 'non-routine' abdominal procedure in seven dogs, ovariohysterectomy in five dogs and perineal hernia repair in one dog. Time from initial surgery to presentation at the referral centre ranged from four days to seven years. Treatment involved major surgery in eight of the 13 dogs. Outcome was excellent in 12 of 13 cases, one dog was euthanased. PMID:21846684

Forster, K; Anderson, D; Yool, D A; Wright, C; Burrow, R

2011-09-24

383

Intraoperative nursing activities performed by surgical technologists.  

PubMed

In this study of delegated intraoperative nursing activities performed by surgical technologists (STs) in low-risk and high-risk surgical procedures, 343 OR directors, perioperative nurses, and STs from rural, community, and medical center hospitals reported that STs frequently perform activities related to surgical counts, the sterile field, and equipment and supplies. Surgical technologists do not frequently perform tasks related to patient transportation, teaching, medication administration, OR environment, patient monitoring, and patients' rights. The investigator used nine competency statements of intraoperative nursing as a framework for the research instrument. Data analysis determined that the levels of risk in patient situations affects how frequently STs perform transportation, teaching, sterile field, OR environment, and patients' rights activities. PMID:7979325

Abbott, C A

1994-09-01

384

Surgical treatment of the sunken upper eyelid.  

PubMed

The youthful upper eyelid shows no depression because the orbital contents are firm and the eyelids are tightly stretched across the bony socket. With progressive aging, there is skeletonization of the orbit as the periorbital tissues undergo laxity or absorption. With aging, hollowing of the eyes results in a deep upper eyelid sulcus. Most surgical procedures that address the aging appearance of the eyes involve excision of excess skin and removal of fat, with resultant volume disproportion that may lead to further hollowing and older appearance. Few procedures have been introduced that address age-related periorbital volume disproportion. We discuss a newly developed surgical technique for the correction of this major orbital aesthetic problem. In this surgical technique, the orbital rim periosteum, periorbita, and released superior extraconal orbital fat are used to fill the superior periorbital space, improving the patient's appearance. PMID:16847174

Maniglia, João J; Maniglia, Ricardo F; Jorge dos Santos, Marco César; Robert, Fabio; Maniglia, Fabio F; Maniglia, Sérgio F

2006-01-01

385

[Interventional radiology procedures for malignancies of the liver: ablation procedures].  

PubMed

Percutaneous ablative procedures allow curative treatment of stage BCLC 0 or BCLC A hepatocellular carcinoma, as well as liver metastases of colorectal cancer. Several methods exist including radiofrequency ablation, the most commonly used. These techniques can be used in combination with surgical excision or alone if surgery is contraindicated. They are associated with significantly reduced mortality as compared to surgery. PMID:24941683

Cristina, V; Pracht, M; Lachenal, Y; Denys, A; Wagner, A D; Bize, P

2014-05-21

386

Whipple Procedure  

MedlinePLUS

... Lab Sol Goldman Center Discussion Board The Whipple Procedure Also called a pancreaticoduodenectomy, which is generally the ... have been many modifications and improvements of the procedure. There is a detailed account of the operative ...

387

Checkout Procedures.  

National Technical Information Service (NTIS)

The reliable performance of some oceanographic instruments is dependent on proper checkout procedures. The Reliability Division of the National Oceanographic Instrumentation Center develops checkout procedures when necessary and disseminates them througho...

1971-01-01

388

Surgical smoke and ultrafine particles  

PubMed Central

Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine (<100 nm) and accumulation mode particles (< 1 ?m). Epidemiological and toxicological studies have shown that exposure to particulate air pollution is associated with adverse cardiovascular and respiratory health effects. Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc.) was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3) of particles in the diameter range of 10 nm to 1 ?m. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

Bruske-Hohlfeld, Irene; Preissler, Gerhard; Jauch, Karl-Walter; Pitz, Mike; Nowak, Dennis; Peters, Annette; Wichmann, H-Erich

2008-01-01

389

[Surgical treatment for intractable epilepsy].  

PubMed

Epilepsy surgery can be divided into two categories, resective and disconnective procedures. The former includes lesionectomy, corticectomy, and lobectomy. The latter comprises MST (multiple subpial transection), corpus callosotomy, and hemispherotomy. In this presentation, the preoperative diagnosis and surgical outcomes of temporal lobectomy and MST will be illustrated. Temporal lobe epilepsy is one of the most common seizures in adult intractable epilepsy. Noninvasive preoperative evaluation, including analysis of seizure semiology, repetitive scalp EEG, and MR imaging, can definitely localize the seizure focus, without depending on invasive monitoring, in 70% of the cases. Seizure outcome after temporal lobectomy is generally satisfactory, with 70% seizure-free and > 90% significantly improved. However, verbal amnesia is an unavoidable sequela when the focus is on the speech-dominant side and preoperative MRI reveals little or no hippocampal atrophy. MST is an epoch-making surgical technique by which surgical treatment of eloquent cortex has become possible. In cases with neocortical epilepsy treated by MST alone or combined with corticectomy, 80% showed significant improvement, that is compatible with reported outcomes of corticectomy. MST can be also applied to treatments of extensive epileptic foci, Rasmussen's encephalitis, or Landau-Kleffner syndrome. PMID:12235806

Shimizu, H

2001-12-01

390

Epidemiology and changed surgical treatment methods for fractures of the distal radius  

PubMed Central

Background and purpose The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004–2010. Patients and methods Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. Results The crude incidence rate was 31 per 104 person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 104 person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ? 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. Interpretation The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating.