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Appendix B: Surgical Procedure  

Center for Biologics Evaluation and Research (CBER)

Text VersionPage 1. Appendix B: Surgical Procedure Marking the Cornea Prior to Surgery ... surgeon's preferred method. Surgical Procedure ... More results from


[Open biopsy of bone and soft tissue tumors : guidelines for precise surgical procedures].  


OBJECTIVE: The objective of an open biopsy is to obtain a sufficient amount of representative tumor tissue in terms of adequate quality and quantity, without adverse effects on later therapy. INDICATIONS: Suspected malignancy after non-invasive diagnostic procedures. Histopathologic evaluation of tumor entity and grading. Planning of the definitive tumor resection and initiation of neoadjuvant therapeutic regimen. Obtaining unfixed, fresh-frozen tumor samples for molecular/genetic analyses or tumor tissue bank. CONTRAINDICATIONS: Hemorrhagic diathesis. Tumor is only accessible with a surgical approach leading to a significant damage of the surrounding tissue. High probability of tumor cell contamination with incisional biopsy. Poor physical status. Poor therapeutic compliance. SURGICAL TECHNIQUE: The biopsy tract should be carefully planned according to oncological principles. The operation begins with a small incision in longitudinal direction to the extremity. The shortest path between skin and lesion that avoids contamination of other compartments is selected. The biopsy tract should be located within the surgical approach which is later used for definitive tumor resection. During the definitive procedure it should be possible to resect the biopsy approach with adequate surgical margins because it is considered to be contaminated with tumor cells. In principle, a wide resection of the biopsy tract should be possible. During the operation meticulous hemostasis has to be performed because any hematoma around a tumor may contaminate the entire extremity. In cases of an intraosseous tumor a cortical window should be made to obtain intramedullary tumor tissue. Drains should be located in continuity with the skin incision or in direct extension of the wound. Wound closure with intracutaneous suture technique. Excisional biopsy in terms of marginal resection should be performed only in the presence of small, epifascial lesions that are assumed to be benign after completion of basic diagnostic procedures. In cases of larger or subfascial tumors an incisional biopsy should be conducted. POSTOPERATIVE MANAGEMENT: Compressive dressing to prevent postoperative hematoma. In cases of tumors affecting load-bearing bones, weight-bearing should be prohibited after biopsy, if there is any fracture risk. Upon receipt of the histopathological results the definitive tumor resection is planned. PMID:23053027

Holzapfel, B M; Lüdemann, M; Holzapfel, D E; Rechl, H; Rudert, M



Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer  

PubMed Central

Objective The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. Methods A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. Results Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0±28.8 minutes, which showed significant difference from the 208.1±46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3±92.4 mL. This was significantly less than that of the laparotomy group (301.9±156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. Conclusion Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Kong, Tae Wook; Lee, Kyung Mi; Cheong, Ji Yoon; Kim, Woo Young; Yoo, Seung-Chul; Yoon, Jong-Hyuck; Chang, Ki-Hong; Ryu, Hee-Sug



Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union  

PubMed Central

We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.

Alvi, F.; Siddique, I.; Zenios, M.; Hirst, P.; Marshall, P.



The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open-heart surgery  

Microsoft Academic Search

Objective: Patients with mitral valve disease and suffering of atrial fibrillation of more than 1 year's duration have a low probability of remaining in sinus rhythm after valve surgery alone. Intraoperative radiofrequency ablation was used as an alternative to simplify the surgical maze procedure. Methods: Seventy-two patients with mitral valve disease, aged 63±11 years ranging from 31 to 80 years,

Hauw T Sie; Willem P Beukema; Anand R Ramdat Misier; Arif Elvan; Jacob J Ennema; Hein J. J Wellens



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.



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


Conscious sedation for surgical procedures  


... tests and procedures conscious sedation may be used for are: Breast biopsy Dental prosthetic or reconstructive surgery Minor bone fracture repair Minor foot surgery Minor skin surgery Plastic or reconstructive surgery Procedures to diagnose and treat ...


Surgical Training System for Laparoscopic Procedures.  

National Technical Information Service (NTIS)

A surgical training system includes a tracking system for tracking the position of one or more instruments during a training procedure and objectively evaluating trainee performance based upon one or more metrics using the instrument position information....

M. Ottensmeyer N. Stylopoulos P. Newmann R. Bardsley S. Cotin S. Dawson



Open core control software for surgical robots  

PubMed Central

Object In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge “intelligent surgical robot” will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are “home-made” in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. Materials and methods In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a “force guide” for supporting operators to perform precise manipulation by using a master–slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. Results The Open Core Control software was implemented on a surgical master–slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a “force guide” on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. Conclusion In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement “General Principles of Software

Kozuka, Hiroaki; Kim, Hyung Wook; Takesue, Naoyuki; Vladimirov, B.; Sakaguchi, Masamichi; Tokuda, Junichi; Hata, Nobuhiko; Chinzei, Kiyoyuki; Fujimoto, Hideo



20 CFR 220.60 - Diagnostic surgical procedures.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2012-04-01 true Diagnostic surgical procedures. 220.60 Section 220...Examinations § 220.60 Diagnostic surgical procedures. The Board will not order diagnostic surgical procedures such as myelograms...



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)



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



42 CFR 416.166 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...2009-10-01 2009-10-01 false Covered surgical procedures. 416.166 Section 416...CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Coverage, Scope of ASC...January 1, 2008 § 416.166 Covered surgical procedures. (a) Covered...



42 CFR 416.166 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Covered surgical procedures. 416.166 Section 416...CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Coverage, Scope of ASC...January 1, 2008 § 416.166 Covered surgical procedures. (a) Covered...



Effect of surgical procedures on prostate tumor gene expression profiles.  


Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALRP). Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens, which are indispensable for molecular analysis and biomarker evaluation. The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature. RNA integrity number (RIN) values were compared between total RNA samples extracted from consecutive LRP (n=11) and ORP (n=24) prostate specimens. Expression profiling was performed using the Agilent human whole-genome expression microarrays. Expression differences by surgical type were analyzed by Volcano plot analysis and gene ontology analysis. Quantitative reverse transcription (RT)-PCR was used for expression validation in an independent set of LRP (n=8) and ORP (n=8) samples. The LRP procedure did not compromise RNA integrity. Differential gene expression by surgery types was limited to a small subset of genes, the number of which was smaller than that expected by chance. Unexpectedly, this small subset of differentially expressed genes was enriched for those encoding transcription factors, oxygen transporters and other previously reported surgery-induced stress-response genes, and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens. The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible, supporting the suitability of LRP surgical specimens for routine molecular analysis. Blunted in vivo stress response in LRP specimens, likely mediated by CO(2) insufflation but not by longer ischemia time, is manifested in the reduced expression of stress-response genes in these specimens. PMID:22864281

Li, Jie; Zhang, Zhi-Hong; Yin, Chang-Jun; Pavlovich, Christian; Luo, Jun; Getzenberg, Robert; Zhang, Wei



Effect of surgical procedures on prostate tumor gene expression profiles  

PubMed Central

Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALRP). Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens, which are indispensable for molecular analysis and biomarker evaluation. The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature. RNA integrity number (RIN) values were compared between total RNA samples extracted from consecutive LRP (n=11) and ORP (n=24) prostate specimens. Expression profiling was performed using the Agilent human whole-genome expression microarrays. Expression differences by surgical type were analyzed by Volcano plot analysis and gene ontology analysis. Quantitative reverse transcription (RT)-PCR was used for expression validation in an independent set of LRP (n=8) and ORP (n=8) samples. The LRP procedure did not compromise RNA integrity. Differential gene expression by surgery types was limited to a small subset of genes, the number of which was smaller than that expected by chance. Unexpectedly, this small subset of differentially expressed genes was enriched for those encoding transcription factors, oxygen transporters and other previously reported surgery-induced stress-response genes, and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens. The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible, supporting the suitability of LRP surgical specimens for routine molecular analysis. Blunted in vivo stress response in LRP specimens, likely mediated by CO2 insufflation but not by longer ischemia time, is manifested in the reduced expression of stress-response genes in these specimens.

Li, Jie; Zhang, Zhi-Hong; Yin, Chang-Jun; Pavlovich, Christian; Luo, Jun; Getzenberg, Robert; Zhang, Wei



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



Surgical Strategies for Management of the Open Abdomen  

Microsoft Academic Search

Since the mid-1990s the surgical community has seen a surge in the prevalence of open abdomens (OAs) reported in the surgical\\u000a literature and in clinical practice. The OA has proven to be effective in decreasing mortality and immediate postoperative\\u000a complications; however, it may come at the cost of delayed morbidity and the need for further surgical procedures. Indications\\u000a for leaving

Justin L. Regner; Leslie Kobayashi; Raul Coimbra


42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Covered surgical procedures. 416.65 Section 416...CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Scope of Benefits for Services...January 1, 2008 § 416.65 Covered surgical procedures. Effective for...



42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...2009-10-01 2009-10-01 false Covered surgical procedures. 416.65 Section 416...CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Scope of Benefits for Services...January 1, 2008 § 416.65 Covered surgical procedures. Effective for...



Percutaneous A1 pulley release by the tip of a 20-g hypodermic needle before open surgical procedure in trigger finger management.  


The objective of the study was to assess the safety, the efficacy, and the result of percutaneous A1 pulley release, using the tip of a 20-G hypodermic needle; the study included 17 patients with 27 trigger digits (18 grade IIIA, 8 grade IIIB, and 1 grade IV). All the patients were assessed by the total range of motion of the affected digit, the visual analog scale score, and the Disability of Arm Shoulder Hand score, before and after the procedure and during the follow-up at 2, 6, 12, and 24 weeks, and then every 3 months, and the improvement was assessed by one sample t test. Sixteen patients with 26 trigger digits (95.4%) showed complete relief of symptoms with no recurrence and a statistically significant improvement in the range of motion, the visual analog scale score, and the Disability of Arm Shoulder Hand score with a P-value <0.0001, which concludes that the procedure is safe, effective, and highly successful with good results and lower complications, comparable to those reported in papers on open release for grade III and IV trigger fingers. PMID:23689860

Mishra, Sudhir R; Gaur, Anil K; Choudhary, Mahesh M; Ramesh, Jayshree



Laparoscopic and Open Cholecystectomy in Surgical Training  

Microsoft Academic Search

Background: Open cholecystectomy (OC) may still be necessary in surgical training to perform safe conversions of laparoscopic cholecystectomy (LC). Our aim was to study the outcome of LCs and OCs performed by surgical trainees. Methods: All consecutive cholecystectomies (1,581 LCs and 984 OCs) were retrospectively analyzed from 1995 until 2008. Operative complications were compared between the cholecystectomies performed by 20

Satu Suuronen; Anu Koski; Pia Nordstrom; Pekka Miettinen; Hannu Paajanen



A novel surgical procedure: scaffold-pulmonary autograft transplantation  

PubMed Central

Mitral valve-related operations are easy to perform and show good results, but to prevent severe thromboembolism or a high ratio of prosthetic valve destruction by tissue, lifetime anticoagulant therapy is essential after the operation. Thus, identifying a new type of surgical procedure and prosthetic valve to cure mitral valve diseases is necessary. Pulmonary valve autograft transplantation (Ross II) with the “top hat” transplantation technique was first reported by Ross DN to cure mitral disease. Because the “top hat” procedure has some shortcomings, we designed the scaffold-pulmonary autograft transplantation procedure and performed animal experiments to confirm the feasibility and effectiveness of the procedure. A total of 13 minipigs, weighing 20-25 kg, were employed as experimental animals to undergo scaffold-pulmonary autograft valve transplantation in our surgical animal lab. The surgical procedure was performed under hypothermic general anaesthesia and extracorporeal circulation (or cardiopulmonary bypass, CPB). Briefly, the chest cave was opened through the left intercostal, the pulmonary valve autograft was harvested during on-pump beating heart, and the pulmonary valve autograft was mounted in a self-made pulmonary valve scaffold and transferred to the mitral valve annulus without removing the mitral instruments. Finally, the outflow tract of the right ventricle was re-established with a pig pulmonary homograft. After finishing data collection, all animals were executed 1 hour after removal from the CPB. For the 13 minipigs that underwent the operation, the CPB time was 182.4 ± 23.4 min. Two of the thirteen cases died of bleeding during the operation and of a post-operative pulmonary embolism, and the remaining eleven survived for one hour. The pressure of the left atrium did not increase significantly (P = 1.00), and the ultrasonic cardiograph (UCG) showed good function of the new mitral valves, with mean ejection fraction (EF) values of 63.6%. The mitral valve orifice areas were 1.10 ± 0.13 cm2 (pre-operation) and 1.01 ± 0.08 cm2 (post-operation) (P = 0.013). The function and structure of the new mitral valves were normal. We preliminarily consider scaffold-pulmonary autograft valve transplantation to be a new alternative to cure mitral valve disease, but advanced chronic animal experiments will be needed to confirm the long-term results of the operation. The results showed it could be a new alternative to cure mitral valve disease.

Xu, Xiu-Fang; Wang, Zhu-Heng; An, Guo-Ying; Guo, Hai-Ping; Wang, Sheng; Pei, Jin-Feng; Qin, En-Ming; Ren, Xue-Jun; Xu, Zhi-Wei; Gong, Da; Li, Wen-Bin



Priapism: review of simple surgical procedure.  


For the surgical treatment of priapism we have created a percutaneous fistula between the glans penis and the corpus cavernosum with good results. This is our preferred method of management for all patients except those undergoing sickle cell crisis. PMID:7420577

Fuselier, H A; Ochsner, M G; Ross, R J



42 CFR 416.166 - Covered surgical procedures.  

Code of Federal Regulations, 2012 CFR

...surgical procedures thatâ (1) Generally result in extensive blood loss; (2) Require major or prolonged invasion of body cavities; (3) Directly involve major blood vessels; (4) Are generally emergent or life-threatening...



Historical perspectives on the evolution of surgical procedures in endodontics.  


The historical pathway to current surgical endodontic procedures and their applications has been tortuous and tumultuous. Influenced heavily in their development by the European sector, these surgical procedures faced many challenges over the decades. Fortunately for today's practitioners, influential members of the oral surgery community, and a few staunch believers in retaining devitalized teeth, persisted in their investigation of and search for improved procedures that had predictable outcomes. Many so-called "revolutionary" or newer techniques practiced today are but a re-emergence of surgical concepts that were lost in the archives of time. With the advent of evidence-based endodontics, these procedures are now supported extensively by science and by the integration of science into materials usage, technique applications and outcomes research. However, in many respects, this story is just beginning, as the "roots" of surgical endodontics are explored. PMID:20491369

Gutmann, James L; Gutmann, Marylou S



Biomechanical function of surgical procedures for acromioclavicular joint dislocations  

Microsoft Academic Search

PurposeSurgical procedures for treatment of acromioclavicular (AC) joint dislocation replace the coracoclavicular (CC) ligaments to minimize motion, allow scarring, and increase the subsequent stability of the joint. The purpose of this study was to evaluate the biomechanical function of the surgically repaired or reconstructed (CC Sling, Rockwood Screw [DePuy Orthopaedics, Warsaw, IN], and Coracoacromial [CA] Ligament Transfer Construct) AC joint

Rajesh Jari; Ryan S. Costic; Mark W. Rodosky; Richard E. Debski



Non-Surgical Cosmetic Procedures: Older Women's Perceptions and Experiences  

Microsoft Academic Search

This paper analyzes findings from in-depth interviews with 44 women aged 50–70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist

Laura Hurd Clarke; Robin Repta; Meridith Griffin



Modeling surgical procedures to assist in understanding surgical approach  

NASA Astrophysics Data System (ADS)

Often within the clinical environment of a neurosurgical brain tumor procedure, the surgeon is faced with the difficulty of orienting the patient's head to maximize the success of removing the pathology. Currently, these decisions are based on the experience of the surgeon. The primary objective of this paper is to demonstrate how a mathematical model can be used to evaluate the different patient positioning for tumor resection therapies. Specifically, therapies involving gravity-induced shift are used to demonstrate how a series of candidate approaches to the tumor can result in significantly different deformation behavior of brain tissue. To quantitatively assess the advantages and disadvantages of potential approaches, three different midline tumor locations were used to evaluate for the extent of tumor exposure and the magnitude of tensile stress at the brain-tumor interface, both of which are reliable indicators of the ease of resection. Preliminary results indicate that the lateral decubitus position is best suited for midline tumors.

Ha, Kevin; Dumpuri, Prashanth; Miga, Michael I.; Thompson, Reid C.



Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system  

Microsoft Academic Search

  We performed a variety of complete total endoscopic general surgical procedures, including colon resection, distal gastrectomy,\\u000a and splenectomy, successfully with the assistance of the da Vinci computer-enhanced surgical system. The robotic system allowed\\u000a us to manipulate the endoscopic instruments as effectively as during open surgery. It enhanced visualization of both the operative\\u000a field and precision of the necessary techniques, as

M. Hashizume; M. Shimada; M. Tomikawa; Y. Ikeda; I. Takahashi; R. Abe; F. Koga; N. Gotoh; K. Konishi; S. Maehara; K. Sugimachi



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



Patient perception of physician reimbursement for common hand surgical procedures.  


Health care-related costs have been the focus of intense scrutiny in politics and in the media. However, public perception of physician reimbursement is poorly understood. The purpose of this study was to determine patient perception of physician reimbursement for 2 common hand surgery procedures: carpal tunnel release and open reduction and internal fixation of a distal radius fracture. Anonymous surveys were completed by 132 patients in an outpatient hand and upper-extremity practice. The surveys asked patients to estimate reasonable surgeon fees and actual Medicare reimbursement for 2 common hand surgery procedures (carpal tunnel release and internal fixation of a distal radius fracture) and 2 common surgical procedures (coronary artery bypass and appendectomy). On average, patients estimated that a reasonable surgeon fee for carpal tunnel release and 90 days of postoperative care was $2629 and that actual Medicare reimbursement was $1891. Patients estimated that a reasonable surgeon fee for internal fixation of an extra-articular distal radius fracture and 90 days of postoperative care was $3874 and that actual Medicare reimbursement was $2671. Higher level of education, annual household income, and insurance status had no statistically significant effect on patient estimates of reimbursement. Patients in an outpatient hand and upper extremity practice believe that surgeons are reimbursed at a rate 3.6 to 4.7 times greater than actual reimbursement. These misperceptions highlight the lack of understanding and transparency in health care costs and may interfere with the ability of patients to make well-informed decisions about health care. PMID:24025005

Fowler, John R; Buterbaugh, Glenn A



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



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

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Performance of listed surgical procedures on an inpatient hospital basis...MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Scope of Benefits for Services... § 416.75 Performance of listed surgical procedures on an inpatient hospital...



Radiation exposure from fluoroscopy during orthopedic surgical procedures  

SciTech Connect

The use of fluoroscopy has enabled orthopedic surgeons to become technically more proficient. In addition, these surgical procedures tend to have less associated patient morbidity by decreasing operative time and minimizing the area of the operative field. The trade-off, however, may be an increased risk of radiation exposure to the surgeon on an annual or lifetime basis. The current study was designed to determine the amount of radiation received by the primary surgeon and the first assistant during selected surgical procedures involving the use of fluoroscopy. Five body sites exposed to radiation were monitored for dosage. The results of this study indicate that with appropriate usage, (1) radiation exposure from fluoroscopy is relatively low; (2) the surgeon's dominant hand receives the most exposure per case; and (3) proper maintenance and calibration of fluoroscopic machines are important factors in reducing exposure risks. Therefore, with proper precautions, the use of fluoroscopy in orthopedic procedures can remain a safe practice.

Riley, S.A. (St. Luke's Hospital, Cleveland, OH (USA))



Which surgical procedure offers the best treatment for pilonidal disease?  

Microsoft Academic Search

Purpose  Our aim was to determine the most effective surgical procedure for treatment of pilonidal disease, by comparing different\\u000a surgical techniques.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 354 patients who underwent operation for pilonidal disease were enrolled in this prospective study. The data included\\u000a patient’s demographic characteristics, age, gender, body mass index, occupation, smoking, concomitant diseases, surgeon’s\\u000a experience, wound-healing problems (wound separation and infection),

Bari? Saylam; Derya Nurhan Balli; Arife Polat Düzgün; M. Vasfi Özer; Faruk Co?kun



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


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. PMID:22655127

Aranda-Narváez, José Manuel; González-Sánchez, Antonio Jesús; Montiel-Casado, Custodia; Sánchez-Pérez, Belinda; Jiménez-Mazure, Carolina; Valle-Carbajo, Marta; Santoyo-Santoyo, Julio



Acute skin lesions after surgical procedures: a clinical approach.  


In the hospital setting, dermatologists are often required to evaluate inflammatory skin lesions arising during surgical procedures performed in other departments. These lesions can be of physical or chemical origin. Povidone iodine is the most common reported cause of such lesions. If this antiseptic solution remains in contact with the skin in liquid form for a long period of time, it can give rise to serious irritant contact dermatitis in dependent or occluded areas. Less common causes of skin lesions after surgery include allergic contact dermatitis and burns under the dispersive electrode of the electrosurgical device. Most skin lesions that arise during surgical procedures are due to an incorrect application of antiseptic solutions. Special care must therefore be taken during the use of these solutions and, in particular, they should be allowed to dry. PMID:24095633

Borrego, L



Surgical motion characterization in simulated needle insertion procedures  

NASA Astrophysics Data System (ADS)

PURPOSE: Evaluation of surgical performance in image-guided needle insertions is of emerging interest, to both promote patient safety and improve the efficiency and effectiveness of training. The purpose of this study was to determine if a Markov model-based algorithm can more accurately segment a needle-based surgical procedure into its five constituent tasks than a simple threshold-based algorithm. METHODS: Simulated needle trajectories were generated with known ground truth segmentation by a synthetic procedural data generator, with random noise added to each degree of freedom of motion. The respective learning algorithms were trained, and then tested on different procedures to determine task segmentation accuracy. In the threshold-based algorithm, a change in tasks was detected when the needle crossed a position/velocity threshold. In the Markov model-based algorithm, task segmentation was performed by identifying the sequence of Markov models most likely to have produced the series of observations. RESULTS: For amplitudes of translational noise greater than 0.01mm, the Markov model-based algorithm was significantly more accurate in task segmentation than the threshold-based algorithm (82.3% vs. 49.9%, p<0.001 for amplitude 10.0mm). For amplitudes less than 0.01mm, the two algorithms produced insignificantly different results. CONCLUSION: Task segmentation of simulated needle insertion procedures was improved by using a Markov model-based algorithm as opposed to a threshold-based algorithm for procedures involving translational noise.

Holden, Matthew S.; Ungi, Tamas; Sargent, Derek; McGraw, Robert C.; Fichtinger, Gabor



Non-surgical cosmetic procedures: older women's perceptions and experiences.  


This paper analyzes findings from in-depth interviews with 44 women aged 50-70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist theorizing on cosmetic surgery which has tended to ignore the experiences of older women and has been divided in terms of the portrayal of cosmetic surgery as either oppressive or liberating. We found that some of the women used the procedures to increase their physical attractiveness and self-esteem, others viewed the procedures as excessively risky, and still others argued that the procedures stemmed from the social devaluation of later life. Treatments that involved the alteration of the surface of the body tended to be viewed as less risky than the injection of foreign substances into the body. PMID:18032254

Hurd Clarke, Laura; Repta, Robin; Griffin, Meridith



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



[Ablative procedures in surgical treatment of malignant bone tumors].  


Limb-sparing surgery is the treatment of choice for primary malignant bone tumors. However, ablative procedures cannot always be avoided. The indication to sacrifice the limb depends on localization, size, and biology of the tumor and does not represent failure of treatment primarily. Amputation of the limb is necessary if there is no other operative procedure to achieve negative surgical margins even if all adjunctive therapeutic options have been considered. Primary ablative resections may be indicated with both curative and palliative intent. Secondary ablative procedures mainly result from local recurrence. Late complications of endoprosthetic or allograft reconstruction also may necessitate ablative surgery. In this paper, general guidelines for ablative surgeries are presented. Following amputation, early prosthetic repair of the extremity is the goal. In those patients with consolidated stump development definitive prosthesis should be adapted. Results of hemipelvectomy and forequarter amputation from our institution are reported. However, this group of patients together with those undergoing shoulder exarticulation and forequarter amputation represent situations with no prosthetic repair possible. The loss of an extremity induces disability and restriction of ego, physical integrity, and quality of life. However, it should be borne in mind that amputation could represent the only chance of cure sometimes. Sharing the decision-making between patient and physician for this procedure is an important step to develop confidence in the therapeutic process. In this setting, direct contact between patients being confronted with the option of an amputation and those patients having already undergone rehabilitative procedures might be very useful. PMID:14615845

Tunn, P-U; Delbrück, H; Schlag, P M



Procedural pain in a paediatric surgical emergency unit.  


Pain induced by various types of procedures was assessed in the Paediatric Surgical Emergency Department at St Göran's Children's Hospital in Stockholm. Assessments of pain were obtained from the nurse, the parent, and children over 10 years of age by means of a visual analogue scale. In children aged 3-9 years, the Smiley Five-Face Scale was used. The nurse and the parent also answered questionnaires about analgesic medication, the child's behaviour, and the parent's overall opinion of the pain management, etc. Irrigation of the glans penis because of balanitis, treatment of fractures and paronychia were considered to be the most painful procedures. Forty-four per cent of the children cried during the procedure and 16% fought against being restrained. In 24% of the cases, the child was judged to be in a state of "panic". In conclusion, we believe that the pain induced by procedures in the emergency rooms is unacceptably high. Children estimate higher pain scores than parents and nurses do. There was a poor correlation between the parent's and child's estimates of pain. Parents are not well informed about the possibilities for pain treatment. Infants and children attending emergency rooms must also benefit from recent advances in the treatment of pain. PMID:8645959

Jylli, L; Olsson, G L



Myelomeningocele (open spina bifida) - surgical management.  


Myelomeningocele has been recognized since ancient times although written descriptions began not before the 17th century. Among all serious congenital malformations, myelomeningocele is unique that is has a steady and considerable prevalence while being compatible with life. It has a dismal prognosis when left untreated where virtually all die within the first year while aggressive treatment have a profound effect on survival and quality of life. Effective surgical treatment became possible parallel to the treatment of hydrocephalus in the late 1950s. Advent of the shunt systems undoubtedly changed the morbidity and mortality rates due to associated hydrocephalus. Aggressive and effective treatment improved survival rates but also those suffering physical and mental disabilities have increased as well. Ethical and socioeconomic concerns have led to proposal for selective treatment criteria which have raised arguments on medical and ethico-legal rounds. After the swing of the pendulum between early treatment in all affected children and selective treatment of those who fulfilled the criteria for good prognosis, early myelomeningocele repair is practiced widely unless the infant is critically ill.Incidence of myelomeningocele has been decreasing especially in the Western world, partly due to prenatal diagnosis and elective terminations, dietary folate supplementation. Still, it is the most common central nervous system malformation and one of the leading causes of paraplegia, worldwide. Unfortunately, gains in the management of myelomeningocele have been mainly on antenatal diagnosis and prevention while efforts on understanding its cause, mechanisms involved are still tentative. Concerning the surgical management, no revolutionary modification improving outcome has been introduced unlike other fields of neurosurgery.Medical management of a child with myelomeningocele requires a lifelong effort of several disciplines including urology, orthopedics physical and social therapy besides neurosurgery. The initial and probably the most crucial step begin with proper repair of the lesion. The aim of surgery, with its simplest definition should be towards maintaining the medical condition of the newborn. In other words, consequences of an open spinal cord segment with associated malformations have to be avoided with appropriate measures. Comparable to the surgical treatment of any congenital malformation, myelomeningocele repair consist of reversing the failed steps of normal neural tube closure. This requires a thorough understanding of the normal and abnormal embryological sequence of events in formation of the spinal cord. Although the purpose of this chapter is to describe the basic concepts and technique of myelomeningocele repair, contemporary information and progress on epidemiology, and etiology and embryology is presented with discussion of controversial issues regarding the selection process, optimal time for surgery and technical modifications. PMID:21997743

Akalan, N



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

Code of Federal Regulations, 2012 CFR

...facility services related to covered ASC surgical procedures performed in hospitals on...facility services related to covered ASC surgical procedures performed in hospitals related to covered ambulatory surgical center (ASC) procedures...



Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures  

Microsoft Academic Search

Background. Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection.Methods. In

Anthony P Furnary; Kathryn J Zerr; Gary L Grunkemeier; Albert Starr



Non-Surgical Procedure Is Effective Treatment for Painful Ovarian Varicose Veins  


... Congestion Syndrome - Chronic Pelvic Pain in Women Non-surgical Procedure Is Effective Treatment for Painful Ovarian Varicose ... stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, ...


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



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



Quality of Care Differs by Patient Characteristics: Outcome Disparities After Ambulatory Surgical Procedures  

Microsoft Academic Search

The surgery literature is filled with reports on racial or gender disparities in quality. However, whether patient demographics are risk factors for complications or death from ambulatory surgical procedures is unknown. This study explores whether racial, age, and gender outcome disparities exist after ambulatory surgeries. Patients studied included adults (>18 years) receiving common ambulatory surgical procedures (N = 3 174

Nir Menachemi; Askar Chukmaitov; L. Steven Brown; Charles Saunders; Robert G. Brooks



[Neuropsychological and psychopathologic changes following cardiac surgical procedures].  


Neuropsychological and neuropsychiatric disorders following open heart surgery are estimated to occur in as many as 80 per cent of all patients. They have been recognised from the very beginning of modern heart surgery. Despite a huge amount of scientific literature, data concerning incidence, the phenomenology and duration of symptoms diverge. This finding may be explained by heterogeneous aetiopathogenetic concepts and methodological and terminological problems associated with the investigation of postoperative delirium or neuropsychological and psychopathological sequelae of cardiac surgery. Nowadays, most authors agree in respect of a multifactorial pathogenesis of cognitive deficits following cardiac surgery. Factors influencing the psychopathological and neuropsychological outcome of cardiac surgery can be divided into pre-, intra- and postoperative variables. Advanced age, degree of cardiovascular impairment and other case histories, as well as history of drug abuse, are those preoperative variables that may be responsible for a postoperative cognitive decline. The predictive value of personality traits (depression and/or anxiety), however, is most controversial. Among the intraoperative variables related to the postoperative cognitive state, are e.g. the type of operation and technical procedure (micro-/macroembolism due to the way of oxygenation, pulsatile/-non-pulsatile flow) and duration of extracorporeal circulation. In the postoperative period, the duration of intubation or ICU stay and related variables (like sleep or sensory deprivation/hyperstimulation) were identified as significant predictors of neuropsychological and psychopathological alterations. Modern research focusses on neurobiochemical markers of brain injury which may serve as early predictors of a postoperative cognitive decrease. These parameters may indicate an early postoperative diagnosis and neuroprotective treatment in patients at risk. PMID:9512983

Walzer, T A; Herrmann, M



The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography  

Microsoft Academic Search

BackgroundPediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the

Lisa M Kohr; Margaret Dargan; Amy Hague; Suzanne P Nelson; Elise Duffy; Carl L Backer; Constantine Mavroudis



Open Debridement and Soft Tissue Release as a Salvage Procedure for the Severely Arthrofibrotic Knee  

Microsoft Academic Search

Postoperative loss of knee motion is a well-recognized phenomenon. This paper reports our results with open debridement and soft tissue release as a salvage procedure in the treatment of patients with severe arthrofibrosis on whom arthroscopic surgical techniques had failed. Eight knees (eight patients) were identified retrospectively. There were four men and four women; mean age was 29 years. All

Peter J. Millett; Riley J. Williams; Thomas L. Wickiewicz



Surgical site infection surveillance after open gastrectomy and risk factors for surgical site infection  

Microsoft Academic Search

Surgical site infection (SSI) surveillance was examined in gastric cancer patients who had undergone an open gastrectomy between\\u000a 1997 and 2003 at Keio University Hospital in Tokyo, Japan. National Nosocomial Infections Surveillance (NNIS) reports and\\u000a several studies have discussed SSI risk factors, but only open gastrectomy was analyzed by regression analysis. The purpose\\u000a of this study was to examine these

Eiko Imai; Masakazu Ueda; Kent Kanao; Koichi Miyaki; Tetsuro Kubota; Masaki Kitajima



Crohn's disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications  

PubMed Central

Surgical management is considered for specific indications in Crohn's disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn's disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

Kolar, B; Speranza, J; Bhatt, S; Dogra, V



Impact of Obesity on Surgical Outcomes following Open Radical Prostatectomy  

Microsoft Academic Search

Objective: The increasing incidence of both obesity and prostate cancer (PCa) detection will confront the urologist more often with obese men having PCa. It is unknown whether obesity affects the surgical and oncological outcomes following open radical retropubic prostatectomy (RRP). Knowledge concerning this issue is relevant when counselling obese patients with PCa for RRP. Patients and Methods: A single institution

Joep G. H. van Roermund; Jean-Paul A. van Basten; Lambertus A. Kiemeney; Herbert F. M. Karthaus; J. Alfred Witjes



A Modular Surgical Robotic System for Image Guided Percutaneous Procedures  

Microsoft Academic Search

This paper presents a robotic system for precise needle ins- ertion under radiological guidance for surgical interventions and for deli- very of therapy. It is extremely compact and is compatible with portable X-ray units and computer tomography scanners. The system presents a modular structure comprising a global positioning module, a miniature robotic module, and a radiolucent needle driver module. This

Dan Stoianovici; Louis L. Whitcomb; James H. Anderson; Russell H. Taylor; Louis R. Kavoussi



[Combined surgical and endovascular treatment( hybrid-procedure) of thoracoabdominal dissecting aneurysm].  


A 50-year-old man was admitted because of enlargement in diameter of the descending thoracoabdominal aorta. Seven years previously, he had undergone Bentall operation and graft replacement of the aortic arch due to an acute dissecting aneurysm, and he had also received graft replacement of the descending aorta due to a rupture of dissecting aneurysm 2 years before. The surgical stress of conventional repair under left lateral thoracotomy and laparotomy was considered to be excessive, and the 3-dimensional computed tomography (3D-CT) image revealed the reconstruction of intercostals artery was difficult. Hence, extra-anatomic bypasses were created to perfuse the visceral and renal vessels, and endovascular thoracic stent-grafts were deployed into the false lumen, because of the severe narrowing of the true lumen( hybrid-procedure). The postoperative course was uneventful and the patient was discharged on postoperative 30 days. Hybrid-procedure of aortic aneurysm is feasible, and may be an alternative to standard open procedures in high-risk patients and emergency cases. PMID:23674035

Otani, Satoru; Yamamoto, Tsuyoshi; Yamada, Yuki; Kuwada, Noriaki



Metacarpophalangeal joint dislocation: indications for open surgical reduction.  


In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed. PMID:9348056

Stiles, B M; Drake, D B; Gear, A J; Watkins, F H; Edlich, R F


Reported analgesic administration to rabbits undergoing experimental surgical procedures  

Microsoft Academic Search

Background  It has become widely accepted that whenever animals are used in scientific procedures, the 3Rs principle of replacement, reduction\\u000a and refinement described by William Russell and Rex Burch should be adhered to. Animals should be replaced with non-sentient\\u000a alternatives if possible, the number of animals used should be reduced and experimental procedures should be refined to minimise\\u000a pain, suffering and

Claire A Coulter; Paul A Flecknell; Matthew C Leach; Claire A Richardson



Office-Based Surgical and Medical Procedures: Educational Gaps  

PubMed Central

Over the past decade, the number of procedures performed in office-based settings by a variety of practitioners—including surgeons, gastroenterologists, ophthalmologists, radiologists, dermatologists, and others—has grown significantly. At the same time, patient safety concerns have intensified and include issues such as proper patient selection, safe sedation practices, maintenance of facilities and resuscitation equipment, facility accreditation and practitioner licensing, and the office staff's ability to deal with emergencies and complications. An urgent need exists to educate practitioners about safety concerns in the office-based setting and to develop various educational strategies that can meet the continued growth of these procedures. This review outlines educational needs and possible solutions such as simulation exercises and education during residency training.

Urman, Richard D.; Punwani, Nathan; Shapiro, Fred E.



Refractive effect of two scleral-buckling surgical procedures  

NASA Astrophysics Data System (ADS)

To reattach the retina, in many instances, biological or synthetic belt-shaped exoplants are inserted in the orbit and tightened around the globe's equator to inwardly depress the sclera until its inner layers contact the retina. In deforming the globe these `buckling procedures' are thought to affect the eye's optical system and thus vision. A new non-contact optical technique was devised to quantify the refractive effect of the two most common techniques used in retinal detachment surgery.

Kuhne, Francois; Parel, Jean-Marie; Takesue, Yoshiko; Villain, Franck; Trivedi, Bavia; Ducournau, Didier; Le Rebeller, Marie-Jose



Designing Procedural Graphics for Surgical Patient-Education Modules: An Experimental Study  

Microsoft Academic Search

To understand how readers approach mechanical procedural instructions, this study tested surgical patient-education modules for the effectiveness of route and survey spatial perspectives in text. The results showed that subjects' ability to comprehend an intricate procedural action in surgery varies with learning styles and task approach along with different text-graphic perspectives. Overall, survey perspective worked better than route perspective in

Debopriyo Roy



Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure  

Microsoft Academic Search

We present our technique for surgically treating Tossy III acromioclavicular joint dislocation, discuss the indications for various procedures, and evaluate our postoperative results. We operated on 17 patients suffering from chronic acromioclavicular instability after such dislocation using a modified Weaver-Dunn procedure, in which there is no lateral clavicular end resection, the coracoacromial ligament graft is sutured to the inferior part

Attila Pavlik; Dezsõ Csépai; Péter Hidas



Use of Articaine in loco-regional anesthesia for day care surgical procedures  

PubMed Central

The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.

Bajwa, Sukhminder Jit Singh; Jindal, Ravi



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



Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma  

Microsoft Academic Search

Background  Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma.Methods  In a retrospective chart review we analyzed 90 eyes (48 OD\\/42 OS) in 90 patients (mean age 75 years, range 60–92 years; 51 men\\/39 woman) with primary open-angle glaucoma

Matthias Grueb; Jens Martin Rohrbach; Karl Ulrich Bartz-Schmidt; Torsten Schlote



Ultrasonic fragmentation for vitrectomy and associated surgical procedures.  


Ultrasonic fragmentation (USF) can be used to fragment various tissues such as the lens, the vitreous, the iris, and the ciliary body, so that they may be aspirated through a 23-gauge canula. Since the technique was first described in 1973, it has been used in 148 eyes in a variety of conditions with encouraging results. In aphakic bullous keratopathy, the corneas and vision improved in 78% of the cases. Pupillary block was relieved in 100% of cases. Cystoid macular edema improved in 63%. Vitreous opacification from other than hemorrhage cleared in all cases, and vision improved in 71%. Massive vitreous hemorrhage was cleared in 86%, and vision improved in 58%. In massive vitreous hemorrhage and retinal detachment, the vitreous was cleared and the retina reattached in 80% of cases. In massive vitreous contraction, the vitreous was removed in all cases and the retina reattached in all (100%) of cases. In massive vitreous membranes and retinal detachment, the membranes were successfully removed in 100% and the retina reattached in 82%. Lens remnants in the vitreous were removed in 100% of cases. Secondary membranes were removed successfully in 100% of cases. Vitreous presentation in the anterior chamber, caused by a ruptured posterior capsule during extracapsular extraction or actual vitreous loss during intracapsular extraction, was treated successfully in 100% of cases. One case of medullo-epithelioma of the ciliary body was removed but recurred twice after ultrasonic fragmentation. Complications occurred in seven of 148 cases (4.8%) and consisted of five cases of retinal detachment (probably because of lens material reaction) and two cases of epithelial downgrowth in cases where the wound was not closed with sutures. Ultrasonic fragmentation appears to be a fairly simple procedure, performed with a machine with no moving parts, through two 1-mm incisions and using two 0.6-mm cannulas, with a minimum of complications and encouraging results. It should be tried before more radical procedures are recommended. A good anatomic result was obtained in 129 of the 148 consecutive cases (88%). The technique is described and the results reported. PMID:960369

Girard, L J; Nieves, R; Hawkins, R S


Anesthetic Management of ThoracoAbdominal Open Procedures  

Microsoft Academic Search

\\u000a Surgical repair of thoraco-abdominal aortic aneurysms is a technically demanding procedure which often mandates the participation\\u000a of very experienced anesthetists, surgeons, and intensivists. Its complexity resides not only in challenging surgical aspects\\u000a such as the need for interrupting the natural cerebral perfusion, but also in the requirement for meticulous monitoring strategies\\u000a during the perioperative period. In order to coordinate and

Javier G. Castillo; George Silvay; Gregory W. Fischer


The role of shortening procedures for the surgical therapy of Peyronie's disease.  


In this article we briefly review the current surgical treatment options for Peyronie's disease (PD) in its stable phase. We emphasize the important role of tunical shortening procedures which account for the major share of operations for PD. Shortening procedures provide excellent curvature correction combined with a very low risk of new erectile dysfunction. Since erectile function is already heavily impaired by the disease and its comorbidities in many patients with PD, tunical shortening procedures often are the treatment of choice for the correction of penile curvature. While there is no hard evidence for the superiority of a specific shortening procedure, several authors prefer the classical Nesbit technique over simple plication techniques. We also present our experiences with the Tunica albuginea underlap technique (TAU-technique), a new modification of the Nesbit procedure, that might add further surgical advantages while preserving the strength of the classical Nesbit technique. PMID:23703100

Schwarzer, J U; Steinfatt, H



"Reality surgery"--a research ethics perspective on the live broadcast of surgical procedures.  


In recent years, the live broadcasting of medical and surgical procedures has gained worldwide popularity. While the practice has appropriately been met with concerns for patient safety and privacy, many physicians tout the merits of real time viewing as a form of investigation, accelerating the process leading to adoption or abolition of newer techniques or technologies. This view introduces a new series of ethical considerations that need to be addressed. As such, this article considers, from a research ethics perspective, the use of live surgical procedure broadcast for investigative purposes. PMID:21292217

Williams, Judson B; Mathews, Robin; D'Amico, Thomas A



Mini-Open Pedicle Subtraction Osteotomy: Surgical Technique.  


Minimally invasive spinal surgery has many favorable attributes that would be beneficial to patients with an adult spinal deformity. Decreased blood loss, lower infection rates, and faster mobilization may help to reduce the high rate of complications associated with these interventions. Although correction of coronal deformity has been well demonstrated with minimally invasive spinal surgery, improvements in lordosis and sagittal balance have not occurred using a minimally invasive surgical approach. With open surgery, the most powerful techniques for improving sagittal balance include some form of a spinal osteotomy. This report describes the evolution of a technique for treating thoracolumbar kyphoscoliosis using a mini-open pedicle subtraction osteotomy combined with interbody fusion and percutaneous pedicle screws. PMID:23043995

Wang, Michael Y; Madhavan, Karthik



Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years.  


Generally, surgical treatment is recommended for Rockwood type 5 traumatic acromioclavicular joint dislocations. Since 1980, the authors have performed the modified Dewar procedure, the modified Cadenat procedure, and anatomical reconstruction of the coracoclavicular ligaments for this injury. The goal of this study was to determine the ideal surgical procedure for acromioclavicular joint dislocations by comparing these 3 procedures. The modified Dewar procedure was performed on 55 patients (Dewar group), the modified Cadenat procedure was performed on 73 patients (Cadenat group), and anatomical reconstruction of the coracoclavicular ligaments was performed on 11 patients (reconstruction group). According to the UCLA scoring system, therapeutic results averaged 27.3 points in the Dewar group, 28.2 in the Cadenat group, and 28.4 in the reconstruction group. The incidence of residual subluxation or dislocation in the acromioclavicular joint was evaluated at final radiographic follow-up. Subluxation occurred in 21 patients in the Dewar group, 18 in the Cadenat group, and 3 in the reconstruction group. Dislocation occurred in 3 patients in the Dewar group. Osteoarthritic changes in the acromioclavicular joint occurred in 20 patients in the Dewar group, 9 in the Cadenat group, and 1 in the reconstruction group. The modified Cadenat procedure can provide satisfactory therapeutic results and avoid postoperative failure or loss of reduction compared with the modified Dewar procedure. However, the modified Cadenat procedure does not anatomically restore the coracoclavicular ligaments. Anatomic restoration of both coracoclavicular ligaments can best restore acromioclavicular joint function. PMID:24093704

Takase, Katsumi; Yamamoto, Kengo



Propensity Score-Matched Analysis of Open Surgical and Endovascular Repair for Type B Aortic Dissection  

PubMed Central

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs). Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients. Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%, P = .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%, P = .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures. Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required.

Brunt, Michael E.; Egorova, Natalia N.; Moskowitz, Alan J.



Tips for successful open surgical reconstruction of posterior urethral disruption injuries.  


This article provides an overview of the open surgical management of posterior urethral disruption injuries. The discussion includes the evaluation of the patient before surgery with a focus on urethral imaging and details of posterior urethroplasty surgical technique. PMID:23905936

Gelman, Joel



Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center  

Microsoft Academic Search

BackgroundPrevious studies defining perioperative risk factors for allogeneic transfusion requirements in cardiac surgery were limited to highly selected cardiac surgery populations or were associated with high transfusion rates. The purpose of this study was to determine perioperative risk factors and create a formula to predict transfusion requirements for major cardiac surgical procedures in a center that practices a multimodality approach

David M. Moskowitz; James J. Klein; Aryeh Shander; Katherine M. Cousineau; Richard S. Goldweit; Carol Bodian; Seth I. Perelman; Hyun Kang; Daniel A. Fink; Howard C. Rothman; M. Arisan Ergin



CT appearance of common cosmetic and reconstructive surgical procedures and their complications.  


In this review, we illustrate the spectrum of imaging features after plastic surgical procedures including transverse rectus abdominis myocutaneous flap, deep inferior epigastric perforators flap, latissimus dorsi flap, liposuction, abdominoplasty, and buttocks augmentation. Examples of complications, including seromas, abscesses, fat necrosis, abdominal hernia, and flap necrosis, will also be discussed. PMID:23174530

Frank, S J; Flusberg, M; Friedman, S; Swinburne, N; Sternschein, M; Wolf, E L; Stein, M W



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



A Survey of Competency-Based Training of Senior House Officers in Performing Minor Surgical Procedures  

PubMed Central

INTRODUCTION The aim of this survey was to ascertain the level of competency and training of basic surgical trainees (SHOs) in performing incision and drainage of a perianal abscess (a minor surgical procedure). MATERIALS AND METHODS Questionnaires were sent to SHOs enquiring about preferred methods of incision and drainage and the teaching received to perform this procedure. RESULTS Of respondent SHOs, 10% did not receive teaching when performing their first incision and drainage and over half did not received any feedback from their trainers. A mere 65% received practical supervision. Use of the curette and de-roofing of the abscess are not routine methods used. In addition, 13% reported inadequate incision and drainage, which required a second procedure. CONCLUSIONS Competency-based training in minor surgical procedures benefits not only from didactic teaching, immediate supervision and appraisal but also from frequent practise. This was found to be lacking for incision and drainage of perianal abscesses by basic surgical trainees surveyed in the study.

Leong, Samuel CL; Waghorn, Alison J



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


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



Horizontal augmentation through the ridge-split procedure: a predictable surgical modality in implant reconstruction.  


Among alveolar ridge augmentation techniques, the ridge-split procedure demonstrates many benefits, including no need for a second (donor) surgical site, rare risk of inferior alveolar nerve injury, and less pain and swelling, and others. Lateral bone augmentation through the ridge-split works best in a localized lateral bony defect intended for 1 or 2 implants and where the ridge is vertically intact. In this article, the authors present a detailed description of the implant-driven technique of alveolar ridge-split procedure in small and large bone deficiencies, in maxilla and mandible, supplemented by multiple photographs. The authors emphasize the need for careful manipulation of the thin ridge based on knowledge of precise surgical principles and stress that a practitioner needs specialized training and experience to perform this type of alveolar bone augmentation. PMID:23402358

Tolstunov, Len; Hicke, Bruce



MDCT in the diagnosis of small-bowel obstruction by a retained surgical swab.  


We describe a case report of gossypiboma (retained surgical swab), a rare occurrence secondary to a previous open surgical procedure. The incidence has been estimated at between 1 in 100 to 5 000 surgical procedures. PMID:22353318

Bindapersad, M; Govender, N; Andronikou, S



Retention of laparoscopic procedural skills acquired on a virtual-reality surgical trainer  

Microsoft Academic Search

Background  Virtual-reality (VR) simulator training has been shown to improve surgical performance in laparoscopic procedures in the operating\\u000a room. We have, in a randomised controlled trial, demonstrated transferability to real operations. The validity of the LapSim\\u000a virtual-reality simulator as an assessment tool has been demonstrated in several reports. However, an unanswered question\\u000a regarding simulator training is the durability, or retention, of

Mathilde Maagaard; Jette Led Sorensen; Jeanett Oestergaard; Torur Dalsgaard; Teodor P. Grantcharov; Bent S. Ottesen; Christian Rifbjerg Larsen



Does robotic assistance improve efficiency in performing complex minimally invasive surgical procedures?  

Microsoft Academic Search

Objective  We used a model of biliary-enteric anastomosis to test whether da Vinci robotics improves performance on a complex minimally\\u000a invasive surgical (MIS) procedure.\\u000a \\u000a \\u000a \\u000a Methods  An ex vivo model for choledochojejunostomy was created using porcine livers with extrahepatic bile ducts and contiguous intestines.\\u000a MIS choledochojejunostomies were performed in two arms: group 1 (laparoscopic, n = 30) and group 2 (da Vinci assisted, n = 30). Procedures

Shiva Jayaraman; Douglas Quan; Ibrahim Al-Ghamdi; Firas El-Deen; Christopher M. Schlachta



Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An Evidence-Based Review  

Microsoft Academic Search

Background  Benign multinodular goiter is one of the most common endocrine surgical problems. The appropriate surgical procedure for its\\u000a effective and safe management is a matter of debate. Though seen by some as an overly hazardous procedure because of the risk\\u000a of recurrent laryngeal nerve injury and damage to parathyroid function, total thyroidectomy has replaced subtotal thyroidectomy\\u000a as the procedure of

Gaurav Agarwal; Vivek Aggarwal



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



Complete small bowel obstruction in the early postoperative period complicating surgical sling procedure.  


The surgical insertion of an absorbable sling mesh has become the most promising technique for excluding the small bowel from the pelvis prior to radiotherapy. Both human and animal studies suggest that this procedure is very safe. The author reports what appears to be the first significant mesh-related complication. A 69-year-old man suffered early postoperative complete mechanical small bowel obstruction after insertion of a polyglactin 910 (Vicryl) surgical sling mesh at the time of low anterior resection for a stromal sarcoma of the rectum. Urgent laparotomy was required and revealed that the Vicryl mesh was associated with an intense inflammatory reaction. Radiation therapy is a critical component of contemporary multimodal treatment of patients with rectal cancer. This case suggests that inserting biodegradeable mesh to protect the small bowel from radiation effects is not without complications. PMID:8129251

Sloan, D A



Outcomes of Inpatients With and Without Sickle Cell Disease After High-Volume Surgical Procedures  

PubMed Central

In this study, we examined differences in inpatient costs, length of stay, and in-hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high-volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002–2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non-SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than 3 decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, approximately 0.6% for cholecystectomy and 0.2% for hip replacement, and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD.

Dinan, Michaela A.; Chou, Chia-Hung; Hammill, Bradley G.; Graham, Felicia L.; Schulman, Kevin A.; Telen, Marilyn J.; Reed, Shelby D.



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



Minimally invasive surgical procedures for the treatment of lumbar disc herniation  

PubMed Central

Introduction In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy) which could serve as a basis for coverage decisions, has been published in Germany. Objective Against this background the aim of the following assessment is: Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc by a posterolateral or posterior approach are included. Methods In order to assess safety, efficacy and effectiveness of minimally-invasive procedures as well as their economic implications systematic reviews of the literature are performed. A comprehensive search strategy is composed to search 23 electronic databases, among them MEDLINE, EMBASE and the Cochrane Library. Methodological quality of systematic reviews, HTA reports and primary research is assessed using checklists of the German Scientific Working Group for Health Technology Assessment. Quality and transparency of cost analyses are documented using the quality and transparency catalogues of the working group. Study results are summarised in a qualitative manner. Due to the limited number and the low methodological quality of the studies it is not possible to conduct metaanalyses. In addition to the results of controlled trials results of recent case series are introduced and discussed. Results The evidence-base to assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery procedures is rather limited: Percutaneous manual discectomy: Six case series (four after 1998) Automated percutaneous lumbar discectomy: Two RCT (one discontinued), twelve case series (one after 1998) Chemonucleolysis: Five RCT, five non-randomised controlled trials, eleven case series Percutaneous laserdiscectomy: One non-randomised controlled trial, 13 case series (eight after 1998) Endoscopic procedures: Three RCT, 21 case series (17 after 1998) There are two economic analyses each retrieved for chemonucleolysis and automated percutaneous discectomy as well as one cost-minimisation analysis comparing costs of an endoscopic procedure to costs for open discectomy. Among all minimally-invasive procedures chemonucleolysis is the only of which efficacy may be judged on the basis of results from high quality randomised controlled trials (RCT). Study results suggest that the procedure maybe (cost)effectively used as an intermediate therapeutical option between conservative and operative management of small lumbar disc herniations

Luhmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner



Revascularization for Chronic Mesentric Ishemia Comparison of Endovascular and Open Surgical Intervention.  

National Technical Information Service (NTIS)

The purpose of this report is to compare the patient groups and outcome following treatment of symptomatic chromc mesenteric ischemia using percutaneous angioplasty/stenting (PAS) or open surgical reconstruction.

A. N. Bowser



Anaesthesia for ophthalmologic surgical procedures in a patient with advanced amyotrophic lateral sclerosis: a case report  

PubMed Central

Introduction Anaesthesia procedures for surgical interventions in patients with amyotrophic lateral sclerosis (ALS) are not commonly found in clinical practice, and often have special considerations that must be taken into account in treatment planning. As a result, these procedures are rarely subject to publication, rendering it difficult for the anaesthesiologists to find useful and reliable information on this topic. ALS also presents a contraindication to the use of nondepolarising neuromuscular blocking drugs during general anaesthesia. Case presentation In the case presented here, a 52-year old, White man, the progression of the disease to tetraparesis and respiratory failure, in addition to having the patient on chronic mechanical ventilation support, provided additional challenges to the handling team. The maturation of cataracts severely impaired communication with the patient, and surgical treatment of the cataract presented the only means to save communication. Such interventions are generally performed under local anaesthesia with the advice of the attending anaesthesiologist. However, in this case the patients' announcements during the operation would be unreadable to the advising anaesthesiologist. Here, the authors share experiences from a successfully applied combination of topical and general anaesthesia for two cataract operations and a vitrectomy. This was tolerated well by the patient, and without any side-effects. Conclusion The applied treatment resulted in a substantial improvement of the vision and allowed communication to be maintained with the patient.

Kowalik, Maciej M; Smiatacz, Tomasz; Pajuro, Robert; Skowronski, Roman; Trocha, Hanna; Nyka, Walenty; Raczynska, Krystyna; Wujtewicz, Maria



Intelligent interaction based on a surgery task model for a surgical assistant robot: Awareness of current surgical stages based on a surgical procedure model  

Microsoft Academic Search

This paper deals with providing a surgical robot with awareness of the current surgical stage. The awareness of the surgical\\u000a stage is the first step toward a natural interaction between a surgeon and a surgical robot, the ultimate goal of which is\\u000a to help the surgeon perform surgery with a minimum control burden. For this purpose, a surgery task model

Seong Young Ko; Woo-Jung Lee; Dong-Soo Kwon



Availability of adipose-derived stem cells in patients undergoing vascular surgical procedures  

PubMed Central

Background Most research evaluating adipose-derived stem cells (ASC) uses tissue obtained from young, healthy patients undergoing plastic surgical procedures. Given the propensity of other adult stem cell lines to diminish with increasing patient age and co-morbidities, we assess the availability of ASC in elderly patients undergoing vascular surgical procedures, and evaluate their acquisition of endothelial cell (EC) traits to define their potential use in vascular tissue engineering. Methods and Methods Adipose tissue obtained by liposuction from patients undergoing vascular procedures (n=50) was digested with collagenase and centrifuged to remove mature adipocytes. The resultant number of cells, defined as the stromal-vascular (SV) pellet, was quantified. Following a seven day culture period and negative selection for CD31 and CD45, the resultant number of ASC was quantified. After culture in differentiating media (EMG-2), ASCs were tested for the acquisition of endothelial-specific traits (expression of CD31, re-alignment in shear, cord formation on Matrigel). Results The SV pellet contained 2.87±0.34 × 105 cells/gm fat, and the resultant number of ASCs obtained was 1.41±0.18 × 105 cells/gm fat. Flow cytometry revealed a homogeneous ASC population (>98% positive for CD13, 29, 90). Advanced age or co-morbidity (obesity, diabetes, renal or peripheral vascular disease) did not significantly alter yield of ASC. After culture in differentiating media (EMG-2), ASCs acquired each of the endothelial-specific traits. Conclusion ASC isolation appears independent of age and co-morbidities, and ASCs harvested from patients with vascular disease retain their ability to differentiate into endothelial-like cells. Adipose tissue, therefore, is a practical source of autologous, adult stem cells for vascular tissue engineering.

Harris, Lisa J.; Zhang, Ping; Abdollahi, Hamid; Tarola, Nicholas A.; DiMatteo, Christopher; McIlhenny, Stephen E.; Tulenko, Thomas N.; DiMuzio, Paul J.



The effect of aromatherapy on postoperative nausea in women undergoing surgical procedures.  


Postoperative nausea and vomiting (PONV) is a common source of patient discomfort and decreased satisfaction. Aromatherapy has been identified as a complementary modality for the prevention and management of PONV. The purpose of this study was to assess the effect of aromatherapy on the severity of postoperative nausea (PON) in women undergoing surgical procedures in the postanesthesia care unit. Women complaining of PON received traditional antiemetics, inhalation of peppermint oil, or saline vapor. A visual analog scale was used to rate nausea at the first complaint; at 5 minutes after intervention; and, if nausea persisted, at 10 minutes after intervention. At both 5 and 10 minutes, statistical analysis showed no significant differences between intervention and nausea rating. Obtaining eligible subjects was challenging. Although many women consented, most received intraoperative antiemetics and did not report nausea postoperatively. PMID:22828020

Ferruggiari, Luisa; Ragione, Barbara; Rich, Ellen R; Lock, Kathleen



Marking the skin for oral surgical procedures: improving the WHO checklist.  


We present a system for marking the skin during oral surgical operations. This system identifies teeth to be extracted or exposed under general anaesthesia. Removal of the wrong tooth can cause appreciable morbidity and leaves the surgeon and organisation liable for litigation and scrutiny by regulatory bodies. A recent review of claims to the NHS litigation authority between 1995 and 2010 showed that in the field of oral and maxillofacial surgery, dentoalveolar surgery resulted in the largest number of claims for negligence, of which removal of the wrong tooth was one of the most common. In 2010/2011 the National Reporting and Learning System (NRLS) of the National Patient Safety Agency (NPSA) were notified of 20 incidents when the wrong tooth had been extracted, which accounted for 5% of all incidents reported. We have therefore developed a robust marking system for oral surgical procedures in our hospital, which improves on the World Health Organisation (WHO) checklist. We have audited patients' perceptions and the clinical application of our marking system, and have shown that the system is welcomed by patients, and is simple and effective for clinicians to use. PMID:23036833

Knepil, Greg J; Harvey, Caroline T; Beech, Andrea N



Interventional Radiological Procedures in Impaired Function of Surgically Implanted Catheter-Port Systems  

SciTech Connect

Purpose: System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS.Methods: Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a goose-neck snare.Results: In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4-10 months.Conclusion: For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.

Herrmann, Karin Anna; Waggershauser, Tobias [Institute of Clinical Radiology, Ludwig Maximilians University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich (Germany); Heinemann, Volker [Department of Internal Medicine III, Oncology, Ludwig Maximilians University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich (Germany); Reiser, Maximilian [Institute of Clinical Radiology, Ludwig Maximilians University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich (Germany)



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


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



[Substantiation of an adequate scope of diagnostic methods and surgical procedures in patients with diabetic foot syndrome].  


Analysed herein are the results of treating a total of 154 patients presenting with diabetes mellitus and pyo-necrotic alterations in the lower limbs. Duration of diabetes prior to the development of necrotic complications averagely amounted to 15 years, in 76 patients of the Study Group we determined the species-specific composition of the pathogens, the number of microbial bodies in 1 gram of necrotic tissues as well as the state of cellular and humoral immunity, and the complex of therapeutic measures was supplemented by cytokine therapy: Operative treatment in 78 patients of the control group consisted of various-scope necrectomies and open management of the wounds. The operative procedures in the Study Group patients included revascularizing operations, as well as secondary surgical debridement of the wounds with placing sutures. In the control group, the limb salvage rate amounted to 57.7% (29 of 78) and that in the Study Group to 88.15% (67 of 76). In the first group, we performed a total of 29 (37.17%) major amputations and 4 (5.25%) in the study group. Conclusion was made on advantages of a comprehensive approach while assessing all impairments in the body of duibetic patients and adequate therapeutic policy aimed at re-establishing blood flow, removal of the purulent focus and decrease of tissue infectedness, correction of the immune status, as well as application of novel methods of treatment and drug therapy. PMID:22929687

Katel'nitski?, I I; Trandofilov, A M



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


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



[Surgical procedures for sterilization of the women: certainty--complications (author's transl)].  


The time (interval, postpartum, postabortum), location (uterus, mucus membrane of the oviducts, tubes), access (transcervical, transvaginal, trans-abdominal) and the actual method of sterilization for the women (surgical, electric, thermic, mechanical) can be differentiated and combined with each other in various ways. Today the usual procedure is sterilization by partial resection of the oviducts performed laparoscopically in the interval via electrocoagulation and surgically after delivery via periumbilical minilaparotomy. Laparoscopic sterilization via electrocoagulation has a rate of failure of about 1:1,000 and the mortality rate is less than 1:10,000. The most frequent complications are: hemorrhages due to injury of the larger vessels and burns in the intestine caused by the electric current. For this reason, conventional (:unipolar") electrocoagulation should be replaced by the so-called bipolar coagulation or other newer methods which avoid these complications. On the basis of the current literature, no definitive statements can be made regarding the reliability of the newer methods (silastic ring, plastic clips, thermocoagulation). An additional, although up until now purely hypothetic, advantage of the newer methods is the possibility of reversibility. With conventional electrocoagulation, the rate of reversilbility is very low. Additional alternatives are also culdotomy and minilaparotomy in the interval with the assistance of a uterus elevator. Both ways of access may be combined with various methods of sterilization. The pros and cons of the hysterectomy as a method of sterilization are still being discussed. Occasional late sequelae of sterilization such as menstrual disorders, pain and, particularly, problems related to sexual intercourse have only recently come to light. They have not yet been adequately investigated. PMID:131732

Hirsch, H A



Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series  

Microsoft Academic Search

Patients prefer robotic surgery due to perceived cosmetic advantages and quicker resumption of regular activity. We compared\\u000a the results of hysterectomy and surgical staging for endometrial cancer using robotic versus open techniques in patients operated\\u000a on by a single surgeon. A retrospective clinical data analysis was performed of all patients who underwent surgical staging\\u000a for endometrial cancer. Patients selected for

Meenu GoelTerrell; Terrell W. Zollinger; David H. Moore



Progressive Management of Open Surgical Repair of Achilles Tendon Rupture  

PubMed Central

A 33-year-old man sustained an acute Achilles tendon rupture which was surgically repaired. Early nonweight-bearing range of motion and strengthening of the ankle and the repaired muscle unit was allowed at 4 weeks postoperatively, and closed-chain dorsiflexion was allowed at 6 weeks. Casts and/or ankle-foot orthoses were used to continue protection of the Achilles from reinjury and full body forces as the repaired muscle continued to heal. In this case, range-of-motion and strengthening exercises were initiated at an earlier stage in the treatment program without compromising the result. When indicated, this treatment will provide excellent posttraumatic function of the surgically repaired Achilles tendon in the motivated and compliant patient.

Dugan, Dirk H.; Hobler, Christopher K.



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


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



Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures  

PubMed Central

The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints.



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

PubMed Central

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, are able to differentiate into muscle, fat, bone and cartilage cell lineages. The aim of this study was to isolate, expand, characterize and assess the differentiation potential of MSCs from human fallopian tubes (hFTs). Methods Lineages of hFTs were expanded, had their karyotype analyzed, were characterized by flow cytometry and underwent in vitro adipogenic, chondrogenic, osteogenic, and myogenic differentiation. Results Here we show for the first time that hFTs, which are discarded after some gynecological procedures, are a rich additional source of MSCs, which we designated as human tube MSCs (htMSCs). Conclusion Human tube MSCs can be easily isolated, expanded in vitro, present a mesenchymal profile and are able to differentiate into muscle, fat, cartilage and bone in vitro.

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



[Endoscopic stent or surgical bypass? A review and evidence-based comparison of palliative procedures in inoperable pancreas tumours].  


This review summarises the data of current meta-analyses on the outcome of endoscopic and surgical biliary bypass procedures applied for inoperable pancreatic tumours. The authors suggest that plastic biliary stents should be used in cases only with short survival (less than six months). In patients with a prognosis of longer than six month, self-expandable metal stents are more cost-effective. This latter technique is as efficient as the traditional surgical bypass procedures. However, surgical bypass is preferable in cases if tumour resection is questionable after staging or in patients with gastric emptying problems.Furthermore, application of duodenal stents is suggested in selected cases only due to relatively frequent late complications (stent migration, perforation, obstruction). Duodenal stents can be used in patients with advanced stage disease or very high operative risk. PMID:17984013

Olgyai, Gábor; Oláh, Attila



Surgical procedure and results of cisternal washing therapy for the prevention of cerebral vasospasm following SAH.  


In 1994, we started cisternal washing therapy (CWT) using urokinase combined with head-shaking method in order to prevent cerebral vasospasm. In this paper, we showed the surgical procedure for CWT and reported the effect of this therapy in preventing vasospasm following SAH. A total of 332 consecutive cases with Fisher group 3 SAH since 1988 were analyzed. Of these patients, 118 cases (56 cases before 1994 and 62 cases after 1994) had not CWT, and, 214 cases after 1994 had this therapy. All of these patients had clipping surgery within 3 days following SAH, and had postoperative management both with normovolemia and normal to mild hypertension. In these two groups, the incidence of symptomatic vasospasm (transiently symptomatic vasospasm without infarction), cerebral infarction due to vasospasm on CT, and mortality and morbidity (M&M) due to vasospasm were analyzed. In the group without CWT, the incidences of symptomatic vasospasm, cerebral infarction on CT, and M&M due to vasospasm were 4.2%, 28.8%, and 17.8%, respectively. On the other hand, in the group with CWT, they were 3.7%, 6.5%, and 2.8%, respectively. In the patients with CWT, the incidence of cerebral infarction on CT due to vasospasm and M&M due to vasospasm were significantly (p < 0.05) decreased. CWT was effective in preventing cerebral vasospasm. PMID:21125454

Nakagomi, Tadayoshi; Furuya, Kazuhide; Nagashima, Hiroshi; Tanaka, Jun-Ichi; Ishii, Teruyuki; Takanashi, Shigehiko; Shinohara, Takeyuki; Watanabe, Fumihiro; Ogawa, Akiko; Fujii, Norio; Tamura, Akira



Low-level laser therapy in treatment of neurosensory deficit following surgical procedures  

NASA Astrophysics Data System (ADS)

In this report of clinical cases of peripheral nerve lesions, we evaluate the efficiency of the diode laser in treating six patients - three female and three male, age ranging from 25 to 36 years - who presented tongue paresthesia after surgical procedures which demanded regional mandible anaesthetic blockage. The patients' presented symptomatology was the absence of gustative sensitivity, the decrease of sensitivity and the increase of the nociceptive threshold on the affected side of the tongue. The treatment was carried out with a diode laser of 50mW, 780nm, continuous wave emission, spot size 3mm, and total dosage of 18 joules per session. We used a verbal scale to measure the intensity of the sensitive response both before and after treatment. The treatment module comprised two weekly sessions over a period of five consecutive weeks. After evaluation of the symptom condition, the patients would undergo another treatment module if necessary. This method of treatment proved to be efficient, resulting in restored sensitivity in al six treated patients. Only one patient reported a residual abnormality sensation concerning the tongue dimension but no discomfort at all. All 6 treated patients were evaluated in a follow-up period of thirty, sixty and ninety days post- treatment.

Ladalardo, Thereza C.; Brugnera, Aldo; Pinheiro, Antonio L.; Takamoto, Marcia; Campos, Roberto A.



Actual Developments of Navi-Robot, a Navigator Able to Block itself in the Correct Position during Orthopaedic Surgical Procedures  

Microsoft Academic Search

A self-balancing Navigation system able to turn itself into a robot, reaching the positions required to precisely guide a tool during a surgical procedure is under construction of the prototype. The instrument is, basically, a goniometric device, characterised by the presence of three arms, each bearing six degrees of freedom. Thus the instrument is able to measure the relative position



Factors Surgical Team Members Perceive Influence Choices of Wearing or Not Wearing Personal Protective Equipment during Operative/Invasive Procedures  

ERIC Educational Resources Information Center

|Exposure to certain bloodborne pathogens can prematurely end a person's life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs…

Cuming, Richard G.



40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...  

Code of Federal Regulations, 2013 CFR

...Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp Mills...Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp Mills...HAP) concentrations from an open biological treatment unit. It is assumed...



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



Open surgical management of a ruptured intracranial aneurysm in Klippel-Trenaunay-Weber (KTW) syndrome.  


A 24-year-old man with a history of Klippel-Trenaunay-Weber syndrome presented with severe headache and neck pain. Work-up revealed subarachnoid hemorrhage and evidence of multiple intracranial aneurysms. The patient was treated with open surgical clipping of his ruptured aneurysm and is currently doing well. PMID:23314873

Smitherman, Adam Derik; Woodall, Michael Neil; Alleyne, Cargill H; Rahimi, Scott Y



Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure  

PubMed Central

AIM: To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer. METHODS: Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study. RESULTS: Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%): 2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival. CONCLUSION: RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.

Chang, Ye Rim; Han, Sung-Sik; Park, Sang-Jae; Lee, Seung Duk; Yoo, Tae Suk; Kim, Young-Kyu; Kim, Tae Hyun; Woo, Sang Myung; Lee, Woo Jin; Hong, Eun Kyung



GALEN: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.  


Generalised architecture for languages, encyclopedia and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalization of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology. PMID:10978911

Trombert-Paviot, B; Rodrigues, J M; Rogers, J E; Baud, R; van der Haring, E; Rassinoux, A M; Abrial, V; Clavel, L; Idir, H



The "Jacobsen flap" technique: a safe, simple surgical procedure to treat Dupuytren disease of the little finger in advanced stage.  


The surgery for advanced stages of Dupuytren disease of the little finger is controversial. In the literature, several techniques have been described with variable reported results and postoperative complications. Percutaneous needle fasciotomy, McCash technique, and dermofasciectomy are often performed for surgical treatment but they present significant complications and limits. This study reviews our experience of using the Jacobsen flap technique, a modification of the McCash procedure. We found that the Jacobsen flap technique for the significant correction of the contracture, the low rate of complications, and the relatively simple surgical approach is an excellent alternative to percutaneous needle fasciotomy, dermofasciectomy, or amputation. PMID:20818219

Tripoli, Massimiliano; Cordova, Adriana; Moschella, Francesco



Postoperative Infection after Surgical Removal of Impacted Mandibular Third Molars: An Analysis of 110 Consecutive Procedures  

Microsoft Academic Search

Objective: The aim of this study was to evaluate the rate of postoperative infection and other complications after the surgical removal of impacted mandibular third molars. Subjects and Materials: Medical records of 110 consecutive patients with 130 consecutive surgical extractions of impacted lower third molar teeth performed under local anesthetic using strict aseptic techniques were reviewed and analyzed. No systemic

Adel Al-Asfour



[Emergency open surgical treatment of extravasations of cytostatic agents in the upper extremity].  


Extravasations of cytostatic agents can create necrosis of soft tissues in the hand and forearm. The early emergency subcutaneous "wash-out" with liposuction is the treatment of choice to avoid the development of soft-tissue defects. The objective of this study was to evaluate the open surgical debridement as a possible alternative method since the liposuction device is not commonly available in every hospital. In our study 10 patients were treated for extravasations of cytostatic drugs with a high potential for necrosis by emergency open debridement. All patients were evaluated prospectively by photography and clinical examination. 9 patients out of ten had a primary wound healing, one displayed a wound dehiscence with pre-existing MRSA infection. Another patient developed a seroma postoperatively which was treated by puncture. The mean functional outcome was good. The Eemergency open surgical treatment is a simple, in every hospital suitable therapy to prevent soft-tissue necrosis after extravasation of cytostatic drugs. PMID:19890780

Telisselis, P; Heers, G; Plock, B; Baier, C; Neugebauer, R; Füchtmeier, B



Comparison Between Open Procedure and Tubular Retractor Assisted Procedure for Cervical Radiculopathy: Results of a Randomized Controlled Study  

PubMed Central

Posterior cervical foraminotomy is an effective surgical technique for the treatment of radicular pain caused by foraminal stenosis or posterolateral herniated discs. The present study was performed to compare the clinical parameters and surgical outcomes of open foraminotomy/discectomy (OF/OFD) and tubular retractor assisted foraminotomy/discectomy (TAF/TAFD) in the treatment of cervical radiculopathy. A total of 41 patients were divided into two groups: 19 patients in Group 1 underwent OF/OFD and 22 patients in Group 2 underwent TAF/TAFD. Among the various clinical parameters, skin incision size, length of hospital stay, analgesic using time, and postoperative neck pain (for the first 4 weeks after the operation) were favorable in Group 2. Surgical outcomes were not different between the two groups. In conclusion, TAF/TAFD should increase patient's compliance and is as clinically effective as much as the OF/OFD.

Kim, Kyoung-Tae



Gel-based surgical preparation resulting in an operating room fire during a neurosurgical procedure: case report.  


Despite general reports of fires in the operating room, those during neurosurgical procedures are rare. The most significant contributor to perioperative fires is excess oxygenation. The consideration of novel gel-based surgical preparation solutions as potential fuel sources should be included in the literature. Given the significant patient risk and legal ramifications of surgical fires, education regarding operating room fires and the potential for prevention and treatment is requisite. The authors describe the case of an 18-month-old girl who, while undergoing a resection of a right retroauricular scalp mass, suffered partial thickness bums as a result of the ignition of surgical preparation solution following the use of monopolar electrocautery. PMID:15881765

Meltzer, Hal S; Granville, Robert; Aryan, Henry E; Aryan, Henry A; Billman, Glenn; Bennett, Rebecca; Levy, Michael L



Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures  

PubMed Central

Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of <3% with unilateral asymptomatic stenosis >60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately powered, multicentre, randomised clinical trial.

Paciaroni, M; Caso, V; Acciarresi, M; Baumgartner, R; Agnelli, G



Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.  


Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787

Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana



Outcomes of Various Surgical Procedures on Acquired Lower Eyelid Epiblepharon in Thyroid Associated Ophthalmopathy  

PubMed Central

Purpose To report the outcomes of acquired lower eyelid epiblepharon after various surgeries in thyroid associated ophthalmopathy (TAO) patients. Methods A retrospective review of the medical records of 53 TAO patients with acquired lower eyelid epiblepharon between October 1999 and June 2011 was performed. Data were collected on demographics, type of lower eyelid epiblepharon, the detailed surgical history such as orbital decompression, retraction repair, or epiblepharon repair and surgical outcomes including follow-up period, recurrence of epiblepharon, and post-operative complications. Results Among the 53 TAO patients with acquired lower eyelid epiblepharon, 25 eyes of 17 patients underwent surgical management; 6 eyes of orbital decompression, 1 eye of orbital decompression followed by retraction repair, 2 eyes of orbital decompression followed by epiblepharon repair, 6 eyes of lower eyelid retraction repair, and 10 eyes of epiblepharon repair. Twenty two lower eyelid epiblepharons (88%) were resolved after final surgical treatment without complication during mean 16.2 months (SD, ±29.9 months) of follow up period; three of 6 epiblepharons that remained after orbital decompression underwent subsequent surgical management of retraction repair or epiblepharon repair, and epiblepharons were well-corrected. Mean amount of lower eyelid retraction was decreased from 1.68 mm (SD, ±1.17 mm) to 0.29 mm (SD, ±0.44 mm) after surgery, regardless of the type of surgery (n = 25, p < 0.000, Wilcoxon signed rank test). Conclusions Acquired lower eyelid epiblepharon of TAO should be managed sequentially according to the general serial order of surgical managements in TAO; orbital decompression, correction of lower eyelid retraction and epiblepharon repair. Acquired lower eyelid epiblepharon was well resolved after surgical management in consecutive order, especially after repair of the lower eyelid retraction with a graft, or lower eyelid epiblepharon repair. Decreased lower eyelid retraction with a resolution of epiblepharon after surgery implied that lower eyelid retraction was associated with lower eyelid epiblepharon.

Park, Sung Wook; Choung, Ho-Kyung; Khwarg, Sang In



[The surgical procedure in blind gunshot wounds of the skull base].  


Personal clinical observations during the recent years allow the authors to confirm the indisputable value of surgical experience got during the Great Patriotic War (1941-1945) and in particular, the "fourfold" scheme proposed by V. I. Voiachek for the diagnosis and treatment of blind gunshot wounds to the skull base. Computed tomography considerably increases the probability of detection of the exact localization of foreign bodies in complex anatomical structures of the skull and thus facilitates choosing the most rational surgical management. The use of the electro-optical transducer for the extraction of foreign bodies from almost inaccessible areas of the skull base decreases the risk of operation. PMID:9915062

Gofman, V R; Kiselev, A S



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



Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures  

Microsoft Academic Search

Purpose To investigate the prevalence of anatomical and surgical findings and complications in maxillary sinus floor elevation surgery, and to describe the clinical implications. Patients and Methods One hundred consecutive patients scheduled for maxillary sinus floor elevation were included. The patients consisted of 36 men (36%) and 64 women (64%), with a mean age of 50 years (range, 17 to

S. A. Zijderveld; Bergh van den J. P. A; E. A. J. M. Schulten; Bruggenkate ten C. M



Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis  

Microsoft Academic Search

The purpose of this study was to evaluate the surgical indication and clinical outcomes of endoscopic decompression for lumbar spinal canal stenosis. From September 1998 to March 2002, 250 consecutive patients underwent posterior endoscopic surgery for lumbar radiculopathy. Among these patients, 27 were treated by posterior endoscopic decompression for lumbar canal stenosis. There were 19 men and 8 women, and

Munehito Yoshida; Akitaka Ueyoshi; Kazuhiro Maio; Masaki Kawai; Yukihiro Nakagawa


Sevoflurane Speeds Recovery of Baroreflex Control of Heart Rate After Minor Surgical Procedures Compared with Isoflurane  

Microsoft Academic Search

Volatile anesthetics attenuate arterial baroreflex func- tions, whereas noxious stimuli may modify baroreflex- induced circulatory responses during anesthesia. We designed the present study to compare baroreflex con- trol of heart rate during sevoflurane and isoflurane an- esthesia in young healthy surgical patients. Baroreflex sensitivity was assessed in 24 patients randomized to receive either sevoflurane (n 5 12) or isoflurane (n

Makoto Tanaka; Toshiaki Nishikawa



Effort Thrombosis: Effective Treatment with Vascular Stent After Unrelieved Venous Stenosis Following a Surgical Release Procedure  

SciTech Connect

Acute symptomatic effort thrombosis in a 33-year-old male necessitated an aggressive approach consisting of thrombolysis, angioplasty, and surgical thoracic outlet release. The patient required postoperative placement of a Wallstent and was placed on anticoagulation. He has remained symptom free for the past 10 months, both clinically and sonographically.

Cohen, Gary S.; Braunstein, Larry; Ball, David S.; Domeracki, Frank [Department of Diagnostic Imaging, Temple University Hospital, Health Sciences Center, Broad and Ontario Streets, Philadelphia, PA 19140 (United States)



Comparison of results of laparoscopic and open antegrade continence enema procedures  

Microsoft Academic Search

Several modifications of the Malone antegrade continence enema (ACE) procedure have now been reported. In this study we have\\u000a compared the results of our experience with the laparoscopic appendicostomy (LACE procedure) with the published results of\\u000a previously described open ACE procedures. Children who had the LACE procedure at our institutions were reviewed. Intra- and\\u000a postoperative problems were identified by review

A. C. Lynch; S. W. Beasley; R. W. Robertson; P. N. Morreau



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


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



Review of surgical ventricular restoration: A procedure to treat cardiac failure  

Microsoft Academic Search

Severe heart failure refractory to medical treatment necessitates the use of other modalities of treatment. Surgical ventricular\\u000a restoration (SVR) surgery can provide relief until donour hearts are available or when transplantation is contraindicated.\\u000a In this review we look at the physiological basis for improvement in cardiac function and cardiac and haemodynamic changes\\u000a that occur after SVR. We also compile the

Anupam A. Sule; Ajey A. Sule; Downey H. Fred; Sanjeev S. Thakur



The Use of a Micro-Computer to Record the Complications of Surgical Procedures  

PubMed Central

A 48K Apple II Plus computer and a 10 megabyte Winchester hard disk form the major components of a system designed to help a group of surgeons review post-operative complications. The software is written in BASIC. The quality of a surgical practice is reflected by the incidence of post-operative complications. Quarterly reports listing the type and number of complications enable the surgeon to regularly examine and review this important aspect of clinical practice.

Squires, J.W.; Wild, B.



Prospective trials of minor surgical procedures and high-fibre diet for haemorrhoids  

Microsoft Academic Search

Two hundred and sixteen consecutive patients seen for the first time with symptomatic haemorrhoids entered trials of conservative and minor surgical treatment. They were divided into two groups according to their pretreatment maximal anal pressure. Patients with pressures of 100 cm H2O (73.7 mm Hg) or more (108 patients) were treated by anal dilatation (37), sphincterotomy (34), or high-fibre diet

M R Keighley; P Buchmann; S Minervini; Y Arabi; J Alexander-Williams



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.



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


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. PMID:24124313

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



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



One-stage hybrid procedure: association between awake minimally invasive surgical revascularization and percutaneous coronary intervention.  


Hybrid revascularization provides minimally invasive options for high-risk patients with multivessel coronary artery disease. We used a hybrid approach in two patients. The surgical revascularization with the left internal mammary artery (LIMA) on the left descending coronary artery was performed through an inferior j-shaped mini-sternotomy keeping the patients awake with high-epidural thoracic anesthesia. At the end of the operations the patients were moved to the angiography laboratory to complete the revascularization with angioplasty. No complications were reported. PMID:19531536

Del Giglio, Mauro; Dell'Amore, Andrea; Zuffi, Andrea; Sokoli, Arvit



A novel surgical procedure for papilla reconstruction using platelet rich fibrin  

PubMed Central

Loss of interdental papilla predisposes to phonetic, functional, and esthetic problem. Surgical techniques are manifold, but are challenging and very unpredictable. The purpose of this case report is to present the use of platelet rich fibrin (PRF) in the reconstruction of papilla in the maxiallry anterior region of a forty year old woman who presented with loss of interdental papillae in 11, 12 and 11, 21 region. PRF was tucked in to the pouch created with a semilunar pedicle flap and the entire gingivopapillary unit was displaced coronally. Optimal fill was noted at 3 and 6 months postoperatively. Use of PRF may thus be the panacea for interdental papilla augmentation.

Arunachalam, Lalitha Tanjore; Merugu, Satyanarayana; Sudhakar, Uma



Emergency surgical salvage for severe intracranial aneurysm rupture during endovascular coiling procedures not amenable to additional coiling  

PubMed Central

Background: We report the management and outcomes of six patients who underwent emergency surgical intervention in the setting of severe intraprocedural rupture during endovascular treatment of an intracranial aneurysm not amenable to additional coiling. Methods: From July 1997 through December 2010, our neurovascular service treated 1613 patients with coil embolization. During this time, we encountered six patients who suffered severe intraprocedural aneurysm rupture, defined by contrast extravasation during the coiling procedure, in whom additional attempted coiling failed to stop the ongoing extravasation. Hospital records, neuroimaging studies, operative reports, and follow-up clinic notes were complete and reviewed in all cases. The follow-up review in surviving patients ranged from 1.5 to 9 years (average 3.8 years), and no patient was lost to the follow-up review. Results: In all cases, persistent extravasation necessitated urgent surgical decompression and securing of the ruptured aneurysm. Of these six cases, three patients achieved a good functional status after prolonged rehabilitation, and one of these had only subtle cognitive changes on formal neuropsychological testing. Two patients died. Conclusion: Intraprocedural rupture during aneurysm coiling is a dangerous and potentially fatal event. Despite the seemingly hopeless nature of this situation, in our experience, aggressive management to control intracranial pressure combined with a rapid reversal of anticoagulation and early surgical intervention can result in reasonable outcomes in some patients.

Nussbaum, Eric S; Defillo, Archie; Janjua, Tariq M; Zelensky, Andrea; Tatman, Penny; Stoller, Richard; Lowary, Jodi; Nussbaum, Leslie A



[Open fractures of the tibia in the adult: surgical treatment and complications].  


Open tibial shaft fractures represent high-energy trauma and are associated with a substantial risk of complications. Management is an emergency, and the first steps in treatment include antibiotic prophylaxis, tetanus booster, surgical debridement, irrigation of the wound and stabilization of the fracture. The Gustilo and Anderson classification helps to guide definitive treatment. Intramedullary nailing is the surgical technique of choice. An indirect approach utilizing external fixation is recommended for Gustilo IIIB and IIIC fractures. The most prevalent complications are compartment syndrome (10%), infection (2%-40% without antibiotics according to Gustilo grading, most notably in the presence of vascular lesions), aseptic nonunion (23%), venous thromboembolism (60% without prevention) and anterior knee pain (>50%). PMID:22288287

Kohlprath, R; Assal, M; Uçkay, I; Holzer, N; Hoffmeyer, P; Suva, D



A comparison of hydrofibre and alginate dressings on open acute surgical wounds.  


This study aimed to compare the performance of a hydrofibre (Aquacel) and an alginate (Sorbsan) dressing on acute surgical wounds left to heal by secondary intention. A total of 100 patients were prospectively randomised pre-operatively to receive either the hydrofibre or the alginate dressing. Dressing performance was measured at operation, at 24 hours and seven days. Parameters measured included ease of: application and removal of the first dressing; re-application on the first postoperative day; and removal and re-application one week postoperatively. The hydrofibre dressing received higher scores for all of these categories. Patients in this group also experienced less pain (mild or none) on removal of the first dressing and at one week. However, these results did not achieve statistical significance, and should be seen as a trend. Nevertheless, the authors recommend the use of hydrofibre dressings on open acute surgical wounds. PMID:11933488

Foster, L; Moore, P; Clark, S



Management of Infections with Rapidly Growing Mycobacteria after Unexpected Complications of Skin and Subcutaneous Surgical Procedures  

PubMed Central

Background Infection caused by rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. Clinical diagnosis is difficult because there are no characteristic clinical features. There is also no standard antibiotic regimen for treating RGM infection. A small series of patients with RGM infections was studied to examine their treatments and outcomes. Methods A total of 5 patients who had developed postoperative infections from January 2009 to December 2010 were retrospectively reviewed. Patients were initially screened using a mycobacteria rapid screening test (polymerase chain reaction [PCR]-reverse blot hybridization assay). To confirm mycobacterial infection, specimens were cultured for nontuberculous mycobacteria and analyzed by 16 S ribosomal RNA and rpoB gene PCR. Results The patients were treated with intravenous antibiotics during hospitalization, and oral antibiotics were administered after discharge. The mean duration of follow-up was 9 months, and all patients were completely cured of infection with a regimen of a combination of antibiotics plus surgical treatment. Although none of the patients developed recurrence, there were complications at the site of infection, including hypertrophic scarring, pigmentation, and disfigurement. Conclusions Combination antibiotic therapy plus drainage of surgical abscesses appeared to be effective for the RGM infections seen in our patients. Although neither the exact dosage nor a standardized regimen has been firmly established, we propose that our treatment can provide an option for the management of rapidly growing mycobacterial infection.

Lim, Jong Min; Kim, Jong Hwan



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


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



Two-team simultaneous open surgical treatment in bilateral shoulder fracture dislocation.  


Different surgical options have been described for the treatment of bilateral shoulder fracture dislocations. We report 2 cases of bilateral shoulder fracture dislocation treated simultaneously by 2 surgical teams. One case had bilateral hemiarthroplasty performed, and the second case had 1 hemiarthroplasty and McLaughlin procedure on the other shoulder. A device to allow holding the patient in a bend chair position, with both shoulders hanging outside the operative table, allowing their free movement, was designed. At 1-year follow-up, neither of the patients had complications and both are pleased with their early result. Simultaneous treatment of both the shoulders by 2 different surgical teams in bilateral shoulder fracture dislocations that need surgical treatment has the advantages of reduced overall hospitalization time, reduced anesthetic risk, faster return to work, and reduced overall cost of care. The decision for simultaneous bilateral shoulder surgery must be made in concert with the patient, medical consultant, and anesthesiologist. Level of Evidence: Level IV-case series. PMID:23160553

Allende, Christian; Bustos, Damian; Bruno, Pablo; Galera, Horacio



Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation.  


Acromioclavicular (AC) joint dislocations are common in young, active patients. In case of surgical indications, Rockwood type IV, type V and selected type III dislocation, we use modified Phemister procedure. At mid-term follow-up, by an average of 35.1 months, we reassessed the records of 14 patients surgically treated for acute AC dislocation from February 2007 to November 2010. In patients with a diagnosis of grade III lesion, indication for surgery was given on the basis of the patient's functional demand. Full recovery was obtained on average 3 months after surgery. Constant Score accounted for 92.7 points, mean Disabilities of the Arm, Shoulder and Hand Score for 3.2 points, and mean Simple Shoulder Test Score for 11.4 points. X-ray findings were partial loss of reduction (9 cases), subclinic re-dislocation (2 cases), calcification (5 cases) and post-traumatic arthritis (2 cases). Modified Phemister is a reliable technique, technically easy, a low learning curve procedure and cheap with low hardware's costs. PMID:23011984

Verdano, M A; Pellegrini, A; Zanelli, M; Paterlini, M; Ceccarelli, F



78 FR 19981 - Federal Open Market Committee; Rules of Procedure  

Federal Register 2010, 2011, 2012, 2013

...Procedure to require that at least one of the seven members constituting a quorum of the Committee...the Board has an authorized membership of seven Governors, the Committee has a maximum authorized membership of twelve members (seven Board members and five Federal...



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


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



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

Microsoft Academic Search

Background  Few studies are available comparing open with laparoscopic treatment of Hirschsprung’s disease. This study compares a laparoscopic\\u000a series of 30 patients with a historical open series of 25 patients.\\u000a \\u000a \\u000a \\u000a Methods  The charts of all patients having had a Duhamel procedure in the period from June 1987 through July 2003 were retrospectively\\u000a reviewed. Open procedures were performed until March 1994. Patients with

D. Vieira Travassos; N. M. A. Bax; D. C. Van der Zee



Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure.  


The Smith-Petersen or modified direct anterior hip surgical exposures have not previously been described for open reduction of femoral neck fractures. This technique of reduction provides a direct approach to the femoral neck and hip joint. Displaced fractures of the femoral neck can easily be reduced through this approach, local osseus defects resulting from impaction can be supported with bone graft, and fracture fixation is then placed through a separate lateral exposure or through small stab incisions. The technique of reduction is presented. PMID:17762484

Molnar, Robert B; Routt, M L Chip



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


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



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



Surgical Procedures for External Auditory Canal Carcinoma and the Preservation of Postoperative Hearing  

PubMed Central

Carcinoma of the external auditory canal (EAC) is an unusual head and neck malignancy. The pathophysiology of these tumors is different from other skin lesions because of their anatomical and functional characteristics. Early-stage carcinoma of the EAC can be generally cured by surgical treatment, and reconstruction of the EAC with a tympanoplasty can help to retain hearing, thus improving the patients' quality of life. In this study, we present two cases of early-stage carcinoma of the EAC treated by canal reconstruction using skin grafts after lateral temporal bone resection. A rolled-up skin graft with a temporal muscle flap was useful for keeping the form and maintaining the postoperative hearing. An adequate size of the skin graft and blood supply to the graft bed are important for achieving a successful operation.

Hoshikawa, Hiroshi; Miyashita, Takenori; Mori, Nozomu



Management of surgical procedures in children with severe FV deficiency: experience of 13 surgeries.  


Homozygous severe factor V (FV) deficiency has a prevalence of around one per million. Even in patients with FV levels of <0.01 IU mL(-1) there appears to be a variation in bleeding phenotype in that there is a subgroup of affected individuals who present in later childhood and have a relatively mild bleeding phenotype, but there are children who present as neonates with intracerebral bleeding events and who have a much more severe bleeding phenotype. The only available current FV replacement is in the form of fresh frozen plasma (FFP) or solvent detergent FFP. We present here our experience with surgical haemostatic cover for 13 surgeries in three children with severe FV deficiency. PMID:23173600

Mathias, M; Tunstall, O; Khair, K; Liesner, R



PS3-53: A Multi-Site Comparison of Laparoscopic Gastric Band vs. Laparoscopic Gastric Bypass Bariatric Surgical Procedures  

PubMed Central

Background/Aims The two most common bariatric surgical procedures are laparoscopic gastric band (LAGB) and laparoscopic gastric bypass (RYGB). Single site comparisons suggest that RYGB may result in greater weight loss at the expense of more short-term complications, whereas LAGB may be associated with less weight loss and more long-term complications. It is unclear whether these results extend to other populations. Methods This is a multi-site retrospective cohort investigation of LAGB vs. RYGB. Outcomes are: 30-day operative complications; rehospitalization at 1 and 2 years; and weight loss at 2 years. Multivariable logistic regression, Cox proportional hazards, and repeated measures will be used to assess outcomes as a function of type of surgery. Results From 2005–2009, there were 1,521 LAGB and 5,963 RYGB procedures at 11 sites. Mean pre-surgical BMI was 42.6 and 44.6, and mean age was 47.0 and 45.8 for each procedure respectively. RYGB patients were more likely to have diabetes, hypertension, gastric reflux, and sleep apnea. RYGB patients had more commercial insurance (89% vs. 72%), were less likely to be Caucasian (67% vs. 73%), and were 84% (vs. 82%) female. Results at 30-days for LAGB vs. RYGB respectively were: Failure to discharge, 0 (0%) vs. 8 (0.1%); mortality, 0 (0%) vs. 1 (0.02%); thrombotic diagnoses, 6 (0.5%) vs. 63 (1.1%); and reintervention, 10 (0.9%) vs. 30 (0.5%). Mean long-term follow-up BMI was 37.2 for LAGB and 33.3 for RYGB. All differences were statistically significant at P = 0.05 in bivariate models. Conclusions Across multiple sites, individuals with higher BMI and morbidity burden were more likely to receive RYGB surgery. Preliminary results suggest that long-term weight loss and certain short-term complications are significantly greater for RYGB than LAGB procedures, and that LAGB procedures are more likely to have 30-day reintervention. Multivariable comparisons adjusting for pre-operative covariates and follow up time will better clarify risks and benefits of these procedures.

Bayliss, Elizabeth; Powers, J. David; Donahoo, W. Troy; Toh, Darren; Polsky, Sarit; Herrinton, Lisa; Butler, Melissa; Portz, Jennifer; Williams, Rebecca; Vijayadeva, Vinutha; Arterburn, David



Surgical repair of acute Achilles tendon rupture using a "mini-open" technique.  


For active patients, surgery is usually the preferred treatment for an acute Achilles tendon rupture. Classical open techniques require a long tendon exposure, which can result in damage to its blood supply and gliding structures. Adhesions may form, which impair the final functional result. Closed surgical techniques do not allow for a perfect adaptation of the tendon stumps and have a higher rate of rerupture. The "mini-open" technique has advantages over both of these techniques. Percutaneously introduced threads prevent adhesions along the tendon. The rupture is exposed through a minimal incision and is carefully sutured with fine threads to allow a direct healing process without the formation of intermediate scar tissue. The minimally invasive approach and the introduction of percutaneous threads considerably reduce the time spent in surgery. An aggressive rehabilitation program can be initiated 1 week after surgery and allows good early functional results. PMID:12512412

Rippstein, Pascal F; Jung, Maximilien; Assal, Mathieu



Anatomic features of the intracranial and intracanalicular portions of ophthalmic artery: for the surgical procedures  

Microsoft Academic Search

The intracranial and intracanalicular portions of the ophthalmic artery is suspectible to various diseases and injuries; therefore,\\u000a knowledge of the microanatomy of the complex bony, dural, vascular, and neural relationships of this segment is necessary\\u000a for proper diagnosis and preservation of the neurovascular structures during subfrontal, pterional and intracanalicular procedures.\\u000a The artery was studied in 38 human adult cadaver specimens

Senem Erdogmus; Figen Govsa



The unreliability of the intermetatarsal angle in choosing a hallux abducto valgus surgical procedure.  


Conventional thinking holds that high intermetatarsal and hallux abductus angles (>15° and >25°, respectively) are associated with a hypermobile first ray and require a Lapidus procedure to achieve satisfactory correction for the treatment of hallux valgus. However, normal first ray motion may be misinterpreted as hypermobility, and it is possible to take advantage of this motion to correct some portion of a large hallux abductovalgus deformity with distal procedures, such as the Austin or first metatarsophalangeal joint fusion. We retrospectively examined radiographs of 61 patients with first intermetatarsal and hallux abductus angles greater than 15° and greater than 25°, respectively, who had undergone hallux abductovalgus correction via Lapidus, Austin, or first metatarsophalangeal joint fusion. Preoperative and postoperative radiographic measurements of the intermetatarsal and hallux abductus angles were made. The results revealed no statistically significant differences in the amount of correction achieved by any of the 3 procedures in comparison with the others. We concluded that, given appropriate patient selection, an Austin or first MTPJ fusion could reliably correct large intermetatarsal and hallux abductus angles that, in the hands of many surgeons, are often treated by means of Lapidus arthrodesis. PMID:21435913

Ravenell, Rahn A; Camasta, Craig A; Powell, Donald R



The perioperative use of oral anticoagulants during surgical procedures for carpal tunnel syndrome. A preliminary study  

Microsoft Academic Search

Background  To evaluate the feasibility of designing a randomized controlled study whether open carpal tunnel release (OCTR) surgery can\\u000a be performed safely under systemic anticoagulant therapy using acetylsalicylacid (ASA) or acenocoumarol (ACM), this preliminary,\\u000a observational study was performed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Prospectively, during 1 year, data were collected from all patients who underwent conventional OCTR at the neurosurgical department\\u000a of the Canisius Wilhelmina Hospital, Nijmegen,

R. D. S. Nandoe Tewarie; R. H. M. A. Bartels



What is a meant when a laparoscopic surgical procedure is described as “safe”?  

Microsoft Academic Search

Background  The literature on laparoscopic surgery contains many studies concluding that a procedure is “safe.” This study aimed to review\\u000a systematically articles from the past 10 years that judged a laparoscopic technique for colon resection and anastomosis to\\u000a be “safe.”\\u000a \\u000a \\u000a \\u000a Methods  The authors searched the Medline database from January 1995 to August 2005 using the search terms “laparoscopic,” “colon,”\\u000a and “safe,” selecting

D. Weizman; J. Cyriac; D. R. Urbach



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


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



Laparoscopic-assisted colon resection. Evolution from an experimental technique to a standardized surgical procedure.  


Between October 1991 and November 1992, 51 patients in the mean age 63.2 years (range 19 to 91 years) underwent laparoscopic colon resection. Indications for surgery were colon carcinoma (31), adenomatous polyps (8), diverticulitis (10) and Crohn's disease (2). In right-sided lesions an extracorporeal anastomosis and in left-sided lesions an intracorporeal anastomosis was performed using the double stapling technique. The mortality rate was 1.9% and the morbidity rate 20.5% in the laparoscopic-treated group. The conversion rate was 13.7%. Except for one anastomotic leakage in a converted patient, no anastomotic problems were encountered. The percentage of infectious complications was 11.7%. Three reinterventions were necessary for treatment of two deep subfascial abscesses and one case of localized peritonitis, caused by a small small bowel injury. The mean hospital stay was 9.1 days (range 4-29 days). In the last 13 consecutive patients, except for a urinary infection, no further post-operative morbidity was encountered. Laparoscopic-assisted colon resection has evolved in to a standardized surgical technique. Initial learning problems are solved by good patient selection, better operative logistics and awareness of the dangers and pitfalls of laparoscopic surgery. PMID:7944223

Jansen, A



Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure  

PubMed Central

Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.



Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study  

PubMed Central

Background and Objectives: The purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown-lengthening in human subjects. Materials and Methods: A clinical trial study involving 15 patients was carried out for a period of 6 months. Sites were divided into 3 groups: treated (TT) sites, adjacent (AD) sites and nonadjacent (NAD) sites. Free gingival margin [FGM], attachment level, pocket depth, bone level, biological width [BW] were recorded at baseline, 1, 3 and 6 months. Direct bone level after flap reflection was recorded before and after osseous resection at baseline only. Level of osseous crest was lowered based on BW, and supracrestal tooth structure needed using a combination of rotary and hand instruments. Statistical Analysis: Student t test and ANOVA were used. Results: Overall, apical displacement of FGM at TT, AD and NAD sites was statistically significant compared to baseline. The apical displacement of FGM at TT site was more when compared to that at AD and NAD sites at 3 and 6 months. The BW at the TT site was smaller at 1, 3 and 6 months compared to that at baseline. However, at all sites, BW was reestablished to the baseline value at the end of 6 months. Interpretation and Conclusion: The BW at TT sites was reestablished to its original vertical dimension by 6 months. In addition, a consistent 2-mm gain of coronal tooth structure was observed at the 1, 3 and 6-month examinations.

Shobha, K. S.; Mahantesha; Seshan, Hema; Mani, R.; Kranti, K



The influence of postoperative telephone calls on pain perception: a study of 118 periodontal surgical procedures.  


This age-matched and sex-matched study examined the influence of postoperative telephone calls on pain perception and on the number of analgesics used for pain relief. Adult periodontitis subjects (n = 118) received periodontal surgery after examination and sanative therapy (scaling, root planing, and removal of local irritants). All subjects received similar care, postoperative instructions, and medication, except 59 subjects were phoned 24 hours postoperative (PC group), and 59 were not (NC group). Callers covered 10 points and were reassuring and positive about surgical outcomes. One week postoperative, subjects completed a questionnaire that rated pain intensity on a visual analogue scale and indicated the number of pills used and whether they had been called. Pain and analgesics used were significantly decreased in the PC group (P < 0.001) compared to the NC group. A significant positive correlation was found between pain and pills used in the groups combined (r = 0.79, P < 0.001 PC + NC), and in the groups separately (r = 0.50, P < 0.001 PC; r = 0.41, P < 0.01 NC). Postoperative communication between healthcare providers and patients significantly reduces pain perception and number of analgesics used for relief. PMID:9780943

Touyz, L Z; Marchand, S



Mouth Opening During Sleep may be a Critical Predictor of Surgical Outcome after Uvulopalatopharyngoplasty for Obstructive Sleep Apnea  

PubMed Central

Study Objectives: To evaluate the value of mouth opening during sleep for predicting surgical outcomes after uvulopalatopharyngoplasty (UPPP). Methods: Retrospectively, 69 out of 120 consecutive patients with obstructive sleep apnea who underwent uvulopalatopharyngoplasty at an academic tertiary referral center were included in this study. Sixty-nine subjects underwent cephalometry, nocturnal polysomnography and sleep videofluoroscopy before and after UPPP. Multiple parameters from the above studies were evaluated as potential predictors of UPPP outcomes. Results: Multivariate analysis showed that an increased angle of mouth opening during sleep was the only significant predictor for surgical failure (p < 0.001). The angle of mouth opening could predict surgical outcome with predictive values of 72.4% and 82.5% for success and failure, respectively. Conclusions: Sleep videofluoroscopy during sleep revealed that the simple measurement of mouth-opening angle could outstandingly predict surgical outcome. Citation: Lee CH; Mo JH; Seo BS; Kim DY; Yoon IY; Kim JW. Mouth opening during sleep may be a critical predictor of surgical outcome after uvulopalatopharyngoplasty for obstructive sleep apnea. J Clin Sleep Med 2010;6(2):157-162.

Lee, Chul Hee; Mo, Ji-Hun; Seo, Beom Seok; Kim, Dong-Young; Yoon, In-Young; Kim, Jeong-Whun



Radiation exposure and associated risks to operating-room personnel during use of fluoroscopic guidance for selected orthopaedic surgical procedures  

SciTech Connect

Because of the increased use of fluoroscopic guidance techniques in certain orthopaedic surgical procedures, surgeons and other operating-room personnel who are involved in these procedures are voicing growing concern over possible associated radiation health hazards. Using thin-layer lithium fluoride chips for thermoluminescence dosimetry, we directly measured the radiation exposure encountered by the primary surgeon during seven operative procedures that were done utilizing fluoroscopic guidance techniques. Dosimetry studies were also carried out using a tissue-equivalent phantom model to determine the directions of maximum scatter radiation. These studies indicated that the standard protective apron that is commonly worn during the use of fluoroscopy provides adequate protection to most of the body; however, the surgeon is exposed to significant levels of scatter radiation to the head, neck, and hands, Dosimetry studies showed that positioning the fluoroscopic beam vertically to the fracture site of the supine patient, with the x-ray source posterior to the patient, provided the lowest levels of scatter radiation to the surgeon in the normal working position.

Miller, M.E.; Davis, M.L.; MacClean, C.R.; Davis, J.G.; Smith, B.L.; Humphries, J.R.



A Fluidic Cell Embedded Electromagnetic Wave Sensor for Online Indication of Neurological Impairment during Surgical Procedures  

NASA Astrophysics Data System (ADS)

Lactate is known to be an indicator of neurological impairment during aortic aneurysm surgery. It is suggested that cerebrospinal fluid removed during such surgery could provide useful information in this regard. Medical professionals find the prospect of online detection of such analytes exciting, as current practice is time consuming and leads to multiple invasive procedures. Advancing from the current laboratory based analysis techniques to online methods could provide the basis for improved treatment regimes, better quality of care, and enhanced resource efficiency within hospitals. Accordingly, this article considers the use of a low power fluidic system with embedded electromagnetic wave sensor to detect varying lactate concentrations. Results are promising over the physiological range of 0 - 20 mmol/L with a calibration curve demonstrating an R2 value > 0.98.

Blakey, R. T.; Mason, A.; Al-Shamma'a, A. I.



Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure  

PubMed Central

Purpose In the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. Methods Two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43–91) years. The median follow-up was 4.2 years (range 1–10.4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre- and postoperatively using patient- and assessor-based outcome scores, as well as radiographic evidence. Results The mean Knee Society knee and function scores, WOMAC-scores, Oxford-score and VAS pain and satisfaction all improved. Nine knees required revision. Eleven patients required an additional arthroscopic procedure due to persisting pain secondary to intra-articular pathology, and four patients required manipulation under anaesthesia because of limited range of motion. The 7-year cumulative survival rate of the arthroplasty was 94.4%. A low incidence (21%) of a radiolucent line beneath the tibial component was observed at 5 years of follow-up. Conclusion This study showed a high survival rate of the Oxford Phase 3 UKA. Patient satisfaction and functional performance were also very high. Major complication rate was low; in addition, the incidence of radiolucency under the tibial component, when compared to present literature, was low. When strict indication criteria are followed, excellent, durable, and in our opinion reliable, results can be expected for this procedure.

van den Bekerom, Michel P. J.; Pilot, Peter; van Dijk, C. Niek; Lisowski, Andrzej E.



OA01.28. Management of post - axial polydactyly by ksharsutra - A minimally invasive Ayurvedic para surgical procedure  

PubMed Central

Purpose: Polydactyly is a most common congenital hand defect in which the hand has one or more extra fingers, commonly seen post axial i.e. on the small finger side, affecting about one out of every 1,000 babies. It is usually treated by surgically removing the extra finger typically, when the child is between 1 and 2 years old. Prognosis after removal of extra digit is good, though not devoid of complications like scar formation, instability and late deformity which may need additional reconstructive surgery to recover full function and improve the hand's appearance. The evidence of polydactyly is linked with superstitions related with divine phenomenon. Due to the myth and fear of complications, parents hesitate or are reluctant to opt for surgery. Method: In this study, Ksharsutra, an Ayurvedic medicated thread coated with herbal alkaline drugs having simultaneous cutting and healing property was used by free ligation technique to remove extra finger in a child, whose parents were not willing to undergo surgery. This was an observational single case design without controlled group. Result: After Ksharsutra ligation, the extra finger started necrosing within 24 hours. The finger turned bluish to black in next 3 days with minimal pain at the site of ligation and finally sloughed out in just nine days with minimal scar formation. Conclusion: Ksahrsutra Ligation showed excellent result in postaxial polydactyly. The results are encouraging enough to warrant more studies to establish and promote this unique para surgical procedure i.e. Ksharsutra in the management of postaxial Polydactyly.

Dwivedi, Amarprakash



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


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



Sprengel Deformity: Morphometric Assessment and Surgical Treatment by the Modified Green Procedure.  


BACKGROUND:: We evaluated the pathologic anatomy of the Sprengel deformity using radiographs, 3-dimensional computed tomography (3D-CT), and magnetic resonance imaging (MRI), and reviewed our results of the modified Green procedure. METHODS:: Between 2002 and 2009, 23 scapulae in 22 patients were treated. The average age at the time of surgery was 3.4 years (range, 1.9 to 7.1 y). The outcome of surgery was assessed on the basis of changes in shoulder abduction and the radiographic findings using Cavendish classification, Rigault classification, scapular elevation, and medialization. Preoperative appearance was classified as grade III in 13 cases and grade IV in 10 cases according to the Cavendish classification, and as grade II in 4 cases and grade III in 19 cases according to the Rigault classification. Using 3D-CT, we assessed the height to width ratio on the scapular posterior view, the superior displacement ratio and rotational difference on the trunk posterior view, and the anterior curvature of the supraspinous portion on the scapular medial view. RESULTS:: The average follow-up postoperative period was 4.4 years (range, 2.2 to 8.7 y). Postoperatively, the shoulder abduction improved well, with a mean improvement of 63 degrees. Improvement of at least 1 Cavendish grade and 1 Rigault grade was attained in all cases. On preoperative 3D-CT, the mean height to width ratio of the affected scapula was significantly smaller than that of the contralateral scapula. There was an inverse relationship between the superior displacement ratio and the rotational difference. Anterior curvature of the supraspinous portion was seen in all cases. Omovertebral bone was found in 20 cases. MRI identified unossified omovertebral cartilage that was not evident by radiographs or CT. Transient brachial plexus palsy occurred in 2 patients, both of whom recovered within 4 months. Postoperative scapula winging and unsightly scarring were seen in 3 and 8 cases, respectively. CONCLUSIONS:: 3D-CT and MRI were helpful in evaluating the pathologic anatomy of the deformity and in planning the surgery. The modified Green procedure provided successful functional and cosmetic results. LEVEL OF EVIDENCE:: Level IV. PMID:23774200

Wada, Akifusa; Nakamura, Tomoyuki; Fujii, Toshio; Takamura, Kazuyuki; Yanagida, Haruhisa; Yamaguchi, Toru; Kubota, Hideaki; Oketani, Yutaka



Carotid axillary artery bypass: an option following failed open and percutaneous procedures.  


Percutaneous transluminal angioplasty and stenting is being employed with increasing frequency for stenosis involving the brachiocephalic circulation. However, the efficacy of these procedures is limited by intimal hyperplasia and subsequent re-stenosis. Long-term results for treating lesions of the subclavian or innominate artery have shown significant re-stenotic rate. Accordingly, carotid-subclavian bypass remains as an important procedure. Alternative methods may still be required, particularly after failure of open re-vascularization and percutaneous techniques. This report describes an underused technique that enables upper extremity revascularization following prior attempts at endovascular and standard open techniques. PMID:23493270

Orozco, Vicente; Impellizzeri, Paul; Naftalovich, Rotem; Dardik, Herbert



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



The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates  

PubMed Central

Background Degenerative disease of the lumbar spine (DLS) is a common condition for which surgery can be beneficial in selected patients. With recent surgical trends toward more focused subspecialty training, it is unclear how characteristics of the surgical consultant may impact on treatment and reoperations. Our objective was to understand the relations between surgeon factors (who), surgical procedures (what) and recent trends (when) and their influence on reoperations for DLS surgery. Methods We performed a longitudinal population-based study using administrative databases including all patients aged 50 years and older who underwent surgery for DLS. We collected data on surgeon characteristics (specialty, volume), index procedures (decompressions, fusions) and reoperations. Results We identified 6128 patients who underwent surgery for DLS (4200 who had decompressions, 1928 who had fusions). We observed an increasing proportion of fusions over decompressions while the per capita surgeon supply declined. Orthopedic specialty and higher surgical volume were associated with a higher proportion of fusions (p < 0.001). The overall reoperation rate was 10.6%. Reoperations were more frequent in patients who had decompressions than those who had fusions at 2 years (5.4% v. 3.8%, odds ratio 1.4, p < 0.013), but not over the long-term. Long-term survival analysis demonstrated that a lower surgical volume was related to a higher reoperation rate (hazard ratio 1.28, p = 0.038). Conclusion Lumbar spinal fusion rates for DLS have been increasing in Ontario. There is wide variation in surgical procedures between specialty and volume: namely high-volume and orthopedic surgeons have higer fusion rates than other surgeons. We observed better long-term survival among patients of high-volume surgeons. Referring physicians should be aware that the choice of surgical consultant may influence patients’ treatments and outcomes. With increasing rates of spinal surgery, the efficacy and cost benefit of current surgical options require ongoing study.

Bederman, S. Samuel; Kreder, Hans J.; Weller, Iris; Finkelstein, Joel A.; Ford, Michael H.; Yee, Albert J.M.



Radiated emission measurement procedures at an open-area test site  

Microsoft Academic Search

Some typical measurement procedures used to perform radiated emission measurements at an open-area test site are discussed. Topics covered include examples of test equipment used, some aspects of emission maximization, equipment under test (EUT) activity during tests, and the minimum set of measurements required to assure compliance. Also discussed are some methods used to distinguish emissions from the EUT from

R. L. Schieve



IC Treatment: Surgical Procedures  


... to try before considering surgery, such as pain management techniques or pain medicines ? What are the chances that I will still have IC symptoms after this surgery? How long will the surgery take, how long will my hospital stay be, and how long is the recovery ...


A Rapid and Simple Procedure for the Establishment of Human Normal and Cancer Renal Primary Cell Cultures from Surgical Specimens  

PubMed Central

The kidney is a target organ for the toxicity of several xenobiotics and is also highly susceptible to the development of malignant tumors. In both cases, in vitro studies provide insight to cellular damage, and represent adequate models to study either the mechanisms underlying the toxic effects of several nephrotoxicants or therapeutic approaches in renal cancer. The development of efficient methods for the establishment of human normal and tumor renal cell models is hence crucial. In this study, a technically simple and rapid protocol for the isolation and culture of human proximal tubular epithelial cells and human renal tumor cells from surgical specimens is presented. Tumor and normal tissues were processed by using the same methodology, based on mechanical disaggregation of tissue followed by enzymatic digestion and cell purification by sequential sieving. The overall procedure takes roughly one hour. The resulting cell preparations have excellent viabilities and yield. Establishment of primary cultures from all specimens was achieved successfully. The origin of primary cultured cells was established through morphological evaluation. Normal cells purity was confirmed by immunofluorescent staining and reverse transcription-polymerase chain reaction analysis for expression of specific markers.

Valente, Maria Joao; Henrique, Rui; Costa, Vera L.; Jeronimo, Carmen; Carvalho, Felix; Bastos, Maria L.; de Pinho, Paula Guedes; Carvalho, Marcia



Estimation of the stapes-bone thickness in the stapedotomy surgical procedure using a machine-learning technique.  


Stapedotomy is a surgical procedure aimed at the treatment of hearing impairment due to otosclerosis. The treatment consists of drilling a hole through the stapes bone in the inner ear in order to insert a prosthesis. Safety precautions require knowledge of the nonmeasurable stapes thickness. The technical goal herein has been the design of high-level controls for an intelligent mechatronics drilling tool in order to enable the estimation of stapes thickness from measurable drilling data. The goal has been met by learning a map between drilling features, hence no model of the physical system has been necessary. Learning has been achieved as explained in this paper by a scheme, namely the d-sigma Fuzzy Lattice Neurocomputing (d sigma-FLN) scheme for classification, within the framework of fuzzy lattices. The successful application of the d sigma-FLN scheme is demonstrated in estimating the thickness of a stapes bone "on-line" using drilling data obtained experimentally in the laboratory. PMID:10719477

Kaburlasos, V G; Petridis, V; Brett, P N; Baker, D A



Clinical, Functional, and Radiographic Assessments of the Conventional and Modified Boyd-Anderson Surgical Procedures for Repair of Distal Biceps Tendon Ruptures  

Microsoft Academic Search

The purpose of this study was to evaluate the clinical, functional, and radiographic outcomes of the conventional and modified Boyd-Anderson procedures for repair of distal biceps tendon ruptures. Thirteen of 18 men who underwent surgical repair for unilateral distal biceps tendon ruptures at one university center participated in the study. In general, follow-up outcomes were favorable with respect to return

Patrick DArco; Michael Sitler; John Kelly; Raymond Moyer; Paul Marchetto; Iris Kimura; Jeff Ryan



Galen-In-Use : Using artificial intelligence termin ology tools to improve the linguistic coherence of a national coding system for surgical procedures  

Microsoft Academic Search

GALEN has developed a language independent common reference model based on a medically oriented ontol ogy and practical tools and techniques for managing healthc are terminology including natural language processing. GALEN- IN-USE is the current phase which applied the model ling and the tools to the development or the updating of cod ing systems for surgical procedures in different national

Jean Marie Rodrigues; Béatrice Trombert-Paviot; Robert Baud; Judith Wagner; Florence Meusnier-Carriota


Does the degree of cyanosis affect myocardial adenosine triphosphate levels and function in children undergoing surgical procedures for congenital heart disease?  

Microsoft Academic Search

Objective: The outcome of children with cyanosis after cardiac surgical procedures is inferior to that of children who are acyanotic. Animal studies indicated detrimental effects of chronic hypoxia on myocardial metabolism and function. We studied whether the presence or the degree of cyanosis adversely affected myocardial adenosine triphosphate, ventricular function, and clinical outcome in children. Methods: Forty-eight children who underwent

Hani K. Najm; W. Jack Wallen; Michael P. Belanger; William G. Williams; John G. Coles; Glen S. Van Arsdell; Michael D. Black; Christine Boutin; Carin Wittnich



Lessons from the past: directions for the future. Do new marketed surgical procedures and grafts produce ethical, personal liability, and legal concerns for physicians?  


New procedures and materials for incontinence and prolapse are proliferating rapidly. Surgical procedures were developed by physicians and carried their names, but over the last 15 years, these procedures are developed by industry and bear the trade names of the companies selling the kits needed to perform them. The Food and Drug Administration (FDA) approves devices, not procedures, and does not require submission of efficacy or adverse-event data to gain this approval by the 510-K process. Evidence-based medicine is lacking in the performance of these procedures that may be considered experimental by an insurance company or malpractice carrier with denial of payment or coverage. Physicians and hospitals are exposing themselves to financial, legal, and ethical risks when performing or allowing such procedures to be performed. Informed consent from the patient cannot be obtained. We must not confuse medical marketing with evidence-based medicine. PMID:17364134

Ostergard, Donald R



Non-Surgical Procedures Open Blocked Arteries to Prevent and Treat Stroke  


... the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off ... vessels. These cells can block arteries to the brain, causing a stroke. Family ... in the carotid artery in the neck, can lead to ischemic stroke. Plaque in the ...


[Postappendectomy surgical site infection: Overall rate and type according to open/laparoscopic approach.  


OBJECTIVE: To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. MATERIAL AND METHOD: Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with ?(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. RESULTS: Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). CONCLUSION: OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI. PMID:23582194

Aranda-Narváez, José Manuel; Prieto-Puga Arjona, Tatiana; García-Albiach, Beatriz; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Sánchez-Pérez, Belinda; Titos-García, Alberto; Santoyo-Santoyo, Julio



Evaluation by policy makers of a procedure to describe perceived landscape openness.  


In the last decade policy makers have increasingly recognized the need to include people's perceptions in methods for describing landscape quality. At the same time, a third wave of Geographic Information Systems (GIS) has become available that make it technically possible to model landscape quality in a realistic manner. However, as there is often a mismatch between science and policy, it remains unclear to what extent perception-based models developed by scientists can be useful to policy makers. The aim of the present study was to evaluate the usefulness to policy making of a GIS-based procedure for describing perceived landscape openness. To this end, a workshop was organized which was attended by eight Dutch policy makers who acted as representatives of their province (region). The Group Decision Room (GDR) technique was used to elicit the policy makers' evaluations of the procedure in an anonymous and reliable manner. The procedure was presented to the policy makers using cases from their own province, which they assessed using a mixture of qualitative and quantitative methods. The results show that policy makers rated the procedure as being highly relevant to policy making, scientifically credible, usable by policy makers and feasible to implement in the policy making process. They especially appreciated the flexibility and transparency of the procedure. The policy makers concluded that the procedure would be of most value for monitoring landscape changes and for analysing impacts on landscape openness in land use scenario studies. However, they requested guidelines for proper implementation of the various options in the procedure. In general, the current study shows that explicit and transparent evaluation of the usefulness of GIS-based tools can aid integration at the science-policy interface and help to ensure that both scientists and policy makers are informed of interrelated options and requirements. PMID:22115507

Weitkamp, Gerd; Van den Berg, Agnes E; Bregt, Arnold K; Van Lammeren, Ron J A



Comparison of Costs of Endovascular Repair versus Open Surgical Repair for Abdominal Aortic Aneurysm in Korea  

PubMed Central

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.

Min, Sang Il; Min, Seung-Kee; Ahn, Sanghyun; Kim, Suh Min; Park, Daedo; Park, Taejin; Chung, Jin Wook; Park, Jae Hyung; Ha, Jongwon; Kim, Sang Joon



Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair.  


To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery. PMID:18786197

Hemal, Ashok K; Mishra, Saurabh; Mukharjee, Satydip; Suryavanshi, Manav



A Systematic Review of Systematic Reviews and Panoramic Meta-Analysis: Staples versus Sutures for Surgical Procedures  

PubMed Central

Objective To systematically evaluate the evidence across surgical specialties as to whether staples or sutures better improve patient and provider level outcomes. Design A systematic review of systematic reviews and panoramic meta-analysis of pooled estimates. Results Eleven systematic reviews, including 13,661 observations, met the inclusion criteria. In orthopaedic surgery sutures were found to be preferable, and for appendicial stump sutures were protective against both surgical site infection and post surgical complications. However, staples were protective against leak in ilecolic anastomosis. For all other surgery types the evidence was inconclusive with wider confidence intervals including the possibly of preferential outcomes for surgical site infection or post surgical complication for either staples or sutures. Whilst reviews showed substantial variation in mean differences in operating time (I2 94%) there was clear evidence of a reduction in average operating time across all surgery types. Few reviews reported on length of stay, but the three reviews that did (I2 0%, including 950 observations) showed a non significant reduction in length of stay, but showed evidence of publication bias (P-value for Egger test 0.05). Conclusions Evidence across surgical specialties indicates that wound closure with staples reduces the mean operating time. Despite including several thousand observations, no clear evidence of superiority emerged for either staples or sutures with respect to surgical site infection, post surgical complications, or length of stay.

Hemming, Karla; Pinkney, Thomas; Futaba, Kay; Pennant, Mary; Morton, Dion G.; Lilford, Richard J.



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



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



Review of Corneal Endothelial Specular Microscopy for FDA Clinical Trials of Refractive Procedures, Surgical Devices and New Intraocular Drugs and Solutions  

PubMed Central

Specular microscopy can provide a non-invasive morphological analysis of the corneal endothelial cell layer from subjects enrolled in clinical trials. The analysis provides a measure of the endothelial cell physiological reserve from aging, ocular surgical procedures, pharmaceutical exposure, and general health of the corneal endothelium. The purpose of this review is to discuss normal and stressed endothelial cell morphology, the techniques for determining the morphology parameters, and clinical trial applications.

McCarey, Bernard E.; Edelhauser, Henry F.; Lynn, Michael J.



Feline onychectomy and elective procedures.  


The development of the carbon dioxide (CO2) surgical laser has given veterinarians a new perspective in the field of surgery. Recently developed techniques and improvisations of established procedures have opened the field of surgery to infinite applications never before dreamed of as little as 10 years ago. Today's CO2 surgical laser is an adaptable, indispensable tool for the everyday veterinary practitioner. Its use is becoming a common occurrence in offices of veterinarians around the world. PMID:12064043

Young, William Phillip



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



The learning curve for surgical margins after open radical prostatectomy: implications for the use of margin status as an oncologic endpoint  

PubMed Central

Purpose Surgical margin status is commonly used as an endpoint for surgical learning. In this study, we examine the learning curve for surgical margins and investigate whether surgical margins are good marker for oncologic outcome. Materials and Methods The study cohort included 7765 prostate cancer patients who were treated with radical prostatectomy by one of 72 surgeons at four major U.S. academic medical centers. We calculated the learning curve for surgical margins and a concordance probability between the surgeon's rates of positive surgical margins and 5-year biochemical recurrence. Results A positive surgical margin was identified in 2059 patients (27%). On multivariable analysis, surgeon experience was strongly associated with surgical margin status (p=0.017). The probability of a positive surgical margin was 40% for a surgeon with 10 prior cases, and decreased to 25% for a surgeon with 250 prior cases (absolute difference 15%, 95% CI 11% to 18%). Learning curves differed dramatically between surgeons. For pairs of surgeons, the surgeon with the superior positive surgical margin rate also had the better biochemical recurrence rate only 58% of the time. Conclusions We have demonstrated a learning curve for surgical margins after open radical prostatectomy. The poor concordance between a surgeon's margin and recurrence rates suggests that, while margins clearly matter, and efforts should be made to reduce positive margin rates, surgical margin status is not a strong surrogate for cancer control. These results have implications for the use of margin rates to evaluate changes in surgical technique and as feedback for surgeons.

AJ, Vickers; FJ, Bianco; AM, Cronin; JA, Eastham; EA, Klein; MW, Kattan; PT, Scardino



Functional Outcome and Health-Related Quality of Life After Surgical Repair of Full-Thickness Rotator Cuff Tear Using a Mini-Open Technique  

Microsoft Academic Search

Background: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss.Hypothesis: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life.Study Design: Cohort study. Level of evidence, 2.Methods: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1)

Deniz Baysal; Robert Balyk; David Otto; Charlene Luciak-Corea; Lauren Beaupre



Postthrombotic syndrome: surgical possibilities.  


Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves. PMID:22084674

Khanna, Ajay K; Singh, Shivanshu



Postthrombotic Syndrome: Surgical Possibilities  

PubMed Central

Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves.

Khanna, Ajay K.; Singh, Shivanshu



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.



A cardiopulmonary bypass perfusion technique for the surgical repair of aortic type I dissections requiring the elephant trunk procedure.  


The effect of cerebral and spinal cord protection by a modified perfusion technique during the elephant trunk procedure was assessed. Between 1997 and 1998, six patients underwent selective cerebral perfusion (SCP) and lower half of the body perfusion (LBP), in which the right subclavian and left femoral arteries were separately cannulated and perfused by individual pump heads. Moderate systemic cooling was used (nasal temp. 20-30 degrees C; rectal temp. 23-26 degrees C). The open distal aortic repair was performed using only the selective cerebral perfusion; while the aortic arch reconstruction was performed using both selective cerebral and lower half of the body simultaneous perfusion. Blood oxygen saturation of the left jugular vein (SjO2) and regional oxygen saturation cerebral (rSO2) in the front region of the brain, was monitored along with the pressure of the left temporal superficial and femoral artery. The mean cardiopulmonary bypass time was 136 minutes, with a mean arrest time of 92 minutes. Mean duration of isolated selective cerebral perfusion was 23 minutes, with flow rates of 5-8 mL/kg/min; a left temporal superficial artery pressure of 50 mmHg; SjO2 65-80%, and rSO2 58-72%. Mean duration of simultaneous selective cerebral and lower half of the body perfusion was 27 minutes; cerebral flow rates 5-8 mL/kg/min; the left temporal superficial artery pressure of 45-50 mmHg; SjO2 70-85% and rSO2 55-76%. At the same time, lower half of the body flow rates were maintained within 30-50 mL/kg/min; with a femoral artery pressure 50-80 mmHg. Mean extubation time was 28 hours; mean ICU time was 4.5 days. There were no neurologic complications in any patient. All patients survived the operation and were discharged from the hospital. This modified perfusion technique of SCP and LBP worked well and provided satisfactory cerebral and spinal cord protection. PMID:11194059

Yang, T; Sun, L; Hei, F; Liu, Y



Severe Surgical Site Infection in Community Hospitals: Epidemiology, Key Procedures, and the Changing Prevalence of Methicillin?Resistant Staphylococcus aureus  

Microsoft Academic Search

objective. To characterize the epidemiology of severe (ie, nonsuperficial) surgical site infection (SSI) in community hospitals. methods. SSI data were collected prospectively at 26 community hospitals in the southeastern United States. Two analyses were performed: (1) a study of the overall prevalence rates of SSI and the prevalence rates of SSI due to specific pathogens in 2005 at all participating

Deverick J. Anderson; Daniel J. Sexton; Zeina A. Kanafani; Grace Auten; Keith S. Kaye



Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain.  


The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97, df = 25, p > .05). This research study indicates that live music therapy using patient-preferred music can be beneficial in improving quality of life indicators such as anxiety, perception of the hospitalization or procedure, relaxation, and stress in patients undergoing surgical procedures of the brain. PMID:18959455

Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer



Intact bridge tympanomastoidectomy (I.B.M.)--combining essential features of open vs. closed procedures.  


In recent years, closed cavity intact wall tympanomastoidectomy or combined approached tympanoplasty--(CAT)--has been described and recommended by many. The pendulum now appears to be swinging back again to open cavity tympanomastoidectomy. Pertinent literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with the achievement of a dry safe ear while a concomitant but secondary objective is hearing retention and restoration utilizing tympanoplasty techniques. Over a three-and-a-half year period we have utilized a one-stage procedure which provides the desirable objectives of both open and closed cavity tympanomastoidectomy called intact bridge tympanomastoidectomy (I.B.M.). The salient features include: (1) good exposure, as in open cavity tympanomastoidectomy; (2) maintaining and widening the middle-ear space by bony bridge retention and facial buttress sculpturing, to enhance grafting and ossiculoplasty such as TORP or PORP, as in canal up tympanomastoidectomy; (3) enhancement of mastoid obliteration for large cavities, by blocking the aditus with bone paté or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques and results are presented and discussed. The results have been gratifying to date. In comparison to intact wall tympanomastoidectomy, this one-stage operation avoids the cost and discomfort of a second and sometimes third stage; surgery for recurrent pathology has been avoided and hearing results have been at least comparable if not improved. PMID:6875358

Paparella, M M; Jung, T T



A New Approach to Restoring Root-End Cavity Preparation in Surgical Endodontic Procedures—A Scanning Electron Microscopy Study  

Microsoft Academic Search

While many different restorative materials are now available for filling root-end preparations in surgical endodontic therapy, each one has drawbacks. The current study suggests that a flowable composite resin, cured by a high-power curing light in 10 seconds, may be the material of choice. The significance of coating the resected root surface with a dentin-bonding agent is also discussed. Learning

Donald C. Yu


The Effects of Modeling on Learning a Simple Surgical Procedure: See One, Do One or See Many, Do One?  

Microsoft Academic Search

The effect of modeling a simple surgical task on the subsequent performance of pre-clinical medical students was investigated.\\u000a Groups of students read a verbal description of the excision of a skin lesion and closure of the resulting wound. Subsequently,\\u000a groups watched zero, one, or four videotapes in which expert surgeons demonstrated the task. Finally, students had to perform\\u000a the task

Eugène J. F. M. Custers; Glenn Regehr; Wendy McCulloch; Charles Peniston; Richard Reznick



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.



Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: A comparative study with open colectomy  

PubMed Central

The aim of the present study was to assess the short-term outcome and survival time of 166 obese patients who received laparoscopic and open colectomy for colorectal cancer (CRC) between January 2007 and December 2012. All 166 patients included in the study had a BMI >28. Laparoscopic or open colectomy procedures were performed on 64 and 102 patients, respectively. The short-term outcome and post-operative survival rates were compared. The patient characteristics were similar between the two groups. Laparoscopic colectomy correlated with an increased duration of surgery compared with open colectomy (183 vs. 167 min, respectively; P<0.05) but intraoperative blood loss was decreased (168 vs. 188 ml, respectively; P<0.05). Hospitalization costs were slightly higher following the laparoscopic procedure compared with open surgery, but this was affordable for the majority of patients (¥56,484 vs. ¥56,161, respectively; P<0.05). The incidence of wound infection (17 vs. 31%; P<0.05) and abdominal abscess rates (6 vs. 18%; P<0.05) were reduced in the laparoscopic group compared with the open group. Pathological characteristics were identified to be similar and no significant differences were identified in overall (log-rank test; P=0.85) and disease-free (log-rank test; P=0.85) survival between the two types of surgery (log-rank test; P=0.76). The current retrospective study demonstrated an improved short-term outcome in laparoscopic colectomy for CRC patients with a BMI >28 compared with patients who underwent the open procedure. Laparoscopic colectomy is technically and oncologically safe and must be popularized in obese CRC patients.




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


Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure  

PubMed Central

Background Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results The mean follow-up duration was 4.9±3.1 years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of 4.4±2.5 years of echocardiographic follow-up (p<0.001). Conclusion Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.

Lim, Ju Yong; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun



Diode Laser Transscleral Cyclophotocoagulation as a Primary Surgical Treatment for Primary Open-angle Glaucoma  

Microsoft Academic Search

Objectives: To evaluate the feasibility of diode laser trans- scleral cyclophotocoagulation (TSCPC) as a primary sur- gical treatment for primary open-angle glaucoma and to compare 2 laser energy settings used for treatment. Methods: In a prospective clinical trial in Cape Coast and Accra, Ghana, 1 eye of each of 92 patients with pri- mary open-angle glaucoma was treated by diode

Peter R. Egbert; Seth Fiadoyor; Donald L. Budenz; Patience Dadzie; Sally Byrd


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



Surgical pathology of atrial appendages removed during the cox-maze procedure: a review of 86 cases (2004 to 2005) with implications for prognosis.  


Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Some patients are managed surgically (Cox-maze procedure) with removal of 1 or both atrial appendages. A retrospective review was performed on surgically excised atrial appendages from 86 consecutive patients with AF (2004 to 2005), at Mayo Clinic in Rochester, MN. These were compared with atrial appendages removed from 2 autopsy control groups without a history of AF (26 without heart disease, and 20 with heart disease). Compared with the 2 control groups, appendages from patients with AF contained more myocyte vacuolization, fatty infiltration, and myocardial inflammation. Among the AF patients, left atrial appendages (LAA) were larger and more likely to show fatty infiltration, endocardial fibroelastosis, and mural thrombus than were right atrial appendages (RAA); in contrast, RAA were more likely to show myocyte hypertrophy and interstitial fibrosis than were LAA. In the LAA, myocyte hypertrophy and interstitial fibrosis were more often seen in patients with long-term AF recurrence than were those who remained in normal sinus rhythm postoperatively (P=0.045 and 0.036, respectively). Given the potential clinical relevance of these findings, it is recommended that the presence or absence of hypertrophy and fibrosis, and their extent, be incorporated into the surgical pathology report of all patients undergoing resection of an atrial appendage. PMID:23629441

Castonguay, Mathieu C; Wang, Yinong; Gerhart, Jacqueline L; Miller, Dylan V; Stulak, John M; Edwards, William D; Maleszewski, Joseph J



The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998-2004)  

PubMed Central

Background In 1998 a formal process using the criteria of safety, effectiveness and cost-effectiveness (evidence based medicine) on the introduction and use of new medical procedures was implemented in Australia. As part of this process an expert panel, the Medical Services Advisory Committee (MSAC) was set up. This paper examines the effectiveness of this process based on the original criteria, that is, evidence based medicine. Method The data for this analysis was sourced primarily from that made available in the public domain. The MSAC web site provided Minutes from MSAC meetings; Annual Reports; Assessment and Review reports; Progress status; and Archived material. Results The total number of applications submitted to the MSAC has been relatively low averaging approximately only fourteen per year. Additionally, the source of applications has quickly shifted to the medical devices, equipment and diagnostic industry as being the major source of applications. An overall average time for the processing of an application is eighteen months. Negative recommendations were in most cases based on insufficient clinical evidence rather than clinical evidence that clearly demonstrated a lack of clinical effectiveness. It was rare for a recommendation, either positive or negative, to be based on cost-effectiveness. Conclusion New medical procedures are often the result of a process of experimentation rather than formally conducted research. Affordability and the question of who should pay for the generation, collection and analysis of the clinical evidence is perhaps the most difficult to answer. This is especially the case where the new procedure is the result of a process of experimentation with an old procedure. A cost-effective way needs to be found to collect acceptable levels of evidence proving the clinical effectiveness of these new procedures, otherwise the formal processes of evaluation such as that used by the Australian MSAC since 1998 will continue to run the risk of committing Type II errors, that is, denying access to medical procedures that are beneficial and efficient.

O'Malley, Sue P



Primary pull-through for Hirschsprung's disease: comparison of open and laparoscopic-assisted procedures.  


Rectosigmoid Hirschsprung's disease is usually amenable to minimally invasive primary neonatal pull-through. This may be performed either entirely transanally or with laparoscopic assistance for biopsies with or without colonic mobilization. In our center, all dissection is performed transanally; laparoscopy is used for obtaining colonic biopsies and orientation of the pulled-through bowel segment. In this paper, we describe our initial experience of a consecutive cohort of 20 one-stage laparoscopic-assisted endorectal pull-through (LAEPT) procedures. A historic consecutive cohort of 22 infants who underwent the same open endorectal pull-through (OPT) with open transabdominal mobilization was used for comparison. Age at operation and mean theater time were not significantly different. The mean postoperative stay was significantly reduced in the laparoscopic group (LAEPT 3.8 days vs. OPT 9.5 days; P = 0.0002). Readmission and enterocolitis rates in the first postoperative year did not differ significantly. LAEPT permits early intraoperative biopsies with a visualization of the pull-through to prevent twisting of the bowel. PMID:18158815

Craigie, Ross J; Conway, Sarah J; Cooper, Louise; Turnock, Richard R; Lamont, Graham L; Baillie, Colin T; Kenny, Simon E



Central venous catheterization in neonates: Comparison of complications with percutaneous and open surgical methods  

PubMed Central

Aim: To compare the complications of two methods of placement of central venous catheters. Materials and Methods: One hundred neonates had percutaneously inserted central venous catheters and another 100 had the catheters placed after surgical incision and vein location. Results No statistical difference was noted in the complication rate or efficacy Conclusions Both the methods are equally safe and effective.

Hosseinpour, Mehrdad; Mashadi, Mohammad Reza; Behdad, Samin; Azarbad, Zohre



Long-term postoperative results in 54 cases of early gastric cancer: the choice of surgical procedure.  


Surgical experience on the management of early gastric carcinoma (EGC) related to a series of 54 subjects was observed from 1974 to 1984. Thirty-four patients were male, 20 were female; median age was 61.84 (range 22-79) years. Malignancy always occurred in the middle or distal third of the stomach. A partial subtotal gastrectomy (two-thirds of the stomach) with Roux en Y or Billroth II reconstruction was performed. Omentectomy and lymph node dissection of the primary and secondary groups of nodes, according to General Rules, was always performed. Age-corrected 5- and 10-year survival rates were 95.7% and 84.3%, respectively. Based on their experience, the authors discuss the surgical approach to EGC stressing the need for an accurate lymph node dissection and pointing out that results of subtotal gastrectomy are similar to that reported in the literature for total gastrectomy. The only absolute need for a total gastrectomy may be the presence of an EGC in the proximal third of the stomach. To this end the authors compare their results with 5- and 10-year series from Japanese and western countries reported in the literature. PMID:2792394

Percivale, P; Bertoglio, S; Muggianu, M; Aste, H; Secco, G B; Martines, H; Moresco, L; Cafiero, F



Successful outcome of modified quad surgical procedure in preteen and teen patients with brachial plexus birth palsy.  


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. PMID:23308301

Nath, Rahul K; Somasundaram, Chandra



[Non-heart surgical procedures in patients with mechanical valve prostheses. Experience with surgery in 38 patients].  


The authors discuss their own experience with noncardiac surgery in continuously Coumarine anticoagulant treated patients with mechanical valvular prostheses. Of 38 patients treated since 1986 were 12 operated under full Coumarine anticoagulant treatment, on eighteen patients were given Heparin preoperatively in a continual infusion, five patients were given an anti-agreggation dose of Heparin and other didn't receive any anticoagulant treatment. According to the authors' opinion it is safer to change the patients before the planned surgical treatment to intravenous Heparin. In case of urgent surgery it is, however, possible to operate also anticoagulant treated patients on. The authors in principle don't recommend K vitamin administration before surgery. Antibiotic prophylaxis before surgery is a matter of course. PMID:8191256

Lonský, V; Mandák, J; Rozsíval, V; Dominik, J



Surgical and catheter procedures in adult congenital heart disease: simple national statistics of the UK tell us something.  


Published national statistics for the last decade in the UK were utilized to figure out the reality of interventions in adolescents and adults with congenital heart disease. There was a clear indication of increase in the number of procedures of some specific types, such as pulmonary valve replacement and other heart valve surgery. Intervention for closure of inter-atrial communication was another entity that showed a marked rise in numbers during the last 10 years. Overall survival rates at 30 days and 1 year were encouraging, including those for relatively uncommon procedures. On the basis of growing understanding and meticulous investigation into every aspect of this field, clinical practice in adults with congenital heart disease is likely directed to a promising future. PMID:23737103

Uemura, Hideki



Surgical Treatments for Fibroids  


... NICHD Research Information Clinical Trials Resources and Publications Surgical Treatments for Fibroids Page Content If you have ... surgery may be the best treatment for you. Surgical treatments can be a major procedure or a ...


The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis  

PubMed Central

Background In the year 2000, the organizational structure of the ICU in the Zaandam Medical Centre (ZMC) changed from an open to a closed format ICU. The objective of this study was to evaluate the effect of this organizational change on outcome in high risk surgical patients. Methods The medical records of all consecutive high risk surgical patients admitted to the ICU from 1996 to 1998 (open format) and from 2003 to 2005 (closed format), were reviewed. High-risk patients were defined according to the Identification of Risk in Surgical patients (IRIS) score. Parameters studied were: mortality, morbidity, ICU length of stay (LOS) and hospital LOS. Results Mortality of ICU patients was 25.7% in the open format group and 15.8% in the closed format group (p = 0.01). Morbidity decreased from 48.6% to 46.1% (p = 0.6). The average length of hospital stay was 17 days in the open format group, and 21 days in the closed format group (p = 0.03). Conclusions High risk surgical patients in the ICU are patients that have undergone complex and often extensive surgery. These patients are in need of specialized treatment and careful monitoring for maximum safety and optimal care. Our results suggest that closed format is a more favourable setting than open format to minimize the effects of high risk surgery, and to warrant safe outcome in this patient group.



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



Effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures: a randomized, single-blind study.  


The purpose of this investigation was to evaluate the effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures. Forty-four adults scheduled for head and neck procedures were randomly assigned into 2 groups for this single-blind investigation. Anxiety and baseline pain levels were documented preoperatively. Both groups received 28 minutes of privacy, during which subjects in the experimental group listened to a guided imagery compact disk (CD), but control group patients received no intervention. Data were collected on pain and narcotic consumption at 1- and 2-hour postoperative intervals. In addition, discharge times from the postoperative anesthesia care unit (PACU) and the ambulatory procedure unit and patient satisfaction scores were collected. The change in anxiety levels decreased significantly in the guided imagery group (P = .002). At 2 hours, the guided imagery group reported significantly less pain (P = .041). In addition, length of stay in PACU in the guided imagery group was an average of 9 minutes less than in the control group (P = .055). The use of guided imagery in the ambulatory surgery setting can significantly reduce preoperative anxiety, which can result in less postoperative pain and earlier PACU discharge times. PMID:20572403

Gonzales, Eric A; Ledesma, Rachel J A; McAllister, Danielle J; Perry, Susan M; Dyer, Christopher A; Maye, John P



Is valgus unloader bracing effective in normally aligned individuals: implications for post-surgical protocols following cartilage restoration procedures.  


PURPOSE: Utilizing valgus unloader braces to reduce medial compartment loading in patients undergoing cartilage restoration procedures may be an alternative to non-weightbearing post-operative protocols in these patients. It was hypothesized that valgus unloader braces will reduce knee adduction moment during the stance phase in healthy subjects with normal knee alignment. METHODS: Gait analysis was performed on twelve adult subjects with normal knee alignment and no history of knee pathology. Subjects were fitted with an off-the-shelf adjustable valgus unloader brace and tested under five conditions: one with no brace and four with increasing valgus force applied by the brace. Frontal and sagittal plane knee angles and external moments were calculated during stance via inverse dynamics. Analyses of variance were used to assess the effect of the brace conditions on frontal and sagittal plane joint angles and moments. RESULTS: With increasing tension in the brace, peak frontal plane knee angle during stance shifted from 1.6° ± 4.2° varus without the brace to 4.1° ± 3.6° valgus with maximum brace tension (P = 0.02 compared with the no brace condition). Peak knee adduction moment and knee adduction impulse decreased with increasing brace tension (main effect of brace, P < 0.001). Gait velocity and sagittal plane knee biomechanics were minimally affected. CONCLUSION: The use of these braces following a cartilage restoration procedure may provide adequate protection of the repair site without limiting the patient's mobility. LEVEL OF EVIDENCE: Therapeutic prospective comparative study, Level II. PMID:22898913

Orishimo, Karl F; Kremenic, Ian J; Lee, Steven J; McHugh, Malachy P; Nicholas, Stephen J



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



A Surgical Algorithm Using Open Rhinoplasty for Correction of Traumatic Twisted Nose  

Microsoft Academic Search

Hsiao and colleagues have presented a simple, clear, and effective algorithm for managing the traumatic twisted nose. Their results are excellent and exemplary of a sound approach to a difficult problem. Their argument for the management of these cases using an open approach is sensible and in line with the practice of many rhinoplasty surgeons. The results for 92 patients

Farzad R. Nahai



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



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.



Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial  

Microsoft Academic Search

Background: The objective of this study was to determine the long-term outcome of laparoscopic and open therapies for acute abdomen, and to assess the patients postoperative quality of life, with special attention to adhesions. Methods: A follow-up study was conducted from June through December 2001 of a case-control trial of laparoscopic and open surgical treatment in patients with acute abdomen.

W. D. Majewski



Management of localized gingival recession by two-stage surgical procedure - Double pedicle flap with CTG and coronally advanced flap: A novel technique  

PubMed Central

Cosmetic treatments have become an integral part of periodontal treatment. One of the commonly used esthetic periodontal procedures is coverage of denuded root surface. While considering the elimination of these defects two criteria should be considered, the esthetic aspects and the functional aspects. This case report has describes a two stage surgical technique using double pedicle flap with connective tissue graft followed by coronally advanced flap for the treatment of a severe localized gingival recession measuring 15 mm. The recession measurement at the end of 12 months was 1 mm. It showed a predictable result at the end of one year. The advantages of this technique are excellent colour matching, dual blood supply to graft and very predictable results. The promising result suggest that this technique can be used in severe gingival recession cases with minimum amount of keratinized tissue.

Prasanth, T.



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


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



Advantages of Robot-Assisted Laparoscopic Radical Prostatectomy in Obese Patients: Comparison with the Open Procedure  

PubMed Central

Purpose Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP). Materials and Methods From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups. Results In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP. Conclusions RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment.

Bae, Jae Jun; Choi, Seok Hwan; Kwon, Tae Gyun



One-step surgical procedure for the treatment of osteochondral defects with adipose-derived stem cells in a caprine knee defect: a pilot study.  


Regenerative therapies offer attractive alternatives for the treatment of osteochondral defects. Adipose-derived stromal vascular fraction (SVF) cells allow the development of one-step surgical procedures by their abundant availability and high frequency. In this pilot study we evaluated the in vivo safety, feasibility, and efficacy of this concept using scaffolds seeded with freshly isolated (SVF) or cultured adipose stem cells (ASCs), and compared these to their acellular counterparts. Osteochondral defects were created in medial condyles and trochlear grooves in knees of eight goats. Defects were filled with acellular collagen I/III scaffolds or scaffolds seeded with SVF cells or cultured ASCs. Osteochondral regeneration was evaluated after 1 and 4 months by macroscopy, immunohistochemistry, biomechanical analysis, microCT analysis, and biochemistry. After 1 month, no adverse effects were noted. Microscopic, but not macroscopic evaluation showed considerable yet not significant differences, with cell-loaded constructs showing more extensive regeneration. After 4 months, acellular constructs displayed increased regeneration, however, to a lesser degree than cell-treated constructs. The latter exhibited more extensive collagen type II, hyaline-like cartilage, and higher elastic moduli, and their glycosaminoglycan content in the cartilaginous layer better approached native tissue values. Moreover, their defect regions contained higher levels of regenerated, mature subchondral bone with more intense collagen type I staining. SVF cells tended to perform best on all parameters. In summary, this pilot study demonstrated the preclinical safety and feasibility of a one-step surgical procedure for osteochondral defect regeneration. Similar regeneration was found between freshly isolated SVF cells and cultured ASCs. Larger studies with longer follow-up are required to substantiate these findings. PMID:23914338

Jurgens, Wouter J F M; Kroeze, Robert Jan; Zandieh-Doulabi, Behrouz; van Dijk, Annemieke; Renders, Greetje A P; Smit, Theo H; van Milligen, Florine J; Ritt, Marco J P F; Helder, Marco N



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



Overall Essen's experience with the E-vita open hybrid stent graft system and evolution of the surgical technique  

PubMed Central

Background The hybrid stent graft prosthesis E-vita open was designed and introduced by us in 2005 to avoid a two-stage surgical approach in the surgical treatment of complex thoracic aortic disease. Experience in ascending aortic and arch replacement with simultaneous stent grafting of the descending aorta was accumulated over the past 8 years. Facilitation of surgical technique by moving the distal suture line from Zone 3 into Zone 2 took place in 2009. We report our mid-term single-center experience comparing both surgical periods. Methods Between January 2005 and July 2013 a total of 132 patients (mean age 59±11 years) underwent one stage surgery for acute (AAD, n=74), chronic aortic dissection (CAD, n=35) or an extensive thoracic aortic aneurysm (TAA, n=23). Patients were separated in two groups according to distal anastomosis level in Zone 2 (Z2, 41/132) and Zone 3 (Z3, 91/132). Outcome, ischemic and operative times as well as adverse events were monitored during follow up. Results Overall in-hospital mortality was 13% (17/132) without difference between the groups. However, Zone 2 anastomosis resulted in reduction of cardioplegic arrest (117±39 vs. 147±35 minutes; P<0.001), selective cerebral perfusion (52±15 vs. 68±18 minutes; P<0.001) and visceral ischemic time (51±19 vs. 72±23 minutes; P<0.001). The incidence of postoperative temporary hemodialysis decreased from 40% to 20% in Z2 (P=0.028), postoperative re-exploration rate from 15% to 2% (P=0.037). No difference was found in dissection with complete false lumen thrombosis in 83% (90/109) within 10 days, as well as in TAA, where 100% aneurysm exclusion was observed. Three-year survival, freedom from thoracoabdominal aortic surgery and endovascular repair was 93%, 88%, 88%, respectively. Overall 5-year survival was 76% in AAD, 85% in CAD and 79% in TAA patients. Conclusions The dimension of surgery could be successfully reduced, indicated by significantly shortened ischemic times and postoperative complications. Durable one-stage repair of complex thoracic aortic disease could be achieved in the majority of cases with acceptable mortality. Distal reintervention is infrequent but associated with low risk when indicated.

Dohle, Daniel; Benedik, Jaroslav; Lieder, Helmut; Jakob, Heinz



Evaluation of combinations of procedures in cesarean section  

Microsoft Academic Search

Objective: To evaluate a procedure for cesarean section, consisting of a number of surgical techniques adopted from various sources and further developed. Methods: The principal elements of the cesarean section procedure followed were: the Joel-Cohen method for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. The postoperative recovery of women

M. Stark; Y. Chavkin; C. Kupfersztain; P. Guedj; A. R. Finkel



Formal teaching of surgical skills in an obstetric-gynecologic residency  

Microsoft Academic Search

Objective: To describe a formal teaching program of basic surgical skills in an obstetric-gynecologic residency program and evaluate its effectiveness.Methods: A surgical skills program was developed for all residents. Using bench and animal laboratory sessions, residents were given instruction and performed both laparoscopic and open abdominal procedures. All were given a pretest and were tested again 6 months later. Residents

Barbara A Goff; Gretchen M Lentz; David M Lee; Lynn S Mandel



An interdisciplinary approach to the rehabilitation of open-heart surgical patients.  


Quite often nurses in environments other than the immediate postoperative setting are responsible for the well-being of patients who have had open-heart surgery (OHS). These patients may be admitted to rehabilitation or home healthcare settings as early as 1 week after surgery. They may be deconditioned because of postoperative complications such as a cerebrovascular accident or cardiopulmonary compromise. Rehabilitation nurses in inpatient or home health environments are key members of the interdisciplinary team in terms of establishing standards of care for OHS patients after surgery. Coordinating care within an interdisciplinary team reduces fragmentation of care, improves patient outcomes, and enhances patient, family, staff, and physician satisfaction. This article focuses on empowering rehabilitation nurses as leaders and members of interdisciplinary teams as they establish standards for coordinating the postoperative care of OHS patients. PMID:10410056

Carbone, L M


Revisiting open capsuloplasty for the treatment of anterior shoulder instability: 35-year follow-up of the Du Toit procedure  

Microsoft Academic Search

The Du Toit open capsuloplasty for the treatment of anterior shoulder instability is based on the concept of restoring joint\\u000a stability by recreating the integrity of the anterior glenoid labrum and inferior gleno-humeral ligament using staples. The\\u000a long-term validity of this procedure for the treatment of anterior shoulder instability was retrospectively assessed by a\\u000a clinical or telephone interview and radiographic

Stefano Zaffagnini; Alessandro Russo; Leonardo Marchesini Reggiani; Francesco Iacono; Giuseppe Filardo; Marco Delcogliano; Andrea Visani; Maurilio Marcacci



Abortion - surgical  


Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion uses a vacuum to remove the fetus and related pregnancy material from the uterus. The ...


New methods for image guidance and visualization for cardiac procedures  

NASA Astrophysics Data System (ADS)

Interventional cardiac MRI has been undergoing rapid development because of the availability of MRI compatible interventional catheters, and the increased performance of the MRI systems. Intravascular techniques do not require an open access scanner, and hence higher imaging performance during procedures can be achieved. Now, with the availability of a short, relatively open cylindrical bore scanner high imaging performance is also available to guide direct surgical procedures.

Guttman, Michael A.; McVeigh, Elliot R.



The open brow lift.  


The open brow lift procedure is discussed in terms of relevant surgical anatomy, preoperative evaluation, and detailed surgical technique for pretrichial coronal forehead lift with hair-bearing temporal lift, direct incisional brow lift, and coronal brow lift. Complications are discussed, and information is presented on patient evaluation and expectations, with a discussion of what patients can expect before and after brow lift surgery. PMID:23186761

Walrath, Joseph D; McCord, Clinton D



“Advanced surgical imaging”  

Microsoft Academic Search

Minimally invasive surgical procedures using laparoscopes have certain benefits in that the surgical incisions are smaller and therefore heal quicker with less post-operative pain. The disadvantages of laparoscopic procedures are technical in nature; there is a loss of tactile feedback and loss of three-dimensional assessment. We have examined both visible and infrared imaging technology to enhance the assessment of anatomic

D. Tadaki



A new procedure for Roothaan's symmetry-restricted open-shell SCF method  

Microsoft Academic Search

Roothaan's symmetry-restricted open-shell SCF method is derived without the use of lagrangian multipliers for a general case of one open shell per symmetry. A single Fock operator is formulated converging to the same eigenfunctions and eigenvalues as obtained by the standard double- eigenvalue method of Roothaan. Comparisons are made with other formulations of the method, and test calculations are provided

Knut Fægri Jr.; Rolf Manne



Surgical helmet systems.  


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



Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression.  


BACKGROUND: Entrapment of the suprascapular nerve (SSN) at the spinoglenoid notch (SGN) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can result. We describe the technique of open SSN decompression at the SGN for infraspinatus involvement and report the results of a consecutive series. MATERIALS AND METHODS: Twenty-nine shoulders underwent SSN decompression at the SGN. The mean age was 44 years (range, 15-69 years), and the mean follow-up was 4.3 years (range, 1-7 years). On manual muscle testing, ER strength was abnormal in all patients: 2/5 in 3, 3/5 in 21, and 4/5 in 5. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 48 (range, 23-83). Atrophy of the infraspinatus was visible or palpable in 72% of shoulders. Magnetic resonance imaging showed ganglion cysts at the SGN in only 20.7% of shoulders. RESULTS: Of the patients, 19 (66%) regained full ER strength, 9 (31%) improved to 4/5, and 1 (3%) had ER strength of 3/5. The mean ASES score improved to 75 (range, 60-100) (P < .05). Of 29 shoulders, 23 (79%) showed improved ER strength within 1 week of surgery. All ganglion cyst cases regained full ER strength within a mean of 6 weeks. In all cases, ER strength improved by at least 1 full strength grade. DISCUSSION: A ganglion cyst is not necessary to produce SSN compression at the SGN. SSN compression at the SGN can present as an isolated entity or can occur in conjunction with rotator cuff pathology or a ganglion cyst. An index of suspicion, physical examination, magnetic resonance imaging, and electromyography confirm the diagnosis. The described operative approach detaches no muscle and allows rapid recovery, and in all cases, ER strength improved to normal or by 1 full grade. PMID:23664748

Mall, Nathan A; Hammond, James E; Lenart, Brett A; Enriquez, Daniel J; Twigg, Stacy L; Nicholson, Gregory P



The effect of different surgical drilling procedures on full laser-etched microgrooves surface-treated implants: an experimental study in sheep.  


OBJECTIVES: To evaluate the influence of instrumentation technique on the early osseointegration histomorphometrics and biomechanical fixation of fully laser-etched microgrooves implant surfaces in a sheep model. MATERIAL AND METHODS: Six sheep were subjected to bilateral hip surgeries 3 and 6 weeks before euthanasia. A total of 48 implants (?4.5 mm, 8 mm in length) were distributed among four sites (8 per animal) and placed in bone sites drilled to 4.6 mm (reamer), 4.1 mm (loose), 3.7 mm (medium) and 3.2 mm (tight) in diameter. After healing, the animals were euthanized and half of the implants were biomechanically tested, while the remainder was subjected to non-decalcified histologic processing. The histomorphometric parameters assessed were bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Statistical analysis was performed using a mixed-model analysis of variance with significance level set at P < 0.05. RESULTS: A general increasing trend is present from 3 to 6 weeks for most of the variables. The groups prepared to be press fit seemed to present higher values, which were maintained throughout the observation period. The reamer group presented the lowest BIC probably due to the drilling technique; however qualitatively, more new bone seemed to be in contact to the implant surface, at 3 weeks, whereas the implants placed in press-fit situations were mainly supported by cortical bone. CONCLUSION: The laser-etched microgrooved implant presented osteoconductive and biocompatible properties for all surgical procedures tested. However, procedures providing increasingly higher press-fit scenarios presented the strongest histomorphometric and biomechanical responses at 3 and 6 weeks. PMID:23772753

Jimbo, Ryo; Tovar, Nick; Yoo, Daniel Y; Janal, Malvin N; Anchieta, Rodolfo B; Coelho, Paulo G



Periodontal Treatments and Procedures  


... are also experts in replacing missing teeth with dental implants. Non-Surgical Treatments Gum Graft Surgery Laser Treatment Regenerative Procedures Dental Crown Lengthening Dental Implants Pocket Reduction Procedures Plastic Surgery Procedures Members Only ...


Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures--New York City, March 1993-June 1994.  


Infections with bloodborne pathogens resulting from exposures to blood through percutaneous injuries (PIs) (e.g., needlestick injuries and cuts with sharp objects) are an occupational hazard for health-care workers (HCWs). PIs have been reported during 1% - 15% of surgical procedures, mostly associated with suturing. Most suturing is done using curved suture needles, although straight needles are used by some surgeons for suturing skin. Blunt suture needles (curved suture needles that have a relatively blunt tip) may be less likely to cause PIs because they do not easily penetrate skin. Based on small studies and anecdotal experience, blunt suture needles appear able to replace conventional curved suture needles for suturing many tissues, although they may require more pressure to penetrate the tissues. This report summarizes results of a study in which CDC collaborated with three teaching hospitals in New York City during 1993-1994 to evaluate a safety device (a blunt suture needle) in gynecologic surgery. The findings indicate that use of blunt needles was associated with statistically significant reductions in PI rates, minimal clinically apparent adverse effects on patient care, and general acceptance by gynecologic surgeons in these hospitals. PMID:9011779



Surgical anatomy of the floor of the oral cavity and the cervical spaces as a rationale for trans-oral, minimal-invasive endoscopic surgical procedures: results of anatomical studies.  


Over the past 10 years, several minimally invasive procedures for thyroid surgery have been developed. Because of extensive dissection in the thoracic and neck region, the name "minimal-invasive" is misleading. The aim of this study was to define a new trans-oral access to the cervical spaces especially to the thyroid on the basis of natural orifice surgery. Three embalmed human specimens were dissected for complete review of the anatomical situation in the cervical region. In additional five fresh frozen human specimens after an experimental trans-oral endoscopic minimally invasive thyroidectomy the anatomical structures of the floor of the oral cavity as well as the anterior neck region were evaluated. It was possible to create a working space under the platysma muscle with respect to the surgical planes of the neck and fascial layers. Within this area, the pretracheal region can be reached and the thyroid gland can be visualized and resected. To access the working space, a trocar for endoscopic view is placed medially in the floor of the oral cavity sublingually. The trocar passes the muscles of the floor of the oral cavity easily without relation to relevant anatomical structures. A first exclusively sublingual approach had to be abandoned because triangulation of the instruments could not be reached. Therefore, the approach was modified by positioning the working trocars in the oral vestibule bilaterally. By this way, a road map for accessing all anterior cervical regions directly under the platysma muscle could be established and anatomical landmarks and areas of possible collateral damage could have been defined. This combined sublingual and bi-vestibular trans-oral endoscopic approach enables an easy access to all structures and spaces of the anterior neck region with respect to anatomical preformed layers neck, even to the thyroid as one of the more distant structures. PMID:20179955

Wilhelm, Thomas; Harlaar, Joris J; Kerver, Anton; Kleinrensink, Gert-Jan; Benhidjeb, Tahar



Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial  

Microsoft Academic Search

The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin–clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin–clavulanic acid 2 hours before operation, and group

Mehmet A. Kuzu; Selçuk Hazinedaro?lu; ?ükrü Dolalan; Nam?k Özkan; Samet Yalç?n; A. Bülent Erkek; Hatem Mahmoudi; Acar Tüzüner; Atilla H. Elhan; Ercümet Kuterdem



Long-Term Surgical Recurrence, Morbidity, Quality of Life, and Body Image of Laparoscopic-Assisted vs. Open Ileocolic Resection for Crohn's Disease: A Comparative Study  

PubMed Central

Purpose Several studies have compared conventional open ileocolic resection with a laparoscopic-assisted approach. However, long-term outcome after laparoscopic-assisted ileocolic resection remains to be determined. This study was designed to compare long-term results of surgical recurrence, quality of life, body image, and cosmesis in patients who underwent laparoscopic-assisted or open ileocolic resection for Crohn’s disease. Methods Seventy-eight consecutive patients who underwent ileocolic resection during the period 1995 to 1998 were analyzed; 48 underwent a conventional open approach in the Academic Medical Centre (Amsterdam, The Netherlands) and 30 underwent a laparoscopic-assisted approach in the Leiden University Medical Centre (Leiden, The Netherlands). Primary outcome parameters were reoperation and readmission rate. Secondary outcome parameters were quality of life, body image, and cosmesis. Results The two groups were comparable for characteristics of sex, age, and immunosuppressive therapy. Seventy-one patients had a complete follow-up of median 8.5 years. Resection for recurrent Crohn’s disease was performed in 6 of 27 (22 percent) and 10 of 44 (23 percent) patients in the laparoscopic and open groups, respectively. Reoperations for incisional hernia were only performed after conventional open ileocolic resection (3/44?=?6.8 percent). Quality of life and body image were comparable, but cosmesis scores were significantly higher in the laparoscopic group. Conclusions Despite small numbers, we found that surgical recurrence and quality of life after laparoscopic-assisted and open ileocolic resection were comparable. Incisional hernias occurred only after open ileocolic resection, and laparoscopic-assisted ileocolic resection resulted in a significantly better cosmesis.

Eshuis, Emma J.; Polle, Sebastiaan W.; Slors, J. Frederik; Hommes, Daan W.; Sprangers, Mirjam A. G.; Gouma, Dirk J.



Clinical evaluation of an end-tidal target-controlled infusion closed-loop system for isoflurane administration in horses undergoing surgical procedures.  


A new volatile anaesthetic agent delivery system was tested in 15 horses undergoing scheduled surgical procedures. The delivery system consisted of a laptop computer (with dedicated software), a computer-controlled syringe driver (loaded with liquid isoflurane) connected to the inspiratory arm of a large-animal circle breathing system and a respiratory gas monitor, providing isoflurane end-tidal concentrations (ET(measured)) every 20 s to the computer. Following induction and connection to the breathing system, mechanical ventilation was started. The bodyweight (BW), fresh gas flow, breathing system and ventilator volume, and end-tidal isoflurane target (ET(target)) were entered into the computer. Using Lowe's equation, the software calculated the prime dose to be delivered by the syringe driver over 2 min. After this, the system delivered each minute the amount of isoflurane as determined by the following equation: Isoflurane (mL) = {2 × ?(B/G) × (200 × BW(0.75)) × (ET(target) - ET(measured)) + (fresh gas flow - (BW(0.75) × 0.07)) × (ET(measured))}/206. A fresh gas flow of 4 L oxygen min(-1) was administered until the inspired fraction of oxygen reached 0.7, and was then decreased. A target of 1.5% end-tidal isoflurane was initially used and subsequently adjusted to the clinical requirements. The system performance was evaluated using the median prediction error (MDPE) and the median absolute performance error (MDAPE), which were -3.6% and 5.29%, respectively. It was concluded that this system was useful to achieve end-tidal target-controlled infusion of isoflurane during equine anaesthesia. PMID:21741863

Franci, Paolo; Bertamini, Andrea; Bertamini, Oscar; Pilla, Tommaso; Busetto, Roberto



The emergent surgical airway: cricothyrotomy vs. tracheotomy.  


The American Society of Anesthesiologists difficult airway algorithm identifies two acceptable emergency surgical airways in the 'cannot intubate, cannot ventilate' scenario: cricothyrotomy and tracheotomy. Little has been published regarding the emergency surgical airway practices at different institutions. The authors investigated whether the primary choice of emergency surgical airway at a major level I trauma centre was cricothyrotomy or tracheotomy. A retrospective chart review was conducted of emergency airways performed over 6 years using relevant current procedural terminology codes. The electronic medical records obtained were reviewed to ensure accurate coding and verify the emergent nature of the procedure. Over the study period, there were 4312 documented emergent airways. 3197 (74.1%) were field intubated by paramedics, 1081 (25.1%) were hospital intubated by anaesthesia, 34 (0.008%) required emergency surgical access of which 24 were tracheotomies and 10 cricothyrotomies. Despite the emphasis in resident training and Advanced Trauma Life Support, there was a paucity of cricothyrotomies during the study period. At the authors' institution, tracheotomy is preferentially used as the emergency surgical airway. A multicentre prospective study is recommended to evaluate current practice in emergency surgical airway and to include the emergency open tracheotomy in residency training and continuing education if needed. PMID:23265756

Dillon, J K; Christensen, B; Fairbanks, T; Jurkovich, G; Moe, K S



A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results  

Microsoft Academic Search

PurposeTo achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal hernia repair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined.

Hitoshi Ikeda; Masahiro Hatanaka; Makoto Suzuki; Junko Fujino; Kazunori Tahara; Yuki Ishimaru



Open Hole Packer and Running Procedure for Hot Dry Rock Reservoir Testing.  

National Technical Information Service (NTIS)

An acute need for open hole packers for high pressure, high temperature operations at the Fenton Hill, Hot Dry Rock (HDR) Geothermal Site has existed since 1981. Cemented-in-liners were used instead of packers while packer technology was brought up to HDR...

D. S. Dreesen J. R. Miller



Use of Matrix Sampling Procedures to Assess Achievement in Solving Open Addition and Subtraction Sentences.  

ERIC Educational Resources Information Center

|This study investigated the feasibility of concurrently and randomly sampling examinees and items in order to estimate group achievement. Seven 32-item tests reflecting a 640-item universe of simple open sentences were used such that item selection (random, systematic) and assignment (random, systematic) of items (four, eight, sixteen) to forms…

Montague, Margariete A.


Surgical Instrument Restraint in Weightlessness.  

National Technical Information Service (NTIS)

Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood...

D. Hooker D. L. Dawson H. Cantu M. R. Campbell S. Melton



Hallux valgus correction using combined reverdin-laird and opening base wedge procedures: a radiographic analysis.  


A retrospective review of 7 patients (8 total feet) was conducted by the authors to determine the effects of combined 1st metatarsal Reverdin-Laird and opening base wedge osteotomy in the management of hallux valgus deformity. Postoperative radiographs were compared with preoperative radiographs for improvement in the 1st intermetatarsal angle, proximal articular set angle, hallux abductus angle, and tibial sesamoid position. PMID:23827496

Dennis, Lester; Snyder, Jason; Khan, Tahir



Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: Preliminary experience  

Microsoft Academic Search

ObjectiveTo evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids.

Cécile Malartic; Olivier Morel; Yann Fargeaudou; Olivier Le Dref; Afchine Fazel; Emmanuel Barranger; Philippe Soyer


Apparatus and Methods for Monitoring Heart Rate and Respiration Rate and for Monitoring and Maintaining Body Temperature in Anesthetized Mammals Undergoing Diagnostic or Surgical Procedures.  

National Technical Information Service (NTIS)

The invention relates to an apparatus for measuring the heart rate and the respiration rate of one or more anesthetized rodent while monitoring and maintaining body temperature of at least one or more anesthetized rodent during diagnostic or surgical proc...

A. D. Jones A. K. Reddy C. J. Hartley S. Madala



Application of prophylactic gel-pads for transcutaneous pacing in patients with complete right bundle-branch block with axis deviation when surgical procedures are performed: 10-year experience from a single Japanese university hospital  

Microsoft Academic Search

This retrospective study aimed to determine whether prophylactic transcutaneous pacing is required for patients with complete\\u000a right bundle-branch block (CRBBB) and axis deviation (AD), so-called bifascicular block, when surgical procedures are performed\\u000a under general or local anesthesia. The authors reviewed 34 063 anesthesia cases that took place at Nara Medical University\\u000a Hospital during a 10-year period (1996–2005). The anesthesia records

Aki Okamoto; Satoki Inoue; Yu Tanaka; Masahiko Kawaguchi; Hitoshi Furuya



A Questionnaire Elicitation of Surgeons' Belief about Learning within a Surgical Trial  

PubMed Central

Introduction Surgeons gain expertise as they repeatedly conduct a procedure. Such learning is widely acknowledged to pose a challenge to evaluating new surgical procedures. Most surgical trials report little if any information on learning. We elicited surgeons’ belief regarding learning within the context of a randomised trial which assessed two surgical procedures. Materials and Methods Surgeons participating in the UKUFF trial were sent a postal questionnaire requesting details on current practice, prior experience and their belief regarding acquiring proficiency and the learning curve of operation time for two surgical procedures (open and arthroscopic rotator cuff repair). Results In total 52 (58%) participating surgeons returned a completed questionnaire. The median (IQR) number of procedures required to acquire proficiency were 17 (10,23) and 35 (23,50) for the open and arthroscopic repairs respectively. The distribution of surgeons’ belief regarding the initial point had median (IQR) of 109 (69,128) and 145 (97,171) minutes for open and arthroscopic repair respectively. Corresponding values for the plateau point were 60 (46, 82) and 79 (58, 110). Conclusions We have shown that information on the current practice, prior experience and beliefs on the learning process of a surgical procedure can be elicited using a short questionnaire. The approach could aid the interpretation of trial results in terms of generalisability and be used a priori in the design of a trial.

Cook, Jonathan A.; Ramsay, Craig R.; Carr, Andrew J.; Rees, Jonathan L.



Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of postoperative surgical wounds.  


Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications like blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post-Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P?=?0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower total treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs associated with treating SSI and other wound complications associated with gauze and tape dressings. PMID:23742125

Abejón Arroyo, Ana; López Casanova, Pabló; Verdú Soriano, José; Torra I Bou, Joan-Enric



Morbid obesity: a surgical perspective.  


Morbid obesity is a chronic illness of multifactorial aetiology which is defined as Body Mass Index (BMI) greater than 40 kg/sq.m. Non-surgical treatments for this condition have been shown to be ineffective. Surgery is the only effective treatment and obtains the best long-term outcomes. Surgery is indicated when BMI is greater than 40, or BMI is greater than 35 with significant associated co-morbidities. Four types of operations are currently performed: restrictive, malabsorptive, combined procedures (malabsorptive-restrictive) and motility-reducing pro-cedures. With restrictive procedures (adjustable gastric banding and vertical banded gastroplasty), patients can expect a long-term excess weight loss of 44-68%; for combined procedures (Roux-en-Y gastric by-pass) this is 60-70%, whereas for malabsorptive procedures (bilio-pancreatic diversion with or without duodenal switch), this is 75-80%. Intra-gastric stimulation is the least invasive treatment, but induces the lowest excess weight loss (32%) in the first two years after the operation. Gastric banding offers the best results when balancing risks and benefits. All procedures are now performed laparoscopically with comparable results to open surgery. The overall mortality rate in specialized centers is less than 0.3%. Different techniques are indicated according to BMI and the patient's eating habits. Surgery for morbid obesity has proved to improve quality of life and significantly reduce associated co-morbidities. PMID:15990935

Lunca, Sorinel; Per?ea, Mihaela; Bouras, George; Dumitru, Leonard; Hatjissalatas, Spyridon G



High-resolution computed tomography of the middle ear and mastoid. Part III. Surgically altered anatomy and pathology  

SciTech Connect

High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.

Swartz, J.D.; Goodman, R.S.; Russell, K.B.; Ladenheim, S.F.; Wolfson, R.J.



42 CFR 419.44 - Payment reductions for procedures.  

Code of Federal Regulations, 2012 CFR

...reductions for procedures. (a) Multiple surgical procedures. When more than one surgical procedure for which payment is made under...payment system is performed during a single surgical encounter, the Medicare program payment...



Living donor liver transplantation for Budd-Chiari syndrome with hepatic inferior vena cava obstruction after open pericardial procedures.  


Living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) presents a unique challenge as it does not involve replacement of the hepatic inferior vena cava (IVC). We report a case of successful LDLT in a patient with BCS associated with occlusion of the hepatic veins as well as the IVC. A 34-year-old woman with a history of two open pericardial procedures had decompensated liver failure and portal hypertension. Venography showed complete obstruction of the hepatic IVC and well-developed collateral vessels. We performed LDLT via sternotomy and laparotomy, with an end-to-end anastomosis between the left hepatic vein of the donor and the patient's suprahepatic vena cava in the pericardium. The patient recovered uneventfully and has been doing well for 5 years. LDLT without caval replacement for BCS in a patient with hepatic IVC obstruction is feasible if the patient has good functional collaterals before liver transplantation. PMID:23188387

Fukuda, Akinari; Ogura, Yasuhiro; Kanazawa, Hiroyuki; Mori, Akira; Kawaguchi, Michiya; Takada, Yasutsugu; Uemoto, Shinji



Image-guided spinal injection procedures in open high-field MRI with vertical field orientation: feasibility and technical features  

Microsoft Academic Search

Objective  We prospectively evaluated the feasibility and technical features of MR-guided lumbosacral injection procedures in open high-field\\u000a MRI at 1.0 T.\\u000a \\u000a \\u000a \\u000a Methods  In a CuSO4·5H2O phantom and five human cadaveric spines, fluoroscopy sequences (proton-density-weighted turbo spin-echo (PDw TSE), T1w TSE,\\u000a T2w TSE; balanced steady-state free precession (bSSFP), T1w gradient echo (GE), T2w GE) were evaluated using two MRI-compatible\\u000a 20-G Chiba-type needles. Artefacts were

F. Streitparth; T. Walter; U. Wonneberger; S. Chopra; F. Wichlas; M. Wagner; K. G. Hermann; B. Hamm; U. Teichgräber



Postoperative cardiac surgical care: an alternative approach  

PubMed Central

Combined appropriate anaesthetic and surgical techniques have allowed increasing numbers of patients to be successfully managed in a general surgical recovery ward after cardiac surgery rather than in an intensive care unit. From 1983 to 1989, 933 of 1542 patients undergoing open heart surgery were transferred to the general surgical recovery ward in the immediate postoperative period. Of these, 718 (77%) had undergone coronary artery bypass grafts, sometimes combined with other procedures and 168 (18%) had had cardiac valve replacements with or without other procedures. The remaining 47 (5%) had had miscellaneous cardiac operations. Significant cardiac complications occurred in 29 (3%) patients. The 24 hour chest radiograph was reported as abnormal (mainly atelectasis and effusion) in 63% of patients. Most resolved spontaneously or with physiotherapy. Twenty nine (3%) patients were re-explored to achieve haemostasis. There were no deaths in the general surgical recovery ward. Thirty seven (4%) patients had to be transferred to the intensive care unit for various reasons. The remaining 896 patients were transferred to the general ward after one night (871 patients) or two nights (25 patients) in the general surgical recovery ward. The average duration of stay in hospital for these patients was 9·3 days. Because of the overall success of such management and the low rate of complications over 80% of patients are now managed in the general surgical recovery ward after open heart surgery. The resulting savings in capital expenditure of equipment, medical, nursing, and technical personnel are substantial, and there are major implications for the planning of new cardiothoracic units.

Jindani, A; Aps, C; Neville, E; Sonmez, B; Tun, K; Williams, B T



Haptics-constrained motion for surgical intervention.  


Current open-heart procedures requiring the use of a medial sternotomy and a heart-lung machine can potentially be performed by entering the heart through the cardiac wall. A new procedure in cardiac surgery involves introducing an ablation tool through the appendage of the left atrium. This method, intended for the treatment of atrial fibrillation, septal defect repair and valve replacement, provides increased control over the ablating instrument. It is believed that this procedure will ultimately be performed under robotic control and image-guidance provided by intra-cardiac ultrasound. However, the intra-cardiac guidance presents several drawbacks, such as limited field of view, temporary loss of signal, and, in some cases, difficulty with interpreting the signal. We believe that the introduction of haptic feedback into this environment will enhance the procedure by providing tactile cues to assist in the location of the surgical targets. PMID:17377307

Ren, Jing; Zhang, Huaijing; Patel, Rajni V; Peters, Terry M



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


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



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.  


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



40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...  

Code of Federal Regulations, 2010 CFR

...for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft...the performance of the open biological treatment unit. E. Determination...Environment Canada's Wastewater Technology Centre and Environmega, Ltd...determine KL for the open biological treatment unit with the...



40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...  

Code of Federal Regulations, 2010 CFR

...for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft...the performance of the open biological treatment unit. E. Determination...Environment Canada's Wastewater Technology Centre and Environmega, Ltd...determine KL for the open biological treatment unit with the...



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



Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures  

Microsoft Academic Search

Purpose  To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures\\u000a and suggest a model for classification of the procedures.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Review of literature, critical analysis of data and tentative model for reducing infectious complications.\\u000a \\u000a \\u000a \\u000a Results  Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the

Magnus Grabe; Henry Botto; Mete Cek; Peter Tenke; Florian M. E. Wagenlehner; Kurt G. Naber; Truls E. Bjerklund Johansen


Do trading rules impact on market efficiency? A comparison of opening procedures on the Australian and Jakarta Stock Exchanges  

Microsoft Academic Search

This paper examines the impact of opening rules on stock market efficiency. In particular, it contrasts the opening call on the Australian Stock Exchange (ASX) and the continuous open on the Jakarta Stock Exchange (JSX). The results suggest that the use of a call enhances market efficiency by increasing liquidity and lowering volatility at the open. The results also indicate

Carole Comerton-Forde



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.



Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

PurposeFor a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our




Selective opening of mitochondrial ATP-sensitive potassium channels during surgically induced myocardial ischemia decreases necrosis and apoptosisq  

Microsoft Academic Search

Objective: Mitochondrial ATP-sensitive potassium channels have been proposed to be myoprotective. The relevance and specificity of this mechanism in cardiac surgery was unknown. The purpose of this study was to examine the effects of the mitochondrial potassium ATP- sensitive channel opener diazoxide on regional and global myocardial protection using a model of acute myocardial infarction. Methods: Pigs (n ¼ 19)

Hidetaka Wakiyama; Douglas B. Cowan; Yoshiya Toyoda; Miceline Federman; Sidney Levitsky; James D. McCully


Minimally Invasive Surgical Treatment of Esophageal Carcinoma  

PubMed Central

Surgical resection has proven successful in eradicating cancer of the esophagus, and it remains one of the main treatment modalities available for the curative management of patients with this disease. Unfortunately, patient morbidity is high because of the extensive nature of the surgery, which traditionally involves opening the chest and abdomen. Most time-honored techniques used to resect the esophagus and reconstruct the alimentary passage use the stomach as the replacement conduit, and a major abdominal dissection is therefore involved. Hoping to decrease the perioperative morbidity associated with esophagectomy, a number of thoracic surgeons have started to experiment with resection of the esophagus using aminimally invasive approach in select groups of patients. In minimally invasive esophagectomy (MIE), body cavities are accessed using a camera and fine, narrow instruments inserted through small incisions. Experience with abdominal surgery over the past decade suggests that a number of operative variables are improved using minimally invasive procedures, such as blood loss, rate of perioperative complications, and length of hospital stay. Data also suggest that the minimally invasive approach is comparable to or more advantageous than open procedures, in terms of both short- and long-term outcomes. Similarly, based on the limited data available today, shortterm outcomes after MIE are at least comparable with outcomes associated with open procedures. Minimally invasive resection of the esophagus for the management of esophageal cancer is feasible and safe. Whether MIE is better than traditional open techniques remains to be determined.



Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth  

Microsoft Academic Search

There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary

Fabio Costa; Massimo Robiony; Corrado Toro; Salvatore Sembronio; Massimo Politi



Laparoscopic versus open bilateral intrafascial nerve-sparing radical prostatectomy after TUR-P for incidental prostate cancer: surgical outcomes and effect on postoperative urinary continence and sexual potency.  


OBJECTIVE: To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRPT) and nerve-sparing retropubic radical prostatectomy (nsRRPT) after TUR-P for incidental prostate cancer. MATERIALS AND METHODS: Between January 2003 and August 2011, 125 nsLRPT and 128 nsRRPT for incidental prostate cancer diagnosed after TUR-P were performed at our clinic. Demographic data, peri- and postoperative measurements and functional outcomes were compared. RESULTS: The mean operative time was 153.1 ± 35.4 min for nsLRPT and 122.5 ± 67.5 min for nsRRPT (p = 0.03). The mean catheterization time was 8 ± 1 days in the laparoscopic group and 11 ± 2 days in the open group (p = 0.02). Also, the length of hospitalization presents statistical significant difference in the two groups. Positive margins were detected in 2.4 and 4.7 % of patients with pT2c tumours in the laparoscopic and open groups, respectively (p = 0.09). At a mean follow-up of 26.9 ± 9.3 months for the nsLRPT group and of 27.8 ± 9.7 months for the nsRRPT group, all patients were alive with no evidence of tumour recurrence. Twelve months postoperatively, complete continence was reported in 96.8 % of patients who underwent an nsLRPT and in 89.4 % of patients in the nsRRPT group (p = 0.02). At that time, 74.4 % of patients in the nsLRPT group and 53.1 % in the nsRRPT group reported the ability to engage in sexual intercourse (p = 0.0004). CONCLUSION: nsLRPT after TUR-P, performed by expert surgeons, results to be a safe procedure with excellent functional outcomes with regard to the urinary continence and sexual potency. PMID:23400788

Springer, Christopher; Inferrera, Antonino; Pini, Giovannalberto; Mohammed, Nasreldin; Fornara, Paolo; Greco, Francesco



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



Surgical navigation in reconstruction.  


Navigational systems are paramount in solving today's traffic dilemmas, and have important applications in the human body. Current imaging must be diagnostic and is often dictated by the radiologist, but it is up to the surgeon to consider surgical procedures and to decide in which case surgical navigation (SN) has advantages. Knowledge of the surgical capabilities of SN is indispensable. The aims of this article are to support real-time image-guided SN, present routine and advanced cases with precise preoperative planning, and show the scientific capabilities of SN. PMID:23642674

Kaduk, Wolfram M H; Podmelle, Fred; Louis, Patrick J



Video-assisted approach combined with the open Brompton technique for intracavitary drainage of giant bullae.  


The modified Monaldi procedure represents a nonexcisional treatment option for patients with giant bullous emphysema as an alternative to bullectomy. We want to highlight its role in the surgical treatment of emphysema and discuss changes made to the open-access Brompton approach through introduction of video-assisted thoracic surgical technique. PMID:22207369

Froeschle, Peter; Krishnadas, Rakesh; Berrisford, Richard



Crown lengthening: a surgical flap approach.  


In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique. PMID:9161156

Lundergan, W; Hughes, W R



Postgraduate surgical flexible endoscopic education.  


Postgraduate surgical education of residents in flexible gastrointestinal endoscopy is mandated by the American Board of Surgery. In that context, a retrospective analysis was performed of the general medical and endoscopic records of patients who experienced diagnostic and therapeutic flexible endoscopy during an 18-month period at the University of South Alabama Medical Center by surgical residents under the supervision of attending surgical endoscopists. That analysis revealed these procedures to be safe (diagnostic and therapeutic flexible endoscopy: morbidity incidence 0.4% and 2.2%, mortality incidence 0.2% and 1.1%, respectively), accurate (100%), and therapeutically beneficial (19% of the flexible endoscopic procedures were performed with therapeutic intent). Review of cumulative resident case profiles revealed that during the course of their clinical education (5 years), each resident performed approximately 400-500 endoscopic procedures, functioning successively as first assistant, primary endoscopist, and teaching assistant. The authors contend that: supervision by surgical endoscopists ensures safety and efficacy of the procedures during the education of postgraduate surgical residents; the surgical milieu--integration of endoscopic, surgical anatomic, and histopathologic data--provides the most effective educational format to acquire the skills necessary to achieve a high degree of accuracy associated with these endoscopic procedures; and therapeutic flexible endoscopy obviated the necessity for more invasive surgical procedures in approximately one-fifth of this patient population. PMID:3954479

Rodning, C B; Zingarelli, W J; Webb, W R; Curreri, P W



Augmented versus non-augmented open surgical repair of fresh tendo-achilles injury: a prospective randomised study.  


Injuries to the tendo-achilles in our country are mostly open injuries due to fall or slippage into the Indian type of lavatory pan. After thorough debridement open repair of the tendoachilles is done by non-augmented or augmented method. We studied about the augmented versus non-augmented open surgicalrepair of fresh tendo-achilles injuries. This was a prospective randomised study. It is evaluated from the study that the mean operative time was about 29 minutes longer (p < 0.001) and there was about 7 cm longer (p < 0.001) incision needed in augmented repair group which is statistically significant. The study shows that, the functional outcome of non-augmented repair group is better at 6 months follow-up but at 9 months follow-up functional outcomes are comparable in both non-augmented and augmented repair groups. The time for full functional recovery is more in augmented repair group. So, it is safer to use non-augmented repair technique in the treatment of fresh cases of tendo-achilles injuries due to less operative time, smaller incision, less complications and early functional recovery. PMID:23785909

Santra, Sabyasachi; Sarkar, Partha Sarathi; Latif, Abdul; Bhattacharyya, Arunangsu



Emergency, anaesthetic and essential surgical capacity in the Gambia  

PubMed Central

Abstract Objective To assess the resources for essential and emergency surgical care in the Gambia. Methods The World Health Organization’s Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities – one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities – and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations. Findings Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway. Conclusion The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions.

Shivute, Nestor; Bickler, Stephen; Cole-Ceesay, Ramou; Jargo, Bakary; Abdullah, Fizan; Cherian, Meena



Surgical Options  


... have significant memory problems and patients who have unstable medical conditions that would increase surgical risk are ... to patients with severe tremor who because of unstable medical conditions are not candidates for DBS. Surgical ...


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


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. ( number NCT01212315). PMID:23435526

Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Orjan; Gudbjartsson, Tomas; Jeppsson, Anders



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. ( number NCT01212315).

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



Surgical management of neonatal limb ischaemia: a technique for open thrombectomy and the novel use of Integra.  


Neonatal limb ischaemia (NLI) is a rare but potentially catastrophic condition. Although medical therapy remains as first-line treatment, surgery has an important role when limb-threatening events are present. In this paper we outline the milking technique for open thrombectomy used by the senior author in the treatment of 5 NLI cases. We also present the use of Integra and it's specific benefits in the management of wounds in these challenging situations. Skin grafts over the Integra can be avoided by staged excision of the silicone layer from the margins. We believe this is a novel approach to the use of Integra. PMID:23318054

Orfaniotis, Georgios; Watson, Stuart B



[Indications for cardiology consultation and management of cardiac patients who will undergo surgical or endoscopic procedures: the proposal of the University Hospital of Trieste, Italy].  


The number of patients affected by cardiovascular disease admitted to internal medicine and geriatric wards is expanding due to the increasing prevalence of cardiovascular disease in the ageing population. This contributes to a growing demand for cardiology consult visits, with requests for perioperative risk stratification for non-cardiac surgery or endoscopy, and general clinical management. This document was jointly drafted by the Cardiology and Anesthesiology departments, medical and surgical departments, and endoscopy services of the Azienda Ospedaliero-Universitaria "Ospedali Riuniti" in Trieste (Italy). It addresses critical issues such as antiplatelet and anticoagulant therapy in non-cardiac surgery, electric device management, and prophylaxis of bacterial endocarditis. It provides general guidelines and appropriateness criteria, prompted by the Joint Commission International and approved by the Hospital Guidelines Committee. It provides a basis for periodic educational meetings, and will be periodically updated. Periodic audits will monitor its application, and critical and controversial points, in order to promote quality of health care, organizational efficiency, and appropriateness. PMID:21033337

Massa, Laura; Vitrella, Giancarlo; Zecchin, Massimo; Berlot, Giorgio; Bergamini, Pier Riccardo; Pelusi, Lucia; Lattuada, Luca; Sinagra, Gianfranco


Challenges in evaluating surgical innovation.  


Research on surgical interventions is associated with several methodological and practical challenges of which few, if any, apply only to surgery. However, surgical evaluation is especially demanding because many of these challenges coincide. In this report, the second of three on surgical innovation and evaluation, we discuss obstacles related to the study design of randomised controlled trials and non-randomised studies assessing surgical interventions. We also describe the issues related to the nature of surgical procedures-for example, their complexity, surgeon-related factors, and the range of outcomes. Although difficult, surgical evaluation is achievable and necessary. Solutions tailored to surgical research and a framework for generating evidence on which to base surgical practice are essential. PMID:19782875

Ergina, Patrick L; Cook, Jonathan A; Blazeby, Jane M; Boutron, Isabelle; Clavien, Pierre-Alain; Reeves, Barnaby C; Seiler, Christoph M; Altman, Douglas G; Aronson, Jeffrey K; Barkun, Jeffrey S; Campbell, W Bruce; Cook, Jonathan A; Feldman, Liane S; Flum, David R; Glasziou, Paul; Maddern, Guy J; Marshall, John C; McCulloch, Peter; Nicholl, Jon; Strasberg, Steven M; Meakins, Jonathan L; Ashby, Deborah; Black, Nick; Bunker, John; Burton, Martin; Campbell, Marion; Chalkidou, Kalipso; Chalmers, Iain; de Leval, Marc; Deeks, Jon; Grant, Adrian; Gray, Muir; Greenhalgh, Roger; Jenicek, Milos; Kehoe, Sean; Lilford, Richard; Littlejohns, Peter; Loke, Yoon; Madhock, Rajan; McPherson, Kim; Rothwell, Peter; Summerskill, Bill; Taggart, David; Tekkis, Parris; Thompson, Matthew; Treasure, Tom; Trohler, Ulrich; Vandenbroucke, Jan



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



[Surgical experience in five years of residency].  


The author presents a series of cases surgically treated (completely or just parts of them) during residency time and focuses upon difficulties and errors made in each surgical procedure. PMID:21774388

Stefanescu, Andreea Madalina



[Donor nephrectomy: less fatigue and better quality of life following laparoscopic kidney removal compared with an open procedure by mini-incision: blind randomised study  

Microsoft Academic Search

OBJECTIVE: Determining possible differences in living donor nephrectomy procedures: laparoscopy against mini-incision concerning discomfort to the donor and the maintenance of good graft function. DESIGN: Blind randomized study. METHOD: In two university medical centres, one hundred living kidney donors were randomly assigned to either total laparoscopic donor nephrectomy or mini-incision muscle-splitting open donor nephrectomy. Primary outcome was physical fatigue measured

N. F. Kok; M. Y. Lind; B. M. Hansson; D. Pilzecker; I. R. Mertens zur Borg; B. C. Knipscheer; E. J. Hazebroek; I. M. Dooper; W. Weimar; W. C. J. Hop; E. M. M. Adang; G. J. van der Wilt; H. J. Bonjer; J. A. van der Vliet; J. N. M. Ijzermans



A dietary intervention to elicit rapid and complex dietary changes for studies investigating the effects of diet on tissues collected during invasive surgical procedures.  


Nutrition intervention trials in patients undergoing surgical treatment for cancer offer a unique opportunity to study the mechanisms and pathways that underlie diet and cancer associations in target tissues. However, due to the short time period between diagnosis and treatment, traditional dietary intervention methods are not feasible. This report describes a novel dietary intervention program designed to elicit rapid and complex dietary change during a condensed study period. The intervention, based on Consumer Information Processing, used standardized menus and exchange lists to guide food choices, and was delivered using a single, in-person session followed by telephone-based counseling. This intervention program was used in a small pilot study evaluating the short-term effects of dietary change in men with newly diagnosed prostate cancer. Eight men were randomly assigned to either a low-fat/low-glycemic load or standard American diet during the 4 weeks preceding prostate surgery. Participants completed 24-hour dietary recalls each week, and were weighed at baseline and at surgery. Compared to men in the standard American arm (n=4), men in the low-fat/low-glycemic arm (n=4) reported consuming less total fat (51.0+/-36.0 vs 93.5+/-8.4 g/day, P=0.06), and had a lower glycemic load (134.8+/-6.0 vs 266.3+/-36.8 units/day, P<0.001). Men in the low-fat/low-glycemic arm lost a mean of 5.3+/-1.7 kg and men in the standard American arm gained 0.8+/-4.5 kg (P=0.04). Results of this small pilot study suggest that a relatively simple and minimally burdensome dietary intervention can elicit rapid and complex dietary changes that are maintained over a 4-week study period. Further studies in larger and more diverse populations are needed to fully understand the potential of this novel intervention approach. PMID:19248862

Schenk, Jeannette M; Neuhouser, Marian L; Lin, Daniel W; Kristal, Alan R



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



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


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



Nanotechnology Applications in Surgical Oncology  

PubMed Central

Surgery is currently the most effective and widely used procedure in treating human cancers, and the single most important predictor of patient survival is a complete surgical resection. Major opportunities exist to develop new and innovative technologies that could help the surgeon to delineate tumor margins, to identify residual tumor cells and micrometastases, and to determine if the tumor has been completely removed. Here we discuss recent advances in nanotechnology and optical instrumentation, and how these advances can be integrated for applications in surgical oncology. A fundamental rationale is that nanometer-sized particles such as quantum dots and colloidal gold have functional and structural properties that are not available from either discrete molecules or bulk materials. When conjugated with targeting ligands such as monoclonal antibodies, peptides, or small molecules, these nanoparticles can be used to target malignant tumor cells and tumor microenvironments with high specificity and affinity. In the “mesoscopic” size range of 10–100 nm, nanoparticles also have large surface areas for conjugating to multiple diagnostic and therapeutic agents, opening new possibilities in integrated cancer imaging and therapy.

Singhal, Sunil; Nie, Shuming; Wang, May D.



Evaluation and stages of surgical innovations.  


Surgical innovation is an important part of surgical practice. Its assessment is complex because of idiosyncrasies related to surgical practice, but necessary so that introduction and adoption of surgical innovations can derive from evidence-based principles rather than trial and error. A regulatory framework is also desirable to protect patients against the potential harms of any novel procedure. In this first of three Series papers on surgical innovation and evaluation, we propose a five-stage paradigm to describe the development of innovative surgical procedures. PMID:19782874

Barkun, Jeffrey S; Aronson, Jeffrey K; Feldman, Liane S; Maddern, Guy J; Strasberg, Steven M; Altman, Douglas G; Barkun, Jeffrey S; Blazeby, Jane M; Boutron, Isabell C; Campbell, W Bruce; Clavien, Pierre-Alain; Cook, Jonathan A; Ergina, Patrick L; Flum, David R; Glasziou, Paul; Marshall, John C; McCulloch, Peter; Nicholl, Jon; Reeves, Bournaby C; Seiler, Christoph M; Meakins, Jonathan L; Ashby, Deborah; Black, Nick; Bunker, John; Burton, Martin; Campbell, Marion; Chalkidou, Kalipso; Chalmers, Iain; de Leval, Marc; Deeks, Jon; Grant, Adrian; Gray, Muir; Greenhalgh, Roger; Jenicek, Milos; Kehoe, Sean; Lilford, Richard; Littlejohns, Peter; Loke, Yoon; Madhock, Rajan; McPherson, Kim; Rothwell, Peter; Summerskill, Bill; Taggart, David; Tekkis, Parris; Thompson, Matthew; Treasure, Tom; Trohler, Ulrich; Vandenbroucke, Jan



Surgical and interventional robotics: part III [Tutorial  

Microsoft Academic Search

Part I of this tutorial described two broad paradigms of interventional assistance: surgical computer-aided design (CAD)\\/computer-aided manufacturing (CAM) and surgical assistance. Part II focused on the underlying concepts of surgical CAD\\/CAM, with a particular emphasis on percutaneous procedures. This final installment of our three-part tutorial series discusses surgical assistance. In this section, we introduce the basic concepts of a surgical




Architecture of a surgical robot  

Microsoft Academic Search

The ROBODOC Surgical Assistant System has been developed to increase the accuracy and efficacy of surgical procedures. The first application is total hip replacement surgery, where the function of the robot is to machine a cavity in the patient's femure for a prosthetic implant. The authors describe the hardware and software architecture of the operating room component of the system.

P. Kazanzides; J. Zuhars; B. Mittelstadt; B. Williamson; P. Cain; F. Smith; L. Rose; B. Musits



Surgical repair of tricuspid atresia  

Microsoft Academic Search

Surgical repair of tricuspid atresia has been carried out in three patients; two of these operations have been successful. A new surgical procedure has been used which transmits the whole vena caval blood to the lungs, while only oxygenated blood returns to the left heart. The right atrium is, in this way, `ventriclized', to direct the inferior vena caval blood

F. Fontan; E. Baudet



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



Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma.  


PurposeTo report the clinicopathologic features in a series of patients after ineffective glaucoma surgery with gold micro shunts (GMS) 2 years after the procedure.MethodsThis was an interventional case series study including two cases of GMS and two of GMS+ removal. Each specimen was sectioned into three portions: proximal, middle, and distal, and embedded into paraffin blocks, cut into 3??m sections and stained with hematoxylin and eosin and Masson's trichrome. In the case of inflammatory infiltrations a reaction with an LCA (CD45) monoclonal antibody was performed.ResultsMean IOP before GMS removal was 28.8±4.3?mm?Hg, and the patients were administered 2.3±0.5 anti-glaucoma drugs. The progression of changes in the visual field was observed in all cases. In three cases different grade intensification of corneal decompression was observed. Colonization of the connective tissue was found in the channels and around the microimplant in all cases. In two cases infiltration was detected from giant polynuclear and mononuclear cells.ConclusionsConnective tissue colonization was the cause of GMS obstruction. This can be a non-inflammatory process, but it may also result from chronic inflammation occurring in the suprachoroidal space. PMID:23867717

R?kas, M; Pawlik, B; Grala, B; Koz?owski, W



Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma  

PubMed Central

Purpose To report the clinicopathologic features in a series of patients after ineffective glaucoma surgery with gold micro shunts (GMS) 2 years after the procedure. Methods This was an interventional case series study including two cases of GMS and two of GMS+ removal. Each specimen was sectioned into three portions: proximal, middle, and distal, and embedded into paraffin blocks, cut into 3??m sections and stained with hematoxylin and eosin and Masson's trichrome. In the case of inflammatory infiltrations a reaction with an LCA (CD45) monoclonal antibody was performed. Results Mean IOP before GMS removal was 28.8±4.3?mm?Hg, and the patients were administered 2.3±0.5 anti-glaucoma drugs. The progression of changes in the visual field was observed in all cases. In three cases different grade intensification of corneal decompression was observed. Colonization of the connective tissue was found in the channels and around the microimplant in all cases. In two cases infiltration was detected from giant polynuclear and mononuclear cells. Conclusions Connective tissue colonization was the cause of GMS obstruction. This can be a non-inflammatory process, but it may also result from chronic inflammation occurring in the suprachoroidal space.

Rekas, M; Pawlik, B; Grala, B; Kozlowski, W



Cognitive function after open-heart surgery: Are postoperative neuropsychological deficits caused by cardiopulmonary bypass?  

Microsoft Academic Search

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the

Ralph H. B. Benedict



Thermal ablation produced using a surgical toroidal high-intensity focused ultrasound device is independent from hepatic inflow occlusion  

Microsoft Academic Search

In the liver, the efficacy of radiofrequency or high-intensity focused ultrasound (HIFU) ablation is impaired by blood perfusion. This can be overcome by hepatic inflow occlusion. Here we report the in vivo evaluation of ablations performed in the liver using a surgical toroidal HIFU device used during an open procedure with and without hepatic inflow occlusion. The HIFU device was

D. Melodelima; W. A. N'Djin; J. Favre-Cabrera; H. Parmentier; M. Rivoire; J. Y. Chapelon



Laparoscopic colonic procedures  

Microsoft Academic Search

With the advent and general acceptance of laparoscopy as a means of surgically treating intraabdominal disease processes, procedures on organs other than the gallbladder and female genital tract have slowly evolved. After developing basic techniques in an animal model, a clinical series (n=19) of laparoscopic procedures for a variety of colonic lesions was undertaken and is herein presented. It included

Morris E. Franklin; Raul Ramos; Daniel Rosenthal; William Schuessler



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.



A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty With Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff TearsDisease-Specific Quality of Life Outcome at an Average 2Year Follow-Up  

Microsoft Academic Search

Background: Rotator cuff tears affect patients' quality of life. The evolution toward less invasive operative techniques for rotator cuff repair requires appropriate comparisons with the standard open procedure, using validated outcomes in a randomized fashion.Hypothesis: There is no difference in disease-specific quality of life outcomes at 2 years between an open surgical repair (open) versus an arthroscopic acromioplasty with mini-open

Nicholas G. Mohtadi; Robert M. Hollinshead; Treny M. Sasyniuk; Jennifer A. Fletcher; Denise S. Chan; Feng X. Li



Have Endovascular Procedures Negatively Impacted General Surgery Training?  

PubMed Central

Objective: Technological advances in vascular surgery have changed the field dramatically over the past 10 years. Herein, we evaluate the impact of endovascular procedures on general surgery training. Methods: National operative data from the Residency Review Committee for Surgery were examined from 1997 through 2006. Total major vascular operations, traditional open vascular operations and endovascular procedures were evaluated for mean number of cases per graduating chief general surgery resident (GSR) and vascular surgery fellow (VSF). Results: As endovascular surgical therapies became widespread, GSR vascular case volume decreased 34% over 10 years, but VSF total cases increased 78%. GSR experience in open vascular operations decreased significantly, as evidenced by a 52% decrease (P < 0.0001) in elective open AAA repair. VSFs have also seen significant decreases in open vascular procedures. Experience in endovascular procedures has increased for both general surgery and vascular residents, but the increase has been much larger in absolute number for VSFs. Conclusions: GSR experience in open vascular procedures has significantly decreased as technology has advanced within the field. Unlike VSFs, this loss has not been replaced by direct experience with endovascular training. These data demonstrate the impact technology can have on how we currently train general surgeons. New educational paradigms may be necessary in which either vascular surgery as an essential component is abandoned or training in catheter-based interventions becomes required.

Grabo, Daniel J.; DiMuzio, Paul J.; Kairys, John C.; McIlhenny, Stephen E.; Crawford, Albert G.; Yeo, Charles J.



Deriving DICOM surgical extensions from surgical workflows  

NASA Astrophysics Data System (ADS)

The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.



Peritonectomy procedures.  

PubMed Central

OBJECTIVE: New surgical procedures designed to assist in the treatment of peritoneal surface malignancy were sought. BACKGROUND: Decisions regarding the treatment of cancer depend on the anatomic location of the malignancy and the biologic aggressiveness of the disease. Some patients may have isolated intra-abdominal seeding of malignancy of limited extent or of low biologic grade. In the past, these clinical situations have been regarded as lethal. METHODS: The cytoreductive approach may require six peritonectomy procedures to resect or strip cancer from all intra-abdominal surfaces. RESULTS: These are greater omentectomy-splenectomy; left upper quadrant peritonectomy; right upper quadrant peritonectomy; lesser omentectomy-cholecystectomy with stripping of the omental bursa; pelvic peritonectomy with sleeve resection of the sigmoid colon; and antrectomy. CONCLUSIONS: Peritonectomy procedures and preparation of the abdomen for early postoperative intraperitoneal chemotherapy were described. The author has used the cytoreductive approach to achieve long-term, disease-free survival in selected patients with peritoneal carcinomatosis, peritoneal sarcomatosis or mesothelioma. Images Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11. Figure 12. Figure 13.

Sugarbaker, P H



Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation  

Microsoft Academic Search

Background: Coarctation of the aorta accounts for almost 5% of all congenital cardiac malformations, and it is usually treated by open surgical procedures. Despite the excellent primary results, many patients may develop anastomotic pseudo-aneurysms, associated with considerable morbidity and mortality rates. We investigated the role of endovascular repair as an alternative to open re-do surgery on the descending aorta. Methods:

Luca Botta; Vincenzo Russo; Guido Oppido; Marzia Rosati; Francesco Massi; Luigi Lovato; Roberto Di Bartolomeo; Rossella Fattori



[Endoscopic and surgical procedures for enteral nutrition].  


Standardized management of oncology patients necessarily includes screening for nutritional risk. Weight loss of >?5 kg within 3 months and diminished food intake are warning signals even in overweight patients. In case oral nutrition is neither adequate nor feasible even by fortification or oral nutritional supplements, the implantation of a percutaneous endoscopic gastrostomy (PEG) or fine needle catheter jejunostomy (FNCJ) offers enteral access for long-term nutritional support. Although the indications derive from fulfilling caloric needs, endoscopic or operative measures are not considered to be an urgent or even emergency measure. The endoscopist or surgeon should be fully aware and informed of the indications and make a personal assessment of the situation. The implantation of a feeding tube requires informed consent of the patient or legal surrogates. The review summarizes recent indications, technical problems and complications. PMID:23719727

Wallstabe, I; Tiedemann, A; Schiefke, I; Weimann, A



The surgical treatment for atrial fibrillation: ablation technology and surgical approaches.  


The Cox maze procedure developed originally in 1987 by Dr James Cox has evolved from a "cut and sew" surgical procedure, where the maze was applied using multiple surgical cuts, to an extensive use of surgical ablation technology where ablation lesions are placed with alternative energy sources (radiofrequency, cryothermy, microwave, and high-frequency ultrasound). Furthermore, the procedure has changed from a median sternotomy approach only to one that can be performed minimally invasively and robotically. The purpose of this paper is to review the current available technology for the ablation of atrial fibrillation as well as the different procedural approaches for the surgical ablation of atrial fibrillation. PMID:23908871

Henry, Linda; Ad, Niv



Surgical orodental implications in ankylosing spondylitis.  


Temporomandibular joint and the pelvic complex are bidirectionally related. Ankylosing spondylitis (AS) is a seronegative arthropathy with the key feature of bony fusion of lumbar vertebrae. A 39 year old known case of AS was presented to private office for left lower impacted third molar surgical removal. Previously, he was rejected to receive oral care for pulpectomy and extraction due to limited mouth opening. Prior to the surgery, lateral neck radiography was obtained to exclude any subluxation of fracture of cervical vertebrae. Neck was supported to insure neck stability during surgical forces. In addition, considering consumption of immunosuppressive medications including corticosteroids, procedure was performed with a great care, with attention to higher possibility of infection and fracture. Access to the surgical site was not desirable, though surgery accomplished without any significant event and the patient discharged with routine analgesic and antibiotics recommendation. Sometimes, impaired access to the oral cavity in patients with AS leads to receive suboptimal or minimal orodental care. Long list of dental implications in these patients may be simplified by considering of careful neck and jaw support, applying at least possible forces and great attention to the infection control rules. It is wised to be performed under patient and skilled hands. PMID:23559963

Mehdizadeh, Mohammad; Poorsattar, Bejeh Mir A



Current Surgical Management  

Microsoft Academic Search

\\u000a For the majority of brain tumors in children, the extent of resection is the most important factor predicting long-term outcome.\\u000a This has led many neurosurgeons to be as aggressive as possible during the initial surgical procedure in an effort to achieve\\u000a gross total resection (GTR;(Pollack 1999)). It should be recognized that GTR is not the primary goal for tumors, where

Nalin Gupta; Kurtis I. Auguste; Mitchel S. Berger


Opening a window into police internal affairs: Impact of procedural justice reform on third-party attitudes  

Microsoft Academic Search

The study explores the impact of a procedural innovation on justice judgments made by third party observers. The innovation\\u000a involved the establishment of a review panel with civilian participants to monitor a police department's investigation of\\u000a allegations of misconduct against its officers. The study distinguishes the impact on racial minority observers from that\\u000a on racial majority observers. Data suggest that

Wayne A. Kerstetter; Kenneth A. Rasinski



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


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



Surgical challenge: endoscopic repair of cerebrospinal fluid leak  

PubMed Central

Background Cerebrospinal fluid leaks (CSF) result from an abnormal communication between the subarachnoid space and the extracranial space. Approximately 90% of CSF leak at the anterior skull base manifests as rhinorrhea and can become life-threatening condition. Endoscopic sinus surgery (ESS) has become a common otolaryngologist procedure. The aim of this article is to consider our experience and to evaluate the outcomes in patients who underwent a purely endoscopic repair of CSF leaks of the anterior skull base. Findings Retrospective chart review was performed of all patients surgically treated for CSF leaks presenting to the Section of Nasal and Sinus Disorders at the Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), between 2004 and 2010. A total of 30 patients who underwent repair CSF leak by ESS. The success rate was 93.4% at the first attempt; only two patients (6.6%) required a second surgical procedure, and none of it was necessary to use a craniotomy for closure. Follow-up periods ranged from 4?months to 6?years. Conclusion Identifying the size, site, and etiology of the CSF leak remains the most important factor in the surgical success. It is generally accepted that the ESS have made procedures minimally invasive, and CSF leak is now one of its well-established indications with low morbidity and high success rate, with one restriction for fistulas of the posterior wall of the frontal sinus should be repaired in conjunction with open techniques.



Influence of initial acute myocardial infarction presentation on the outcome of surgical procedures after coronary stent implantation: a report from the CREDO-Kyoto PCI/CABG Registry Cohort-2.  


Several previous publications have consistently reported that surgical procedures performed early after coronary stenting were associated with significantly higher risk for ischemic events than those performed late. In the current post hoc analysis of the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting Registry Cohort-2, we compared the outcomes of early (within 42 days) versus late surgery (beyond 42 days) after coronary stenting stratified by the initial clinical presentations [acute myocardial infarction (AMI) [early N = 153, and late N = 586] and non-AMI (early N = 202, and late N = 1457)]. Cumulative incidence of death/myocardial infarction/stent thrombosis at 30 days after surgery was significantly higher in the early group than in the late group in the AMI stratum [18.4 vs. 2.6 %, P < 0.0001, and adjusted HR 5.65 (95 % CI 2.42-13.5), P < 0.0001], but not in the non-AMI stratum [3.0 vs. 1.8 %, P = 0.3, and adjusted HR 1.52 (95 % CI 0.47-4.17), P = 0.5]. There was a significant interaction for the risk of ischemic events between the clinical presentation and the timing of surgery (P interaction = 0.03). Deaths in patients with early surgery in the AMI stratum were mostly related to preoperative complications of AMI (76 %), but not related to perioperative stent-related complications (4.0 %). In conclusion, significantly higher risk of early versus late surgery for perioperative ischemic events was seen only in patients with initial AMI presentation, but not in patients with non-AMI presentation. Previous observations suggesting higher risk in early surgery might not be related to the timing after stent implantation per se, but related to more morbid preoperative conditions in patients who underwent early surgery. PMID:23015155

Tokushige, Akihiro; Shiomi, Hiroki; Morimoto, Takeshi; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Iwabuchi, Masashi; Shizuta, Satoshi; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Hamasaki, Shuichi; Tei, Chuwa; Nakashima, Hitoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi



Survey on surgical instrument handle design: ergonomics and acceptance.  


Minimally invasive surgical approaches have revolutionized surgical care and considerably improved surgical outcomes. The instrumentation has changed significantly from open to laparoscopic and robotic surgery with various usability and ergonomics qualities. To establish guidelines for future designing of surgical instruments, this study assesses the effects of current surgical approaches and instruments on the surgeon. Furthermore, an analysis of surgeons' preferences with respect to instrument handles was performed to identify the main acceptance criteria. In all, 49 surgeons (24 with robotic surgery experience, 25 without) completed the survey about physical discomfort and working conditions. The respondents evaluated comfort, intuitiveness, precision, and stability of 7 instrument handles. Robotic surgery procedures generally take a longer time than conventional procedures but result in less back, shoulder, and wrist pain; 28% of surgeons complained about finger and neck pain during robotic surgery. Three handles (conventional needle holder, da Vinci wrist, and joystick-like handle) received significantly higher scores for most of the proposed criteria. The handle preference is best explained by a regression model related only to comfort and precision (R(2) = 0.91) and is significantly affected by the surgeon's background (P < .001). Although robotic surgery seems to alleviate physical discomfort during and after surgery, the results of this study show that there is room for improvement in the sitting posture and in the ergonomics of the handles. Comfort and precision have been found to be the most important aspects for the surgeon's choice of an instrument handle. Furthermore, surgeons' professional background should be considered when designing novel surgical instruments. PMID:21868419

Santos-Carreras, Laura; Hagen, Monika; Gassert, Roger; Bleuler, Hannes



Prerandomization Surgical Training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 Trial  

PubMed Central

Objective: To train surgeons in a standardized technique of sentinel lymph node biopsy and to prepare them for the requirements of a prospective randomized surgical trial. Summary Background Data: The NSABP B32 trial opened to accrual in May 1999. A significant component of this trial was a prerandomization training phase of surgeons performed by a group of core surgical trainers. The goals of this training phase were to expeditiously instruct surgeons in a standardized technique of sentinel lymph node biopsy and to educate those same surgeons in complete and accurate data collection and source documentation for the trial. Methods: This study is a description of the training data collected in a prospective fashion for the training component for surgeon entry into the B32 trial, evaluating the effectiveness of the training program in regards to surgical outcomes and protocol compliance. Results: Two hundred twenty-six registered surgeons underwent site visit training by a core surgical trainer and 187 completed training and were approved to randomize patients on the trial. The results of 815 training (nontrial) cases demonstrated a technical success rate for identifying sentinel nodes at 96.2% with a false negative rate of 6.7%. A protocol compliance analysis, which included the evaluation of 94 separate fields, showed mean protocol compliance of 98.6% for procedural fields, 95.5% for source documentation fields and 95.0% for data entry fields. Conclusions: This training and quality control program has resulted in a large number of surgeons capable of performing sentinel lymph node biopsy in a standardized fashion with a high degree of protocol compliance and pathologic accuracy. This will ensure optimal results for procedures performed on the randomized phase of the trial.

Harlow, Seth P.; Krag, David N.; Julian, Thomas B.; Ashikaga, Takamaru; Weaver, Donald L.; Feldman, Sheldon A.; Klimberg, V Suzanne; Kusminsky, Roberto; Moffat, Frederick L.; Noyes, R Dirk; Beitsch, Peter D.



Effect of high perioperative oxygen supplementation on surgical site infections.  


Over the past 15 years, several randomized controlled trials, long-term follow-up studies, meta-analyses, and editorials have been published in regard to the effect of a high fraction of inspired oxygen concentration (FiO2) during the perioperative period on the incidence of surgical site infections. Although the evidence is not uniformly favorable for all types of surgeries, a beneficial association of 80% FiO2 has been documented among open abdominal procedures, especially colorectal surgeries. PMID:23899687

Munoz-Price, L Silvia; Sands, Laurence; Lubarsky, David A



Surgical management for overactive bladder  

Microsoft Academic Search

The majority of patients with overactive bladder can be managed with office-based techniques. When medical therapy fails as\\u000a treatment for overactive bladder, surgical intervention ranging from electrical stimulation administered in the office to\\u000a extensive procedures, such as augmentation or urinary diversion, may be needed. Any surgical intervention should be tailored\\u000a to the patient with consideration of the degree of his

Rodney A. Appell; Timothy B. Boone



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



Automated quality control procedure for the {open_quotes}water equivalent of snow on the ground{close_quotes} measurement  

SciTech Connect

Snow water equivalent (SWE) has been measured daily by the United States National Weather Service since 1952, whenever snow depth is 2 in. (5 cm) or greater. These data are used to develop design snow loads for building, for hydrological forecasting, and as an indicator of climate change. To data they have not been subjected comprehensively to quality control. An automated quality control procedure for these data is developed here, which checks daily SWE values for common data entry errors, values beyond reasonable limits, and consistency with daily precipitation and estimated melt. Potential effects of drifting in high winds and of the intrinsic microscale variability of SWE are also considered. An SWE measurement is declared suspicious if a sufficient discrepancy is found with respect to the expected SWE data from the northeastern United States are also summarized. 26 refs., 2 figs., 3 tabs.

Schmidlin, T.W. [Kent State Univ., OH (United States); Wilks, D.S.; McKay, M. [Cornell Univ., Ithaca, NY (United States)] [and others



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



Evolution in surgical management of esophageal cancer.  


Esophageal resection remains the primary treatment for local regional esophageal cancer, although its role in superficial (T1A) cancers and squamous cell cancer is in evolution. Mortality associated with esophagectomy has historically been high but is improving with the current expectation of in-hospital mortality rates of 2-4% in high-volume centers. Most patients with regional cancers (T2-4 N0-3) are recommended for neoadjuvant therapy, which most commonly involves radiochemotherapy. Some centers have proposed treating with definitive chemoradiation and reserving surgery for patients who have persistent or recurrent disease. 'Salvage resections' are possible but are associated with higher levels of perioperative morbidity and mortality, and treatment decisions should routinely be based on multidisciplinary discussion in the tumor board. Although open surgical resection (both transthoracic and transhiatal operations) remain the most common approach, minimally invasive or hybrid operations are being done in up to 30% of procedures internationally. There are some indications that minimally invasive esophagectomy may decrease the incidence of respiratory complications and decrease length of stay. At this point, oncologic outcomes appear equivalent between open and minimally invasive procedures. Recent reviews from high-volume esophagectomy centers demonstrate that elderly patients can selectively undergo esophagectomy with the expectation of increased complications but similar mortality and survival to younger patients. Multiple studies confirm that quality of life following esophagectomy can be equivalent to the general population when surgery is done in experienced centers. Patients requiring surgical treatment of esophageal cancer should be referred to high-volume centers, especially those with established care pathways or enhanced recovery programs to improve outcomes including morbidity, mortality, survival, and quality of life. PMID:23797119

Low, Donald E



Transaortic Modification of the Viabahn Open Revascularization Technique (VORTEC) to Facilitate Renal Artery Revascularization in a Hybrid EVAR Procedure.  


Purpose : To present a modification of the Viabahn open revascularization technique (VORTEC) to facilitate right renal artery (RRA) revascularization via a limited thoracotomy and transaortic sheath during endovascular aneurysm repair (EVAR). Case Report : A 51-year-old man with uncontrolled hypertension and limited respiratory reserve presented with a pararenal abdominal aortic aneurysm (AAA) measuring ?15×8.5×8 cm extending into the iliac arteries. Via a limited low thoracoabdominal incision and retroperitoneal approach, 3 of the renovisceral branches were exposed, but there was difficulty in approaching the RRA. A handmade 4-branched polytetrafluoroethylene graft (PTFE) was anastomosed to the descending thoracic aorta, and the 3 exposed renovisceral branches were bypassed sequentially. A modification of the VORTEC with a transaortic approach to revascularize the RRA was successful; a 7-mm×10-cm Viabahn stent-graft was advanced into the RRA and deployed into the RRA limb of the PTFE graft. The Viabahn-PTFE graft junction was fixed with interrupted suture, and its transaortic portion was dilated with a 7-mm balloon. EVAR was then accomplished with a 28.5-mm Excluder stent-graft. The final angiogram documented patent bypass grafts and no endoleak. Follow-up imaging showed a satisfactory stent-graft and patent PTFE graft without undue kinking of the Viabahn or stenosis within its transaortic portion. The patient remained well after 1-year follow-up. Conclusion : This transaortic modification may be a useful option for hybrid EVAR and application of a sutureless telescoping anastomosis technique. PMID:24093316

Tsai, Meng-Ta; Tseng, Cheng-Che; Kan, Chung-Dann



The Problem Surgical Colleague  

PubMed Central

‘All doctors are problem doctors.’ R Smith1 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?

Mosley, John G



Is three-dimensional videography the cutting edge of surgical skill acquisition?  


The process of learning new surgical technical skills is vital to the career of a surgeon. The acquisition of these new skills is influenced greatly by visual-spatial ability (VSA) and may be difficult for some learners to rapidly assimilate. In many cases, the role of VSA on the acquisition of a novel technical skill has been explored; however, none have probed the impact of a three-dimensional (3D) video learning module on the acquisition of new surgical skills. The first aim of this study is to capture spatially complex surgical translational flaps using 3D videography and incorporate the footage into a self-contained e-learning module designed in line with the principles of cognitive load theory. The second aim is to assess the efficacy of 3D video as a medium to support the acquisition of complex surgical skills in novice surgeons as evaluated using a global ratings scale. It is hypothesized that the addition of depth in 3D viewing will augment the learner's innate visual spatial abilities, thereby enhancing skill acquisition compared to two-dimensional viewing of the same procedure. Despite growing literature suggesting that 3D correlates directly to enhanced skill acquisition, this study did not differentiate significant results contributing to increased surgical performance. This topic will continue to be explored using more sensitive scales of measurement and more complex "open procedures" capitalizing on the importance of depth perception in surgical manipulation. Anat Sci Educ. © 2012 American Association of Anatomists. PMID:22278856

Roach, Victoria A; Brandt, Michael G; Moore, Corey C; Wilson, Timothy D



Risk factors associated with incorrect surgical counts.  


Incorrect surgical counts after surgery are a perplexing problem for nurses working in the perioperative environment. To determine factors associated with an incorrect surgical count, this cross-sectional, correlational study examined explanatory variables (eg, patient and nurse characteristics, intraoperative circumstances, staff involvement) by using data abstracted from perioperative medical records and primary data collected from perioperative nurses. In the final multivariate analysis, six variables were significantly associated with an incorrect surgical count: a higher surgical risk, a lower body mass index, a complicated procedure, an unplanned procedure, an increased number of perioperative personnel involved, and an increased number of specialty teams involved. PMID:22935256

Rowlands, Aletha



Re-engineering surgical services in a community teaching hospital.  


The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the annual budget of +10.3 million; Recruited 10 new podiatrists and increased the volume of cases brought to Northwest Region facilities by surgical specialists. This added 100 cases in 1996, and is projected to add 500 cases in 1997. A 14.5 percent reduction in the cost of operating the Surgical Services was achieved. This was accompanied by enhanced staff morale, physician satisfaction and a higher quality of patient care. PMID:10172985

Cohen, M M; Wreford, M; Barnes, M; Voight, P



Surgical Correction of Fixed Kyphosis  

PubMed Central

Study Design A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. Purpose To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. Overview of Literature Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. Methods There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. Results The average kyphotic angle was 71.8° preoperatively, 31.0° postoperatively, and the average final angle was 39.2°. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. Conclusions Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Cho, Woo-Jin; Kang, Chang-Nam; Park, Ye-Soo; Kim, Hyoung-Jin



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.



Other surgical interventions.  


Optimal management of patients with chronic neuropathic pain requires a multidisciplinary approach that may include surgery. Yet despite the fact that lumbosacral spinal surgery, for example, is performed in thousands of patients every year, there is very little controlled clinical data to support its use or that of other surgical techniques in the treatment of chronic nonmalignant pain, especially neuropathic pain. Nevertheless, there is evidence of some success for ablative techniques such as dorsal root entry zone lesioning for phantom limb pain and girdle-zone neuropathic pain, and sympathectomy for the treatment of complex regional pain syndrome, and a variety of operations for tic douloureux. However, before considering a surgical procedure, a nonsurgical approach should have been tried and the suitability of the patient must be carefully assessed. To fully establish the role of surgery in the treatment of chronic neuropathic pain, further well-designed, prospective, controlled trials are essential. PMID:17309711

Loeser, John D



Surgical management of presbyopia.  


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. PMID:23055664

Torricelli, André Am; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J



Surgical palliation for unresectable hilar cholangiocarcinoma  

PubMed Central

The majority of patients who present with hilar cholangiocarcinoma will have incurable disease and require only palliation. Efficient relief of disabling symptoms is required with minimal morbidity and mortality and can be achieved by either surgical or non-operative options. A review of the indications, anatomical considerations and surgical techniques is presented. Segment III cholangio-jejunostomy is the most frequently used surgical bypass procedure and in those patients with an expected survival of more than 6 months, surgical palliation offers good quality and long-lasting palliation. There is a need for randomized controlled data to define the optimal role of surgical palliation in this difficult disease.

Connor, S.; Wigmore, S. J.; Madhavan, K. K.; Parks, R. W.



CPAP Use in a Hospital or Surgical Setting  


... 293.3650 CPAP USE IN A HOSPITAL OR SURGICAL SETTING This Patient Education Bulletin specifically addresses issues ... hospitalized for a medical condition or for a surgical procedure. Many of the items may also be ...


Percutaneous implantation of the CoreValve aortic valve prosthesis in patients at high risk or rejected for surgical valve replacement: Clinical evaluation and feasibility of the procedure in the first 30 patients in the AMC-UvA  

Microsoft Academic Search

Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the CoreValve ReValving System was performed under general anaesthesia in 30 high-risk (surgical) patients with a symptomatic severe aortic

J. Baan; Z. Y. Yong; K. T. Koch; J. P. S. Henriques; B. J. Bouma; Hert de S. G; Meulen van der J; J. G. P. Tijssen; J. J. Piek; Mol de B. A. J. M



The MILD procedure.  


We are following with great interest the increasing generally favorable impressions of the long-term results of the MILD (minimally invasive lumbar decompression) procedure for treating spinal stenosis due to hypertrophied ligamentum flavum (LF). We are also influenced by the cautionary surgical observations and opinions of Tumialan et al and publications about the lack of efficacy or placebo effect. The impression indeed has been virtual safety of the MILD procedure, but Tumialan et al describe some major complications resulting from the procedure. An algorithm for clinical use is needed. PMID:23517504

Racz, Gabor B; Heavner, James E; Bosscher, Hemmo; Helm, Standiford



Elective surgical cricothyroidotomy in oral and maxillofacial surgery.  


Surgical Cricothyroidotomy is regarded as an emergency procedure today even though it has a good evidential record as an elective surgical airway. A misunderstanding of Jackson's landmark paper in 1921 has made the simple and safe procedure unpopular because of the fear of subglottic stenosis. We present the incidence of subglottic stenosis after surgical cricothyroidotomy, discuss evidence for elective surgical cricothyroidotomy, and suggest potential applications in oral and maxillofacial surgery. PMID:23668941

Teo, Noah; Garrahy, Ann



Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass.  


Over the past 20 years bariatric surgery proved to be a valid treatment for reduction and elimination of obesity-related diseases and long-term sustainable weight loss. Minimally invasive or laparoscopic techniques such as laparoscopic Roux-en-Y (LRNY) have replaced open procedures. Many factors play important roles in the small intricacies and variations of the procedure, chief of which is the creation and size of the gastrojejunostomy. Regardless of the variations in technique, the LRNY remains the gold standard for the surgical treatment of clinically severe or morbid obesity, with relatively low morbidity and mortality. PMID:22054149

Powell, Myron S; Fernandez, Adolfo Z



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.



78 FR 17940 - Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...  

Federal Register 2010, 2011, 2012, 2013

...2945] Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components...entitled Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components...and Procedure filed on behalf of MAKO Surgical Corp. on March 19, 2013. The...



Surgical treatment of missed Monteggia lesions in children  

PubMed Central

Purpose The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation. Methods Six consecutive cases of missed Monteggia lesions were treated in our institution between August 2001 and September 2003. Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 2 weeks. Results There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction. Conclusions Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint.

Ceroni, Dimitri; Lefevre, Yan; De Rosa, Vincenzo; De Coulon, Geraldo; Kaelin, Andre



[Unstable angina pectoris from surgical view (author's transl)].  


Between January 1974 and September 1977 37 patients with unstable angina pectoris have been treated (7,6% of the patients operated upon). 49% suffered from an old myocardial infarct, 86% had a 2 or more coronary vessel disease, and only 4 patients showed critical stenoses on the left main stem. We preferred a combined medical and surgical treatment. By means of medical treatment all patients but one became painfree. At the same time coronary angiography had been performed without any complications. 37 patients received 67 vein bypasses (graft-patient-relation of 1,8). The surgical degree of revascularization was 80%. The hospital mortality came to 2,7%, the late mortality to 2,8%. Perioperatively 3 patients underwent a myocardial infarction. 84% of the patients were painfree and clinically improved. 41% went back to work in their old jobs. 84% of the vein bypasses were open. The effective degree of revascularization was 67%. Conclusion: There is no difference between patients with stable and unstable angina referring to coronary morphology, rate of survival and of surgical complications as well as to clinical and objective improvement. We recommend an early but not emergency angiography and we prefer an elective surgical treatment and not an emergency procedure. PMID:721029

Leitz, K H; Liese, W; Lichtlen, P; Borst, H G



[Comparison of laparoscopic and open splenectomy].  


Introduction: Conventional operative techniques are gradually being replaced by minimally invasive surgical methods in the surgery of the spleen. We summarized our 10-year-experience after the introduction of laparoscopic splenectomy at the University of Szeged, Department of Surgery, comparing open and minimally invasive techniques. Material and method: Between 1st January 2002 and 1st December 2011 we performed 141 splenectomies of which 17 were acute operations. Of the 124 elective procedures 54 were laparoscopic and 70 open operations. In 40 cases (open procedures) splenectomy was part of multivisceral surgery which were excluded from the analysis. In this retrospective analysis a comparison of laparoscopic and open elective technique was carried out. Results: Average operating time of laparoscopic procedures was slightly longer than that of open technique (133 vs. 122 minutes, p = 0.074). After the learning period, duration of laparoscopic procedures became shorter (first five years: 147 min., second five years: 118 min, p = 0.003), larger spleens were removed (220 vs. 450 grams, p = 0.063) and conversion rate became lower. In cases of laparoscopic procedures fewer reoperations needed to be performed (1.5% vs. 6%, p = 0.718), bowel motility recovered earlier (2 vs. 3 days, p = 0.002) and hospital stay was shorter (5 vs. 8 days, p ? 0.001). Conclusion: Our study proves that laparoscopic splenectomy is a safe method with many advantages. Our results correlate with data of international publications. PMID:23428723

Nyilas, Aron; Paszt, Attila; Simonka, Zsolt; Abrahám, Szabolcs; Pál, Tamás; Lázár, György



Endoscopic cochlear implant procedure.  


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



Automated Support for da Vinci Surgical System.  

National Technical Information Service (NTIS)

While adoption of da Vinci systems has been rapid worldwide, there exists a wide variance in surgical procedure performance impacting care quality, cost and patient safety negatively, due in part to inefficient training practices and limited mechanisms fo...

J. Berkley



Method for determining bioburden of surgical gloves.  


A washing procedure that removed maximum numbers of contaminating microorganisms from whole surgical gloves was developed. Washing, coupled with membrane filtration, proved to be a simple and effective method for bioburden determinations on whole gloves. PMID:96130

Lammerding, A M; Day, D F



Percutaneous Versus Surgical Tracheostomy  

PubMed Central

Objective To compare surgical (SgT) and percutaneous (PcT) tracheostomies. Background Percutaneous tracheostomy has been said to provide numerous advantages over classical SgT. Methods A prospective randomized trial with a double-blind evaluation was used to compare SgT and PcT. SgT and PcT were performed according to established techniques (n = 70). The procedure was performed at the bedside in the intensive care unit in 21 cases (30%). The outcome measures were divided into procedure-related variables, perioperative complications, and postoperative complications. The procedure-related variables (location, duration, and difficulty) were evaluated by the surgeon. The perioperative and postoperative complications were divided into serious, intermediate, and minor. Perioperative and early postoperative (14 days) complications were evaluated daily by an intensive care unit nurse blinded to the technique used. Long-term postoperative complications were evaluated 3 months after decannulation by a surgeon blinded to the surgical technique. Results There were no major complications in either group. Most variables studied were not statistically different between the PcT and SgT groups. The only variables to reach statistical significance were the size of the incision (smaller with PcT, p < 0.0001), minor perioperative complications (greater with PcT, p = 0.02), and difficult cannula changes (greater with PcT; p < 0.05). Among nonsignificant differences, difficult procedures and false passages were more frequent with PcT, whereas long-term unesthetic scars were more frequent with SgT. Conclusions Both techniques are associated with a low rate of serious or intermediate complications when performed by experienced surgeons. There were more minor perioperative complications with PcT and more minor long-term complications with SgT.

Gysin, Claudine; Dulguerov, Pavel; Guyot, Jean-Philippe; Perneger, Thomas V.; Abajo, Blanca; Chevrolet, Jean-Claude



Surgical Management of Refractory Trochanteric Bursitis  

Microsoft Academic Search

We reviewed a single surgeon's experience with the surgical management of refractory trochanteric bursitis in an active population group. The surgical procedure consisted of simple longitudinal release of the iliotibial band over the greater trochanter and excision of the subgluteal bursa. To our knowledge, this is the first series to use this technique. Seven hips in five patients form the

Daniel P. Slawski; Richard F. Howard



Surgical management of upper lid entropion  

Microsoft Academic Search

One hundred and eighty-three surgical procedures were conducted on 107 patients over seven years. 91% of the cases of upper lid entropion were corrected satisfactorily with only one operation. It is postulated that this level of success is achieved by grading the degree of surgical intervention according to the clinical established on systematic examination of upper lid entropion.

E G Kemp; J R Collin



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.



[Surgical metabolism].  


Trauma, operative interventions, infection and other disturbances of homeostasis lead to a uniform reaction of the body, namely release and activation of hormones and cytokines. Profound alterations of substrate flow result, with mobilization of energy stores and degradation of structural and functional proteins of vital organs like the gut mucosa. Due to these reactions the energy demands of the organs are met and energy-consuming synthesis of substrates is indicated. Clinically, hypermetabolism, hyperglycemia, lipolysis and increased urea production with negative nitrogen balance can be observed. The metabolic reactivity is reached by an increased substrate cycling. To avoid negative consequences such as organ dysfunction, a rational situation-adapted substrate supply is warranted as well as reduction of catabolic stimuli and stimulation of anabolic factors. The metabolic care of the surgical patient is still a basic and important task. PMID:9324431

Jauch, K W



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


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



Minimally invasive surgical management of ureteropelvic junction obstruction: laparoscopic and robot-assisted laparoscopic pyeloplasty.  


Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures. PMID:14649575

Munver, Ravi; Del Pizzo, Joseph J; Sosa, R Ernest; Poppas, Dix P



Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques  

Microsoft Academic Search

Background: The development of laparoscopic radical prostatectomy (LRP) has been one of the surgical advances in the treatment of localized prostate cancer. The procedure aims to combine the advantages of minimal access surgery with resection based on established oncological principles with cure rates and functional results that are at least comparable to open radical prostatectomy (ORP).Objectives: This review compares the

A M Omar; N Townell



Delayed assessment and eager adoption of laparoscopic cholecystectomy: Implications for developing surgical technologies  

PubMed Central

Despite the prevailing emphasis in the medical literature on establishing evidence, many changes in the practice of surgery have not been achieved using proper evidence-based assessment. This paper examines the adoption of laparoscopic cholecystectomy (LC) into regular use for the treatment of cholecystitis and the process of its acceptance, focusing on the limited role of technology assessment in its appraisal. A review of the published medical literature concerning LC was performed. Approximately 3000 studies of LC have been conducted since 1985, and there have been nearly 8500 publications to date. As LC was adopted enthusiastically into practice, the results of outcome studies generally showed that it compared favorably with the traditional, open cholecystectomy with regard to mortality, complications, and length of hospital stay. However, despite the rapid general agreement on surgical technique, efficacy, and appropriateness, there remained lingering doubts about safety, outcomes, and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard. Using LC as a case study, there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice. We highlight one recent example, natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.

Allori, Alexander C; Leitman, I Michael; Heitman, Elizabeth



High-resolution computed tomography of the middle ear and mastoid. Part III. Surgically altered anatomy and pathology  

Microsoft Academic Search

High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear

J. D. Swartz; R. S. Goodman; K. B. Russell; S. F. Ladenheim; R. J. Wolfson



Surgical video systems.  


Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible. In this study, we evaluated 19 SVSs from 10 manufacturers, focusing on their use in laparoscopic applications in general surgery. We based our ratings on the usefulness of each system's video performance and features in helping clinicians provide safe and efficacious laparoscopic surgery. We rated 18 of the systems Acceptable because of their overall good performance and features. We rated 1 system Conditionally Acceptable because, compared with the other evaluated systems, this SVS presents a greater risk of thermal injury resulting from excessive heating at the distal tip of the laparoscope. Readers should be aware that our test results, conclusions, and ratings apply only to the specific systems and components tested in this Evaluation. In addition, although our discussion focuses on the laparoscopic application of SVSs, much of the information in this study also applies to other MIS applications, and the evaluated devices can be used in a variety of surgical procedures. To help hospitals gain the perspectives necessary to assess the appropriateness of specific SVSs to ensure that the needs of their patients, as well as the expectations of their clinicians, will be satisfied, we have included a Selection and Purchasing Guide that can be used as a supplement to our Evaluation findings. We have also included a Glossary of relevant terminology and the supplementary article, "Fiberoptic Illumination Systems and the Risk of Burns or Fire during Endoscopic Procedures," which addresses a safety concern with the use of these devices. While we made every effort to present the most current information, readers should recognize that this is a rapidly evolving technology, and developments occurring after our study was complete may not be reflected in the text. For additional information on topics related to this study, refer to the following Health Devices articles: (1) our Guidance Article, "Surgical Video Systems Used in Laparoscopy," 24(1), January 1995, which serves as an introduction to SVS terminology and includes a discussion of the significance of many SVS specifications; (2) our Evaluation, "Video Colonoscope Systems," 23(5), May 1994, which includes a detailed overview of video endoscopic applications and technology; and (3) our Evaluations of laparoscopic insufflators (21[5], May 1992, and 24[7], July 1995), which address issues related to the creation of a viewing and working space inside the peritoneal cavity to facilitate visualization in laparoscopic procedures. PMID:8750067



MR imaging guidance for minimally invasive procedures  

NASA Astrophysics Data System (ADS)

Image guidance is one of the major challenges common to all minimally invasive procedures including biopsy, thermal ablation, endoscopy, and laparoscopy. This is essential for (1) identifying the target lesion, (2) planning the minimally invasive approach, and (3) monitoring the therapy as it progresses. MRI is an ideal imaging modality for this purpose, providing high soft tissue contrast and multiplanar imaging, capability with no ionizing radiation. An interventional/surgical MRI suite has been developed at Brigham and Women's Hospital which provides multiplanar imaging guidance during surgery, biopsy, and thermal ablation procedures. The 0.5T MRI system (General Electric Signa SP) features open vertical access, allowing intraoperative imaging to be performed. An integrated navigational system permits near real-time control of imaging planes, and provides interactive guidance for positioning various diagnostic and therapeutic probes. MR imaging can also be used to monitor cryotherapy as well as high temperature thermal ablation procedures sing RF, laser, microwave, or focused ultrasound. Design features of the interventional MRI system will be discussed, and techniques will be described for interactive image acquisition and tracking of interventional instruments. Applications for interactive and near-real-time imaging will be presented as well as examples of specific procedures performed using MRI guidance.

Wong, Terence Z.; Kettenbach, Joachim; Silverman, Stuart G.; Schwartz, Richard B.; Morrison, Paul R.; Kacher, Daniel F.; Jolesz, Ferenc A.



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



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



The role of simulation in surgical skills training in gynaecological endoscopy.  


Minimal-access surgery has revolutionised diagnosis and management in many surgical specialties, including gynaecology. It is well known that the surgical skill set required to carry out endoscopic surgery is essentially different from open surgery, creating a longer learning curve. Fewer opportunities exist for trainees as a result of reduced working hours and also the use of less invasive procedures, such as endometrial ablation procedures, Mirena(®) intrauterine system, and methotrexate in treating ectopic pregnancies. Significant work has been undertaken to introduce simulation to enhance laparoscopic training and to test the construct validity and face validity of different simulators. In this chapter, we summarise the evidence on simulation training in minimal-access gynaecology, and provide practical recommendations to develop an evidence-based simulation-training curriculum. PMID:23434059

Haerizadeh, Hadi; Frappell, Jonathan



Use of negative pressure wound therapy over clean, closed surgical incisions.  


The literature has reported that surgical site infections account for 17-22% of health care-associated infections, while surgical wound dehiscence rates range from 0.25% to 3.0% (post laparatomies), 1.6% to 42.3% (post-caesarean incisions) and 0.5% to 2.5% (sternal incisions). These types of incisional complications can become a significant cost burden to the health care system because of lengthy hospital stays and readmissions, additional nursing care and added surgical procedures. Therefore, the type of therapy used for surgical incisions plays a critical role in the healing process. The success of negative pressure wound therapy (NPWT; V.A.C.® Therapy; KCI USA, Inc., San Antonio, TX) for open wounds has been well documented and has led to its use over clean, closed surgical incisions. This review will focus on clinician experience and literature review of incisional NPWT and will include clinical cases describing NPWT's successful use over surgical incisions. PMID:22727138

Stannard, James P; Gabriel, Allen; Lehner, Burkhard



Minimally Invasive Parathyroidectomy Using Surgical Sonography  

PubMed Central

Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Localization of the offending adenoma in minimally invasive parathyroidectomy (MIP) has been described in the literature aided by isotope, telescope or ultrasound guidance. We present a prospective study of two techniques based on surgeon experience. Thirty patients diagnosed with primary hyperparathyroidism at the Mater hospital in Dublin, Ireland were randomized to have a minimally invasive parathyroidectomy using surgical sonography (MIPUSS) or the conventional unilateral open procedure (OP) over a two year period. The age, sex and serum calcium/parathormone were comparable in both groups. There was no significant difference in complications between the two groups with temporary hypocalcemia occurring in 3 patients undergoing unilateral neck exploration and in 2 MIPUSS patients. There was one transient episode of recurrent laryngeal neuropraxia occurring in the OP group which resolved at 30 day follow-up. The incision size, operating time, hospital stay, and required post-operative analgesia were all markedly reduced in the MIPUSS group. In conclusion, MIPUSS is safe, effective and has advantages in terms of operating time, incision size and early discharge.

Sadik, Karim W; Kell, Malcolm; Gorey, Tom



Stereolithographic Surgical Template: A Review  

PubMed Central

Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures.

Dandekeri, Shilpa Sudesh; Sowmya, M.K.; Bhandary, Shruthi



Blepharoplasty and periorbital surgical rejuvenation.  


The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist's point of view. PMID:23254728

Naik, Milind


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.



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 Central

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 124I-labeled chimeric monoclonal antibody G250 (124I-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 124I-cG250 (ie, 124I-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.

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.



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.  


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



An evaluation of hernia education in surgical residency programs.  


PURPOSE: The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias. METHODS: A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey. Comparisons based on training level were made using ?(2) test of independence, Fisher's exact, and Fisher's exact with Monte Carlo estimate as appropriate. A p value <0.05 was considered significant. RESULTS: The survey was returned by 183 residents from 250 surgical programs. Resident postgraduate year (PG-Y) level was equivalent among groups. Preferred techniques for open ventral hernia varied; the most common (32 %) was intra-abdominal placement of mesh with defect closure. Twenty-two percent of residents had not heard of the retrorectus technique for hernia repair, 48 % had not performed the operation, and 60 % were somewhat comfortable with and knew the general categories of mesh prosthetics products. Mesh choices, biologic and synthetic, varied among the different products. The most common type of hernia education was teaching in the operating room in 87 %, didactic lecture 69 %, and discussion at journal club 45 %. Number of procedures, comfort level with open and laparoscopic techniques, indications for mesh use and technique, familiarity and use of retrorectus repair, and type of hernia education varied significantly based on resident level (p < 0.05). CONCLUSION: Exposure to hernia techniques and mesh prosthetics in surgical residency programs appears to vary. Further evaluation is needed and may help in standardizing curriculums for hernia repair for surgical residents. PMID:23644776

Hope, W W; O'Dwyer, B; Adams, A; Hooks, W B; Kotwall, C A; Clancy, T V



Surgical technique affects outcomes in acromioclavicular reconstruction.  


Optimal treatment for acromioclavicular (AC) dislocation is unknown. Numerous surgical procedures for AC injuries have been described with little comparison. This study sought to compare the clinical and radiographic results of various surgical techniques in order to identify the optimal surgical technique. Ninety patients met inclusion criteria of AC reconstruction at this institution. A retrospective review of outcomes was performed using the electronic records system. Radiographs were measured for pre- and postoperative grade and percent elevation versus the contralateral side. Overall revision rate was 9%. Suture button fixation had a revision rate of 0% compared to 14% (p = .01). Reconstruction procedures performed with distal clavicle excision showed a higher revision rate, 17% compared to 0% (p = .003). There were no statistically significant clinical differences. AC reconstructions performed with suture button construct were superior to other surgical techniques. Procedures performed with distal clavicle excision were inferior to those without. PMID:23449059

Grassbaugh, Jason A; Cole, Chad; Wohlrab, Kurt; Eichinger, Josef



How can educators use simulation applications to teach and assess surgical judgment?  


Surgical simulation applications have been largely limited to the acquisition and assessment of technical skills. Current teaching and assessment of surgical judgment is nonsystematic and prone to error. Interest in methods to enhance the acquisition and assessment of knowledge-based (judgment) skills for intraoperative decision making has led to the application of cognitive task analysis (CTA) and human error assessment to facilitate this process. CTA-based delineation of the steps and hazards of a surgical procedure creates a structured process to teach and assess expert surgical judgment and improves trainees' operative planning, hazard recognition, error prevention, and error recovery when coupled with low-fidelity, synthesized simulation models for open and laparoscopic surgery. Web-based simulation applications facilitate curricular learning (rules-guided skills), allow cognitive rehearsal of procedures, and are accessible independent of location and time. Simulation applications that facilitate the assessment and learning of expert intraoperative judgment should include a consensus-derived outline based on CTA of the operative steps and potential points of risk for each surgical procedure; the ability to detect the situational awareness of the performer and the options considered to avoid error at critical steps; an assessment (scoring) of options considered or attempted; immediate evaluation feedback to inform improved performance; and a program of deliberate practice in which progressively more challenging scenarios can be introduced, based on the trainee's demonstrated skills. High-fidelity simulators currently lack these essential components, and future simulation-assisted teaching and assessment of surgical judgment skills are likely to employ low-fidelity simulators coupled to Web-based instruction. PMID:22622214

Andersen, Dana K



Surgical cost of care in Crohn's disease.  


Abstract The aim of the studywas to evaluate the cost of surgical care and short-term outcomes of Crohn's disease(CD) in the era of laparoscopy and biologic therapy. Material and methods. Review of a prospective database identifiedCD patients that underwent surgical management. Patients were stratified into laparoscopic, open, and converted approaches. Main outcome measures were short-term patient outcomes and cost of care by approach. Results. 92 patients were analyzed- 63.1% laparoscopic, 32.6% open, 4.3% converted. The majority was elective (100% converted, 94.8% laparoscopic, 90% open) and segmental resections (75% converted, 70.7% laparoscopic, 43.3% open). Operative times were similar between laparoscopic and open (152 minutes and 138 minutes, respectively). More open patients required ICU care (20% versus 12.1% laparoscopic and 0% converted). The median LOS was 3 (1-25) days laparoscopic, 4 (1-29) open and 4 (3-8) converted. The laparoscopic complication rate was 15.5%, readmission rate 12.1%, and reoperation rate 8.6%. The mean total hospital cost was $9,702 laparoscopic, $10,782 open, and $13,293 for converted cases (US Dollars). Conclusions. Laparoscopy is appropriate for most CD cases. When necessary to combine with open surgery, this results in efficient and effective patient outcomes and healthcare utilization. These results are important when weighing the cost of ongoing medical therapy versus surgical intervention. PMID:24133109

Keller, Deborah S; Katz, Jeffry; Stein, Sharon L; Delaney, Conor P



Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists  

Microsoft Academic Search

Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin\\u000a rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed\\u000a to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has\\u000a not been determined if this phenomenon exists amongst non-fellowship-trained

Ralph Madeb; Dragan Golijanin; Joy Knopf; Craig Nicholson; Stuart Cramer; Frederick Tonetti; Kelly Piccone; John R. Valvo; Louis Eichel



[Possibilities of surgical therapy of lymphedema].  


The surgical treatment of lymphedema, which was mainly used on limbs, was, up until the beginning of the last century marked by radical resection methods. Over the last 20 years, through the development of microsurgical techniques, lymphatics and lymph nodes are anastomosed after autologous transplantation to bypass blockages that occur after lymphonodal dissection after cancer therapy. As a further efferent surgical method, the lympho-venous anastomosis was propagated during the recent decades.In addition, other minimal invasive surgical techniques concerning dissection have been developed. The well known liposuction technique, which has been frequently and successfully used in cosmetic surgery, is capable of removing tissue changes that are caused by lymphedema with satisfying cosmetic results.Other surgical procedures are so called "additive lymphologic surgical treatments", such as dermatolipectomy and surgical resection of secondary lymphedema-lesions, like papillomatosis cutis, lymphcysts, lymphatic fistulas, which occur especially in lymphedema of the genitals. PMID:23591856

Döller, Walter



Caesarean section surgical site infection surveillance  

Microsoft Academic Search

Summary Surveillance of surgical site infection (SSI) is an important infec-tion control activity. The Caesarean section procedure was selected, as part of the Scottish Surveillance of Healthcare Associated Infection Programme, to monitor and report upon the incidence of SSI. Data were collected prospec-tively for 715 patients undergoing a Caesarean section procedure for 35 weeks during the latter months of 2002

A. Johnson; D. Young; J. Reilly



Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy  

Microsoft Academic Search

Background  Carbon dioxide (CO2) pneumoperitoneum effects are still controversial. The aim of this study was to investigate cardiopulmonary changes in patients\\u000a subjected to different surgical procedures for cholecystectomy.\\u000a \\u000a \\u000a \\u000a Methods  In this study, 15 patients were assigned randomly to three groups according to the surgical procedure to be used: open cholecystectomy\\u000a (OC), CO2 pneumoperitoneum cholecystectomy (PP), and laparoscopic gasless cholecystectomy (abdominal wall lifting

G. Galizia; G. Prizio; E. Lieto; P. Castellano; L. Pelosio; V. Imperatore; A. Ferrara; C. Pignatelli



[Surgical strategy for extended aortic arch aneurysm].  


The management of an extended aortic arch aneurysm still remains a clinical challenge. Open surgery can be invasive for the patients with comorbidities. Since thoracic endovascular aneurysm repair (TEVAR) was introduced, hybrid therapy has been applied for the extended arch aneurysm. From 1997 to 2013, 379 patients have undergone aortic arch surgery. Of those, 241 patients of non-dissection aneurysm were studied. Open surgical repair with L-shaped thoracotomy was done in 28 patients, frozen elephant trunk( FET) in 30 patients, long elephant trunk( LET) with 2nd TEVAR in 21 patients, debranched TEVAR in 10 patients and standard arch grafting in 152 patients as a control group. The brain infarction rate was high in debranched TEVAR (40%) and L-shaped group (25%). The paraplegia rate was high in FET group( 23.3%). The respiratory failure rate was high in the L-shaped group and the LET group. In-hospital mortality was 0.0% in the L-shaped group, 6.7% in the FET group, 4.8% in the LET group, 20% in the debranched group and 0.7% in the control group. The debranched TEVAR group is our early experience, and the recent outcomes of this procedure have improved. The management of extended aortic arch aneurysm has changed with hybrid approach combined with TEVAR. Open repair is still the gold standard, but hybrid therapy is used for high-risk patients. Off-pump debranched TEVAR tends to be applied for extended arch aneurysm. PMID:24105110

Araki, Yoshimori; Mutsuga, Masato; Tokuda, Yoshiyuki; Okada, Masaho; Abe, Tomonobu; Oshima, Hideki; Usui, Akihiko



Timing of surgery for common pediatric surgical conditions.  


Depending upon various factors the surgical procedures in childhood are divided into three groups--immediate, intermediate and elective. The timing of surgery is probably the most important factor governing the outcome of surgical correction in pediatric surgery. With continuing research and clinical experience our understanding of the various conditions have improved and with that has come a change in the optimum timing of many surgical procedures. This paper highlights the best timing of surgery for some of the commoner pediatric surgical procedures and the reasons behind these so that the children may be referred to pediatric surgeons in time. PMID:10830058

Agarwala, S; Mitra, D K


Surgical smoke evacuation systems.  


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



Prospective randomized single-center, single-blind Comparison of laparoscopic vs open repair of pediatric inguinal hernia  

Microsoft Academic Search

Background: The repair of indirect inguinal hernia (IH) is one of the most common pediatric surgical procedures, and open surgery (OS) is the standard treatment. The aim of this study was to determine whether the recently developed laparoscopic repair (LR) of IH is superior to OS. Methods: Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients

K. L. Chan; W. C. Hui; P. K. H. Tam



Evaluation of the pediatric surgical patient with congenital heart disease.  


Children with cardiac disease who undergo noncardiac surgical procedures may encounter risks beyond those usually associated with surgical procedures. In this article, several complicating factors seen in children with heart disease are discussed, including arrhythmias, cyanosis, congestive heart failure, pulmonary hypertension, and subacute bacterial endocarditis. PMID:6356416

Werner, J C; Fripp, R R; Whitman, V



Risk of surgical site infection in patients undergoing orthopedic surgery.  


This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses' clinical practice. PMID:22249670

Ercole, Flávia Falci; Franco, Lúcia Maciel Castro; Macieira, Tamara Gonçalves Rezende; Wenceslau, Luísa Cristina Crespo; de Resende, Helena Isabel Nascimento; Chianca, Tânia Couto Machado


2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design.  


This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS. PMID:22382715

Calkins, Hugh; Kuck, Karl Heinz; Cappato, Riccardo; Brugada, Josep; Camm, A John; Chen, Shih-Ann; Crijns, Harry J G; Damiano, Ralph J; Davies, D Wyn; DiMarco, John; Edgerton, James; Ellenbogen, Kenneth; Ezekowitz, Michael D; Haines, David E; Haissaguerre, Michel; Hindricks, Gerhard; Iesaka, Yoshito; Jackman, Warren; Jalife, Jose; Jais, Pierre; Kalman, Jonathan; Keane, David; Kim, Young-Hoon; Kirchhof, Paulus; Klein, George; Kottkamp, Hans; Kumagai, Koichiro; Lindsay, Bruce D; Mansour, Moussa; Marchlinski, Francis E; McCarthy, Patrick M; Mont, J Lluis; Morady, Fred; Nademanee, Koonlawee; Nakagawa, Hiroshi; Natale, Andrea; Nattel, Stanley; Packer, Douglas L; Pappone, Carlo; Prystowsky, Eric; Raviele, Antonio; Reddy, Vivek; Ruskin, Jeremy N; Shemin, Richard J; Tsao, Hsuan-Ming; Wilber, David



Surgical Robotics Research in Cardiovascular Disease  

SciTech Connect

This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ({sup 31}P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery devices utilizes an open-loop configuration involving a team consisting of neurosurgeon, neurologist and neurophysiologist all present and participating in the decision process of delivery. We propose the development of an integrated system which provides for distributed decision making and tele-manipulation of the instrument delivery system.

Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles



Cephalosporins in surgical prophylaxis.  


Controlled clinical trials have shown that antimicrobial prophylaxis can lower the incidence of infection after certain operations, thus reducing morbidity, hospital stay, antibiotic usage and mortality due to sepsis. An effective prophylactic regimen should be directed against the most likely infecting organisms, but need not be active against every potential pathogen. Infection can be prevented when effective concentrations are present in the blood and the tissue during and shortly after the procedure. Therefore, antimicrobial prophylaxis should begin just before the operation: beginning earlier is unnecessary and potentially dangerous, beginning later is less effective. A single-dose prophylaxis after the induction of anesthesia is sufficient. If surgery is delayed or prolonged, a second dose is advisable if an antimicrobial drug with a short half-life is used. Postoperative administration is unnecessary and is harmful. Cephalosporins are considered to be the drug of choice, because they offer fewer allergic reactions. From the first generation cephalosporins, cefazolin has been widely recommended with success. From the second generation cephalosporins, cefuroxime, cefamandole and cefoxitin are increasingly recommended. Their antistaphylococcal activity is somewhat less strong but their activity against gram-negative bacteria is stronger. In addition, cefoxitin has good activity against anaerobes. Third generation cephalosporins, such as cefotaxime, cefoperazone, ceftriaxone, ceftazidime or ceftizoxime are generally not recommended for surgical prophylaxis. Despite these recommendations, they have been accepted by the medical community and are today in use in many countries as the most common drugs in surgical prophylaxis. Ceftriaxone in particular, is far exceeding the sales of any other drug for prophylaxis. Contra-indications, limitations, additional or other drugs and practical recommendations for specific procedures are discussed and the results of several prospective randomized studies are presented. PMID:11936371

Geroulanos, S; Marathias, K; Kriaras, J; Kadas, B



A Quantitative, Qualitative, and Critical Assessment of Surgical Waste Surgeons Venture Through the Trash Can  

Microsoft Academic Search

Objectives.\\\\p=m-\\\\Toquantitatively and qualitatively evaluate the surgical waste produced from several common surgical procedures, define categories of waste that might be readily separated for alternative disposal practices or substitution, and determine the change in surgical waste output that elimination or alternative han- dling methods may effect. Design.\\\\p=m-\\\\Acase series evaluating the surgical waste from five types of surgical procedures including operations of

Myles E. Tieszen; James C. Gruenberg



Using a Simulated Surgical Skills Station to Assess Laceration Management by Surgical and Nonsurgical Residents  

PubMed Central

Objective To assess laceration management performance among surgical and nonsurgical postgraduate year-1 (PGY-1) residents objectively and to test for interval improvement. Methods From 2006 to 2008, 106 PGY-1 residents from 10 medical specialties were evaluated with a simulated surgical skills station using pigs' feet before and after internship. Subjects were given 11 minutes to choose the proper suture, prepare and close the wound, and answer laceration management questions. Trainees were classified as surgical (emergency medicine, general surgery, obstetrics and gynecology, orthopedics, and otolaryngology) and nonsurgical (family medicine, internal medicine, neurology, pediatrics, and transitional year). An objective checklist was used to assess performance. Results A total of 106 PGY-1 residents (age range, 25–44 years; mean, 28.7 years) participated, consisting of 41 surgical (39%) and 65 nonsurgical residents (61%). Surgical group scores improved from 78.4% to 87.7% (P?surgical, 9.4%; nonsurgical, 5.9%; P??=??.21). Surgical residents outscored nonsurgical residents before (P?Surgical residents outperformed nonsurgical residents before and after the PGY-1 year with similar score improvements. A simulated surgical skills station can be used to evaluate procedure performance objectively and to test for interval improvement. A simulated surgical skills station may serve as a useful adjunct to apprenticeship in assessing procedure competence.

Fargo, Matthew V; Edwards, John A; Roth, Bernard J; Short, Matthew W



Surgical Straightening With Penile Prosthesis  

Microsoft Academic Search

Peyronie’s disease (PD) is an incurable, chronic condition producing scarring fibrosis of the tunica albuginea and is associated\\u000a with penile deformity and erectile dysfunction. Although men afflicted with PD usually have a number of treatment options,\\u000a those who also present with erectile dysfunction (ED) arising from it are not easily treated. Surgical straightening procedures\\u000a that have been used to treat

Steven K. Wilson; Culley C. Carson


Photodigitizing procedures  

Microsoft Academic Search

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

P. D. Kilgore; J. H. Gottbrath



Surgical treatment of hemangiomas of the nose.  


The approach to a rapidly growing vascular tumor is determined by a number of objective and subjective factors. As a rule, treatment of a hemangioma in an infant is usually delayed, in the expectation that involution will be complete. While most hemangiomas are harmless vascular marks, some may grow to become large, infiltrating masses. Local factors that influence treatment decision making include volume, ulceration, secondary infection, and bleeding of the tumor. Hemangiomas situated on the nose are distinguished from other locations by a few but important aspects and may demand a more aggressive position from the surgeon. An important consideration is the potential for aplasia of the delicate nasal cartilages that are undergoing development, due to the mass effect of the tumor. Nasal tip hemangiomas are slow to regress, and contour deformities result from the fibrofatty tissue that invariably remains even after total involution. More importantly, hemangiomas of the nasal region are particularly prone to causing great social distress to the parents, who will request prompt treatment for such a visible, deforming lesion. A definite solution that ensures removal of affected tissue and preservation of anatomy seems to be the best treatment for these tumors. In this article, the experience of the senior author (IP) in treating hemangiomas located on the nose is reviewed. The elliptical midline incision over the nasal dorsum described in the text was developed to address three important aspects: an expedient procedure to treat a highly disfiguring disease; an open access to allow for complete resection and, at the same time, allow for the correction of underlying cartilaginous disruption; and placement of a scar in an anatomic location proven to be very satisfactory aesthetically, permitting access for secondary procedures for better definition of nasal contour. Careful patient selection for this surgical procedure is emphasized. PMID:8792967

Pitanguy, I; Machado, B H; Radwanski, H N; Amorim, N F



Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials  

Microsoft Academic Search

Background: For the scientific evaluation of the endoscopic and open mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials (RCT) are necessary. The Lichtenstein repair is one of the most common open mesh techniques and therefore of special interest. Methods: After an extensive search of the literature and a quality assessment, a total of 34 RCT

C. G. Schmedt; S. Sauerland; R. Bittner



[Surgical treatment of portal hypertension].  


A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective and durable procedures to control variceal bleeding in patients with low operative risk and good liver function (Child A). In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) or a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergent endoscopic treatment or TIPS insertion fail to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) can be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascula