These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease  

PubMed Central

Objective To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases. Design Case series study with retrospective analysis of prospectively collected nonrandomized data. Methods Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan–Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency. Results HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively). Conclusion Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency.

Zhou, Min; Huang, Dian; Liu, Chen; Liu, Zhao; Zhang, Min; Qiao, Tong; Liu, Chang-Jian

2014-01-01

2

Teaching Physician Guidelines for Surgical Procedures Minor Surgical Procedures  

E-print Network

Teaching Physician Guidelines for Surgical Procedures Minor Surgical Procedures: § Procedures, the teaching physician must be present for the entire procedure § Teaching physician or resident may document the teaching physician's presence for the entire procedure High Risk and Complex Surgical Procedures

Goldman, Steven A.

3

Abstract--Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma  

E-print Network

Abstract-- Replacing open-heart surgical procedures with beating-heart interventions substantially on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator. I. INTRODUCTION UE

Dupont, Pierre

4

Surgical procedures for evacuatory disorders.  

PubMed

This review addresses the range of treatments suggested to be of contemporary value in the treatment of constipation with critical evaluation of efficacy data, complications, patient selection, controversies and areas for future research. Resection-rectopexy, stapled prolapsectomy, mesh procedures, rectocele repair, stapled rectal resection and anterograde enema are among the reported procedures, but none of them showed a clear superiority over the others due to the lack of prospective randomised trials. Both open and laparoscopic interventions have been used. The outcome is usually positive in the short-term, but long term follow up showed that most procedure carry a high recurrent rate, possibly because the target of surgery is represented by the evident organic lesions, whereas the occult functional causes tend to be underestimated. In conclusion, the authors recommend a strict and selective surgical policy when dealing with patents suffering from evacuation disorders. PMID:19967883

Arezzo, Alberto; Pescatori, Mario

2009-01-01

5

Angioplasty and Other Noninvasive Vascular Surgical Procedures  

Microsoft Academic Search

The field of vascular surgery has undergone significant changes recently. Beginning with the development of less invasive\\u000a techniques to manage general surgical pathology, such as laproscopic procedures, there has been a paradigm shift in the type\\u000a of techniques that are available to treat patients. Historically, vascular surgery patients have been successfully treated\\u000a with open surgical procedures in the majority of

Sherry D. Scovell

6

Surgical procedures for voice restoration  

PubMed Central

Surgical procedures for voice restoration serve to improve oral communication by better vocal function. They comprise of phonomicrosurgery, with direct and indirect access to the larynx; laryngoplasty; laryngeal injections; and surgical laryngeal reinnervation. The basis for modern surgical techniques for voice disorders is the knowledge about the ultrastructure of the vocal folds and the increasing experience of surgeons in voice surgery, while facing high social and professional demands on the voice. Vocal activity limitation and participation restriction has become more important in the artistic and social areas. A number of surgical methods that have been developed worldwide for this reason, are presented in this article. Functional oriented surgery has to meet high standards. The diagnostics of vocal function has to be multi-dimensional in order to determine the indication and the appropriate surgical intervention. PMID:22073062

Nawka, Tadeus; Hosemann, Werner

2005-01-01

7

A comparison of surgeons' posture during laparoscopic and open surgical procedures  

Microsoft Academic Search

Background: There is increasing recognition of surgeons' physical fatigue in the new ergonomic environment of laparoscopic surgery. The\\u000a purpose of this study was to determine what the differences are in the movement of the surgeon's axial skeleton between laparoscopic\\u000a and open operations.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: Surgeons' body positions were recorded on videotape during four laparoscopic (LAP) and six open (OP) operations. The

R. Berguer; G. T. Rab; H. Abu-Ghaida; A. Alarcon; J. Chung

1997-01-01

8

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia  

Microsoft Academic Search

The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure\\u000a of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established\\u000a place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause\\u000a of its non-destructive nature and because it

Guido Orlandini

2002-01-01

9

Surgical skill facilitation in videoscopic open surgery.  

PubMed

The operating room (OR) was traditionally characterized as a closed environment, in which the view of the operative field was available to the surgeon and assistant only. In laparoscopy, integration of technology into the surgical theatre has transformed surgical procedures into minimally invasive events, with viewing of the surgical field using endoscopic cameras. Similar technical advances to the open surgical environment will allow visualization and coordination of finer surgical maneuvers on standard video monitors. The objective of this study was to develop optimal protocols for performing basic open surgical maneuvers without direct viewing of the operating field, instead watching a monitor that displays the image of the surgical field captured by an endoscopic camera. The AESOP robotic arm and Alpha Virtual Port (Computer Motion, Goleta, California) were used to hold the endoscopic camera in different positions relative to the surgeon and the operative table. The surgeons conducting the study evaluated six such different setups. Based on the average time to complete the task in each of these setups and the ease of adaptation to the new working conditions, we concluded that at least one of these setups could be translated into the OR. The advantages of integrating video image enhancement over classical open surgery (OS) are that the surgical field can be magnified to perform finer maneuvers, and to share views of the surgical field with additional clinicians and trainees. PMID:14733703

Panait, Lucian; Rafiq, Azhar; Mohamed, Ahmed; Doarn, Charles; Merrell, Ronald C

2003-12-01

10

Augmented reality in surgical procedures  

NASA Astrophysics Data System (ADS)

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

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

2008-02-01

11

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

12

Evaluation of surgical procedures for trigeminal neuralgia.  

PubMed Central

Trigeminal neuralgia is a type of facial pain that is difficult to treat. The pain can be excruciating and debilitating. The wide range of treatments currently used for trigeminal neuralgia is ample evidence that there is no simple answer to how it should be managed. This review will evaluate the current surgical procedures used for the treatment of trigeminal neuralgia. A critical analysis of the evidence-based studies to date was done to evaluate and compare the efficacy of the different surgical procedures. Arguments for and against the use of surgery for trigeminal neuralgia are presented. In addition, the surgical procedures were compared with other treatments for trigeminal neuralgia. PMID:14959906

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

2003-01-01

13

Characterization of aerosols produced by surgical procedures.  

National Technical Information Service (NTIS)

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 produc...

H. C. Yeh, B. A. Muggenburg, D. L. Lundgren, R. A. Guilmette, M. B. Snipes

1994-01-01

14

Characterization of aerosols produced by surgical procedures  

SciTech Connect

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

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

1994-07-01

15

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. PMID:7773907

LeBourdais, E

1995-01-01

16

Surgical Procedures in Predoctoral Periodontics Programs.  

ERIC Educational Resources Information Center

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

Radentz, William H.; Caffesse, Raul G.

1991-01-01

17

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

2010-01-01

18

[Amniotic membrane utilization in ophthalmological surgical procedures].  

PubMed

The amniotic membrane, which is the innermost layer of the fetal membranes, is composed of a single layer of epithelial cells that lie on a basement membrane, and of a non-vascular collagenous stroma. These three components give the amniotic membrane its beneficial properties. The first therapeutic application of the amniotic membrane was in 1910, when it was used in skin transplantation. Thereafter, it was used in surgical procedures related to the abdomen, genitourinary tract and to the head and neck. In ophthalmology, De Roth, in 1940, was the first to use the amniotic membrane for conjunctival reconstruction. However, it was only in 1995 that publications on the subject started appearing again, when Tseng and many others began using the amniotic membrane again in the treatment of ocular surface (cornea and conjunctiva) diseases. In cases of total stem cell deficiency, amniotic membrane transplantation has been shown to be very useful when used in conjunction with limbal autografts or allografts. At this stage, however, further studies are needed to elucidate the real potential of the amniotic membrane in the treatment of different ocular surface (and other) disorders, and its exact mechanism(s) of action. This will help establish the applications of such treatment in medicine, in general, and in ophthalmology, in particular. PMID:16398211

Waked, Naji; El-Kazzi, Valia

2005-01-01

19

20 CFR 220.60 - Diagnostic surgical procedures.  

Code of Federal Regulations, 2010 CFR

...the Board's disability program. In addition, the Board will not order procedures such as cardiac catheterization and surgical biopsy. However, if any of these procedures have been performed as part of a workup by the claimant's treating physician or...

2010-04-01

20

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. PMID:24040474

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

2013-01-01

21

[Surgical procedure in combined proctologic diseases].  

PubMed

In 301 (23%) out of 1264 surgical cases with various pathologies of the rectum, pararectal and sacrococcygeal regions some combined diseases were observed. Such combinations as chronic paraproctitis (rectal fistulae) with hemorrhoids and with anal fissure are the most common ones. 176 one-stage operations and 63 double-stage operations were carried out. The average period of hospitalization was 16 days after one-stage operation and 24 days after double-stage operation. The authors believe that timely diagnosing of combined pathology allows to prevent the development of possible complications and to choose the most helpful surgical tactics in every specific case. PMID:716150

Nazarov, L U; Orgusian, R V

1978-10-01

22

[The surgical procedure in acute anaerobic paraproctitis].  

PubMed

A method of active outstripping incisions with special reference to the localization of the primary anaerobic focus and possible pathways of the spreading of purulent exudate is proposed on the basis of experiences with surgical treatment of 14 patients with acute anaerobic paraproctitis and investigations of topographical-anatomical localization of cellular spaces in the pararectal area. PMID:8091577

Toropov, Iu D; Stavitski?, V V; ZgurskiI, V G; Kravtsov, N G

1993-01-01

23

Immersive Electronic Books for Teaching Surgical Procedures  

E-print Network

with the use of immersive virtual reality technology for trauma surgery training. We discuss our technical for trauma surgery. We focus on a class of trauma injuries that are both potentially lethal and also particularly difficult to treat, namely blunt liver traumas. Today, the pace of surgical innovations has

Yang, Ruigang

24

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

PubMed

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

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

2014-03-01

25

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

26

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

27

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

28

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

29

The Gastric Bypass for Failed Bariatric Surgical Procedures  

Microsoft Academic Search

Background: Revision of failed bariatric surgical procedures is a significant challenge for every bariatric surgeon. Methods:\\u000a Evaluated are surgical difficulties, management problems and weight loss in patients with distal gastric bypass as a revisionary\\u000a procedure. Eighty patients were followed up to 3 years; four were lost to follow-up. Mean age was 43; mean prebariatric surgery\\u000a weight 134 kg; height 1.65

S. Ross Fox; Katherine M. Fox; Ki Hyun Oh

1996-01-01

30

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.

2007-03-01

31

Intraductal papillomas: diagnostic and surgical procedures.  

PubMed

A series of 98 patients with spontaneous nipple discharge, is reported. Diagnosis was based on: clinical examination, cytology of breast secretion, mammography and galactography. Surgical resection was recommended in the following cases: galactographic evidence of intraductal papilloma or papillomatosis, dubious or positive cytology, persisting hemorrhagic or sero-hemorrhagic secretion. The injection of vital staining before the operation allowed the precise location of the lesion. In the group of patients studied ten cases of ductal carcinomas (5 in situ and 5 smaller than 1 cm), 4 cases of atypical intraductal hyperplasia, 13 cases of solitary papilloma and 22 cases of multiple papillomatosis were diagnosed. PMID:2987154

Vio, A; Barbanti, F; Dell'Amore, D; Amadori, D; Ravaioli, A; Maltoni, M; Casadei Giunchi, D

1985-01-01

32

Patient perception of physician reimbursement for common hand surgical procedures.  

PubMed

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

2013-09-01

33

[Recurrent varicose veins. Surgical procedure--results].  

PubMed

We report 96 patients (107 legs) with recurrence after varicose vein surgery. We define a recurrent varicose vein as a new transfascial insufficiency after incomplete interruption of the saphenofemoral as well as popliteal junction with reflux in the epifascial venous system. 92 patients underwent external primary surgery. Morphologically an insufficient high ligation of the V. saphena magna (Moszkowicz's operation) led in 30 cases to a recurrent varicose vein. In 47 cases an incomplete isolated, in 29 cases an incomplete saphenofemoral ligation during a Babcock procedure and in one case an incomplete saphenopopliteal ligation for V. saphena parva insufficiency were the reasons for the recurrence. As recurrent surgery we performed 106 ligations of the saphenofemoral junction. In 38 of these cases an isolated saphenofemoral ligation and in 68 cases an additional stage-adjusted ligation of the V. saphena magna were carried out. In one case of recurrent saphenopopliteal insufficiency a repeated ligation of the V. saphena parva was performed. The recurrence is an avoidable complication of a not perfect primary surgery. The main cause is an inadequate access with incomplete saphenofemoral or -popliteal ligation. PMID:11503464

Pourhassan, S; Zarras, K; Mackrodt, H G; Stock, W

2001-07-01

34

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

PubMed

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

Shapiro, A; Cooper, D L

2012-05-01

35

Factors influencing the ionization of calcium during major surgical procedures.  

PubMed

The existence of a clinically feasible calcium electrode makes it possible to obtain rapid, accurate levels of ionized calcium. It is now possible to study the actual ionization of calcium under normal and abnormal physiologic conditions. The present investigation was directed at changes in ionized calcium during major surgical procedures. The total series of 125 patients was divided into three groups according to the type of plasma volume expander: group 1, whole blood alone; group 2, whole blood plus exogenous albumin, and group 3, albumin alone. Ionized calcium levels dropped significantly, p less than 0.001, in all three groups. Although albumin alone produced a decrease in ionized calcium, the addition of albumin to whole blood did not result in a greater decline than that experienced with whole blood alone. Chelation with the citrate ion of bank blood preservative was the major factor responsible for the decrease in ionized calcium. There was no statistically significant relationship between the extent of the decrease, the total volume of blood, the volume of blood per kilogram of the rate of transfusion in milliliters per kilogram per minute. Although the ionized calcium level fell initially, it increased while blood administration continued. In view of these facts, it is difficult to estimate the acutal level of ionized calcium at any point during the operation. Twenty patients in the series had ionized calcium levels below 1.25 milliequivalents per liter, range of 0.51 to 1.24 milliequivalents per liter. With the possible exception of one patient, no adverse cardiovascular effects could be attributed to the low levels of ionized calcium. The results in this series confirm our previous conclusion that the administration of exogenous calcium is not necessary during massive transfusion, with the possible exception of bypass open heart procedures and exchange transfusions in children. PMID:11568

Howland, W S; Schweizer, O; Jascott, D; Ragasa, J

1976-12-01

36

Surgical Treatment of Patients with Open Tibial Fractures  

Microsoft Academic Search

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

Chris Brown; Shirley Henderson; Shirley Moore

1996-01-01

37

Major surgical procedures in children with cerebral palsy.  

PubMed

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

Theroux, Mary C; DiCindio, Sabina

2014-03-01

38

Surgical treatment in chronic pancreatitis timing and type of procedure.  

PubMed

Pain relief and improvement in the quality of life are of paramount importance for any intervention in chronic pancreatitis. In several trial good results have been published after different drainage procedures and resections. An optimal surgical intervention should manage mainly the intractable pain, resolve the complications of the adjacent organs and achieve the drainage of the main pancreatic duct. An optimal procedure should guarantee a low relapse rate, preserve a maximum of endocrine and exocrine function, and most importantly, restore quality of life. Thus an ideal operation should representing a one-stop-shopping. According to the trials conducted so far, Duodenum-preserving resection of the pancreatic head offers the best short-term outcome. It combines the highest safety of all surgical procedures with the highest efficacy. By varying the extent of the cephalic resection, it offers the possibility of customizing surgery according to the individual patient's morphology. PMID:20510830

Bachmann, Kai; Kutup, Asad; Mann, Oliver; Yekebas, Emre; Izbicki, Jakob R

2010-06-01

39

Effect of short surgical procedures on salivary paracetamol elimination.  

PubMed Central

The effect of short surgical procedures on paracetamol elimination was studied in seven male patients undergoing surgery with epidural anaesthesia. Five healthy volunteers who did not undergo surgery served as a control group. Paracetamol concentration was measured in saliva at various intervals 1 day before and after surgery. Paracetamol half-life (t1/2,z) decreased and metabolic clearance rate (CL) increased after surgery as compared to preoperative values. The results suggest that surgical stress may enhance the hepatic metabolism of paracetamol. PMID:4041337

Ray, K; Adithan, C; Bapna, J S; Kangle, P R; Ray, K; Ramakrishnan, S

1985-01-01

40

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. 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

2012-01-01

41

Palliative Techniques and Supportive Procedures in Surgical Oncology  

Microsoft Academic Search

In palliative treatment surgery plays an important role: the primary aim of any palliative surgery is the relief of symptoms,\\u000a with preservation or improvement in the quality of life [1]. In oncological practice, palliative surgery in the broadest sense refers to surgery that is by nature non curative. Palliative\\u000a surgery also involves surgical procedures that are aimed primarily at the

Patrizia Racca; Baudolino Mussa; Riccardo Ferracini; Dorico Righi; Lorenzo Repetto; Rosella Spadi

42

[The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?].  

PubMed

The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain. PMID:23890168

Prins, M W Wiesje; Voropai, D A Dasha; van Laarhoven, C J H M Kees; Akkersdijk, Willem L

2013-01-01

43

THD Doppler procedure for hemorrhoids: the surgical technique.  

PubMed

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

Ratto, C

2014-03-01

44

Developing clinically relevant aspects of the nuss procedure surgical simulator.  

PubMed

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

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

2014-01-01

45

Increasing surgical throughput in a busy day procedure unit.  

PubMed

In August 2001 the Mater Hospital in Belfast opened a new day procedures unit. The unit comprises an admissions area, two theatres, an endoscopy suite and a 23-bed ward, with one theatre almost solely dedicated to ophthalmic surgery. There are three consultant ophthalmologists who currently perform cataract, orbital, corneal, vitreoretinal and plastic surgery on a regular basis. In the four years that the unit has been running we have had a 57% increase in ophthalmic day case surgery. PMID:16502742

McColgan, Karen

2006-02-01

46

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

1999-01-01

47

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

PubMed Central

Summary Aim The aim of our study is to evaluate which surgical procedures can be considered the ideal teaching procedure for a resident surgeon. Materials and methods This is a retrospective study. A chart review was performed on all patients who underwent inguinal hernia repair, saphenectomy, excision of pilonidal sinus and hemorrhoidectomy at our institution, between September 2000 and July 2011, and have at least 1 year of follow-up. We evaluated operative time and complications comparing the results obtained by resident or attending surgeon. Results We obtained a higher operative time among the procedures performed by resident surgeons for all evaluated interventions. Whereas the occurrence of complications after hernia repair and excision and primary closure of pilonidal sinus were similar in case and control subjects (p = 0,1 and p = 0,1), the occurrence of complications after hemorrhoidectomy and saphenectomy was significantly higher in the case group (p = 0,08 and p = 0,1). Conclusion Hernia repair and excision and primary closure of pilonidal sinus have to be considered the ideal teaching procedure in a residency program, giving to the young surgeon the opportunity of reach several skills that he needs to master most difficult surgical procedures. Saphenectomy and hemorrhoidectomy should be considered safe only if performed by a senior resident surgeon. PMID:24342157

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

2013-01-01

48

Open core control software for surgical robots  

Microsoft Academic Search

Object  In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement\\u000a of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each\\u000a other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming\\u000a very important for accomplishing complex surgical

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

2010-01-01

49

Femoroacetabular Impingement in Professional Ice Hockey PlayersA Case Series of 5 Athletes After Open Surgical Decompression of the Hip  

Microsoft Academic Search

Background: Femoroacetabular impingement of the hip joint has been identified as a major cause for hip pain in athletes. Surgical open decompression of the hip has historically been proposed as the first treatment of choice. Functional outcomes in athletes after this procedure are unknown.Purpose: To describe the functional and sport-related outcome 2 years after open surgical hip decompression in a

Mario Bizzini; Hubert P. Notzli; Nicola A. Maffiuletti

2007-01-01

50

Local anaesthesia for major general surgical procedures. A review of 116 cases over 12 years.  

PubMed Central

Between 1980 and 1992, 116 patients had either a simple mastectomy (32) or intra-abdominal procedures (84) under local anaesthesia (0.5-1% lignocaine with 1:200 000 adrenaline). A wide variety of general surgical procedures were feasible using only supplementary intravenous sedation (54%). Complications were uncommon and related to surgical procedure (three incorrect diagnoses, three procedures impossible) rather than the anaesthetic technique. There were no anaesthetic toxicity or postoperative problems. Local anaesthesia is extremely safe and facilitates larger surgical procedures than is generally appreciated. PMID:8871461

Dennison, A.; Oakley, N.; Appleton, D.; Paraskevopoulos, J.; Kerrigan, D.; Cole, J.; Thomas, W. E.

1996-01-01

51

Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy  

PubMed Central

Purpose Colonoscopy is a safe and commonly used method for the screening of colon cancer, but sometimes major complications, such as, colonic perforation or hemorrhage occur during the procedure. The aim of this study was to compare the surgical outcomes of laparoscopic and open surgery for colon perforation after colonoscopy. Methods A retrospective review of patient records was performed on 25 patients with iatrogenic colon perforation during colonoscopy during the 7-year period from January 2005 to June 2012. Demographic data, operative procedures, operation times, postoperative complications, hospital course, and morbidities in the laparoscopic surgery group (LG) and open surgery group (OG) were compared. Results Seventeen of the 25 patients underwent laparoscopic surgery (68%) and 8 patients open surgery (32%). The most common surgical methods were primary repair in the LG, and Hartmann's operation in the OG. Average time to first flatus was 2.9 days in the LG and 4.5 days in the OG, and average times to first meals were 4.5 days and 5 days, respectively. Mean hospital stays were 10.8 days in the LG and 17 days in the OG. After surgery, complications occurred in two patients in the LG, but no complication occurred in the OG. Conclusion Laparoscopic repair for iatrogenic colonic perforation during colonoscopy seems to be useful and safe surgical method in early period after perforation. However, open surgery is also needed for the delayed cases after perforation. PMID:25247167

Kim, Jeongsoo; Lee, Gil Jae; Lee, Won-Suk

2014-01-01

52

Open and Arthroscopic Surgical Anatomy of the Ankle  

PubMed Central

Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

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

2013-01-01

53

The first successful laparoscopic Whipple procedure at Hat Yai Hospital: surgical technique and a case report.  

PubMed

Whipple procedure is the most complex abdominal surgical procedure to treat periampullary carcinoma. With the benefit of minimally invasive approach, many institutes attempt to do Whipple procedure laparoscopically. However, only 146 cases of laparoscopic Whipple procedure have yet been reported in the literature worldwide between 1994 and 2008. The authors reported the first laparoscopic Whipple procedure at Hat Yai Hospital in December 2009. The patient was a 40-year-old, Thai-Muslim female, with the diagnosis of ampullary carcinoma. The operating time was 685 minutes. The patient was discharged on postoperative day 14 without serious complication. The surgical technique and postoperative progress of the patient were described. PMID:20873085

Khaimook, Araya; Borkird, Jumpot; Alapach, Sakda

2010-09-01

54

Prospective Comparison of Stereotactic Core Biopsy and Surgical Excision as Diagnostic Procedures for Breast Cancer Patients  

PubMed Central

Objective To determine whether stereotactic core biopsy (SCNB) is the diagnostic method of choice for all mammographic abnormalities requiring tissue sampling. Summary Background Data Stereotactic core needle biopsy decreases the cost of diagnosis, but its impact on the number of surgical procedures needed to complete local therapy has not been studied in a large, unselected patient population. Methods A total of 1,852 mammographic abnormalities in 1,550 consecutive patients were prospectively categorized for level of cancer risk and underwent SCNB or diagnostic needle localization and surgical excision. Diagnosis, type of cancer surgery, and number of surgical procedures to complete local therapy were obtained from surgical and pathology databases. Results The malignancy rate was 24%. Surgical biopsy patients were older, more likely to have cancer, and more likely to be treated with breast-conserving therapy than those in the SCNB group. For all types of lesions, regardless of degree of suspicion, patients diagnosed by SCNB were almost three times more likely to have one surgical procedure. However, for patients treated with lumpectomy alone, the number of surgical procedures and the rate of negative margins did not differ between groups. Conclusions Stereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities. However, for patients undergoing lumpectomy without axillary surgery, it is an extra invasive procedure that does not facilitate obtaining negative margins. PMID:11303136

Morrow, Monica; Venta, Luz; Stinson, Tamy; Bennett, Charles

2001-01-01

55

Design and development of a tissue retractor for use in minimally invasive surgical procedures  

E-print Network

Laparoscopic surgery is a widespread and rapidly growing surgical technique. One of the challenges facing surgeons performing laparoscopic procedures is the retraction of anatomical structures that restrict vision and ...

Begg, Nikolai David Michael

2009-01-01

56

Use of an open stereotactic ring for neurosurgical procedures.  

PubMed

We describe an open ring as a new design to the Zamorano-Dujovny (Z-D) stereotactic unit. The titanium base ring has an opening of 45 degrees that can be located in any chosen position. Imaging studies such as computed tomography, X-ray, positron emission tomography, digital angiography, and digital substraction angiography can be performed with the open stereotactic ring for multimodality image localization. Preoperatively and intraoperatively, this open design provides the anesthesiologist with an unobstructed pathway for airway management. During the surgical procedure, it facilitates approach to any intracranial lesion, including orbitozygomatic, combined supra-infratentorial, and others. During awake craniotomies it not only allows for easy airway management, but also provides good access to the patient's face for intraoperative evaluation of speech and visual functions. Accuracy and reliability of this unit were similar to results obtained with the original circular ring. This system can be used in conventional stereotaxis with the Z-D arc, as well as a reference for intraoperative registration with any digitizer system. The open stereotactic unit is a relatively inexpensive, reliable, and easy-to-use solution for resections using conventional stereotaxis or interactive image guidance in any intracranial site. PMID:9359083

Zamorano, L; Vinas, F C; Buciuc, R; Jiang, Z; Li, O H; Diaz, F G

1997-09-01

57

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. PMID:23225921

Bajwa, Sukhminder Jit Singh; Jindal, Ravi

2012-01-01

58

Field immobilization of muskrats (Ondatra zibethicus) for minor surgical procedures.  

PubMed

A combination of ketamine hydrochloride and xylazine hydrochloride at doses of 50 mg/kg and 5 mg/kg, respectively, was used to immobilize 48 muskrats (Ondatra zibethicus) from October 1993 to November 1994 in Tennessee (USA). Mean (+/-SD) time for induction was 2.97 +/- 1.1 min. After a mean (+/-SD) duration of 27.2 +/- 3.5 min intramuscular yohimbine hydrochloride at a dose of 0.125 mg/kg was administered. Mean (+/-SD) recovery time was 48.1 +/- 21.6 min. All anesthetic inductions were smooth and sufficient depth of anesthesia was achieved to allow surgical collection of adipose tissue. Recovery times were more variable than expected. There was a significant (P < or = 0.05) drop in heart rate, respiratory rate, and body temperature during anesthesia. One animal died during recovery. PMID:9027708

Sleeman, J; Stevens, R; Ramsay, E

1997-01-01

59

Radiofrequency thermal ablation (RFA) of liver tumors: open surgical or percutaneous approach?  

PubMed

RFA was used to ablate 81 liver lesions: 61 liver metastases and 20 hepatomas. An open surgical approach was adopted in 19 instances (27.5%), 12 of which were simultaneously treated for associated diseases, and percutaneous treatment was adopted in 50 instances (72.5%). The CT liver control at 6 months showed a complete necrosis in 50 lesions (66.3%). The advantages of the percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and less discomfort in repeating the procedure. In conclusion, radiofrequency liver nodule ablation could be considered, today, as one of the promising and versatile techniques for loco-regional liver cancer control. PMID:15675487

Crucitti, A; Danza, F M; Pirulli, P G V; Antinori, A; Antonacci, V; La Greca, A; Bock, E; Magistrelli, P

2004-11-01

60

Local Anesthesia for Surgical Procedures of the Upper Eyelid Using Filling Cannula: Our Technique  

PubMed Central

Summary: Sometimes, after local anesthetic injection for surgical procedures of the upper eyelid, it is possible to observe superficial preseptal hematomas or excessive lid swelling that may distort the tissues and obscure surgical landmarks. We present a technique to perform local anesthesia of the upper eyelids, using a 27-gauge needle and a 26-gauge filling cannula, that may decrease the incidence of hematomas and bruising.

Veneroso, Aniello

2014-01-01

61

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

Federal Register 2010, 2011, 2012, 2013

...SYSTEM 12 CFR Part 272 Federal Open Market Committee; Rules of Procedure AGENCY: Federal Open Market Committee, Federal Reserve System...SUMMARY: The Federal Open Market Committee is amending its...

2013-04-03

62

Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures  

PubMed Central

Background Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods Data were retrospectively collected for patients (n?=?240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n?=?103) or without (n?=?137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. Results 240 patients (176 M: 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n?=?53), cardiac assist devices (n?=?113), coronary artery bypass grafts (n?=?20), valve procedures (n?=?19), lung transplantation (n?=?17), aortic dissection (n?=?8), and other (n?=?10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 93.4?±?41 min. vs. Control: 107.6?±?56 min., p?=?0.02). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1594?±?949 mL vs. Control: 2112?±?1437 mL, p?

2014-01-01

63

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

PubMed

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

2011-01-01

64

Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures  

PubMed Central

ABSTRACT Aim: This paper reports two clinical cases in which the application of low-level laser therapy (LLLT) enhanced the postoperative symptoms after pediatric surgical procedures. Background: The uses of novel technologies allow more comfort to the patients and ensure a rapid procedure, and LLLT application has shown a positive effect in the prevention of discomfort after invasive procedures. Case description: Low-level laser therapy protocol was applied after surgical removal of supernumerary tooth and frenectomy resulting in less swallow and pain with no need of medication intake. Conclusion: The laser application was well accepted by both children and parents and showed a clinical efficiency in the follow-up examinations beyond the satisfactory quality of wound healing. Clinical significance: The LLLT approach is an excellent adjuvant therapy resource for delivery an optimal postoperative after surgical procedures in children. How to cite this article: Paschoal M, Souza J, Santos-Pinto L, Pansani C. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures. Int J Clin Pediatr Dent 2014;7(2):125-129.

Souza, Juliana; Santos-Pinto, Lourdes; Pansani, Cyneu

2014-01-01

65

The efficacy of the surgical delay procedure in pedicle TRAM breast reconstruction.  

PubMed

Although experimental evidence suggests that the preliminary surgical delay procedure physiologically improves the circulation of the TRAM flap, there are no published controlled studies evaluating the clinical outcomes associated with this procedure. The purpose of this study was to evaluate the efficacy of the surgical flap delay versus no delay in consecutive patients having pedicle TRAM breast reconstruction. This was a retrospective cohort study of breast cancer patients at the University of Michigan who had pedicle TRAM reconstruction between January 2004 and March 2008. Prior to September 2005, all patients had pedicle TRAM reconstruction without the delay procedure. Starting in September 2005, all patients had the delay procedure prior to TRAM flap reconstruction. Descriptive statistics were used to compare demographic data, comorbidities, and complication rates between the 2 cohorts. Regression analysis was used to determine the effects of the surgical delay procedure on the incidence of flap ischemia and major and minor complications while controlling for patient and treatment level factors. Eighty-seven postmastectomy breast cancer patients had unipedicle TRAM flap reconstruction, in which 112 flaps were used to reconstruct breasts. The nondelay cohort consisted of 42 consecutive patients (51 flaps) and the delay cohort consisted of 45 consecutive patients (61 flaps). Of the patients without the surgical delay procedure 17.6% experienced at least one ischemic complication of the flap compared with 6.6% of those who were surgically delayed (P = 0.082). When controlling for patient and treatment level factors, the delay procedure was found to significantly decrease the incidence of flap ischemia (OR = 0.21, P = 0.018). In addition, there were no significant differences in the incidence of major or minor complication rates in the surgically delayed versus nondelayed groups (P = 0.247, P = 0.486, respectively). When patient and treatment level factors were taken into consideration, undergoing the delay procedure also did not increase the incidence of having a major or minor complication. These data support the use of the preliminary surgical delay procedure to decrease ischemic complications of the flap in pedicle TRAM postmastectomy breast reconstruction. PMID:19770703

Atisha, Dunya; Alderman, Amy K; Janiga, Tim; Singal, Bonita; Wilkins, Edwin G

2009-10-01

66

Surgical site infections in standard neurosurgery procedures- a study of incidence, impact and potential risk factors.  

PubMed

OBJECTIVES. Surgical site infections (SSIs) may be devastating for the patient and they carry high economic costs. Studies of SSI after neurosurgery report an incidence of 1-11%. However, patient material, follow-up time and definition of SSI have varied. In the present study we prospectively recorded the prevalence of SSI 3 months after standard intracranial neurosurgical procedures. The incidence, impact and risk factors of SSI were analysed. METHODS. We included patients admitted during 2010 to our unit for postoperative care after standard neurosurgical procedures. SSI was defined as evident with positive cultures from surgical samples or CSF, and/or purulent discharge during reoperation. Follow-up was done after 3 and 12 months and statistics was obtained after 3 months. The predictive values on the outcome of demographic and clinical factors describing the surgical procedure were evaluated using linear regression. RESULTS. A total of 448 patients were included in the study and underwent a total of 466 procedures. Within 3 and 12 months, 33 and 88 patients, respectively, had died. Of the surviving patients, 20 (4.3% of procedures) developed infections within 3 months and another 3 (4.9% of procedures) within 12 months. Risk factors for SSI were meningioma, longer operation time, craniotomy, dural substitute, and staples in wound closure. Patients with SSI had significantly longer hospital stay. Multivariate analysis showed that factors found significant in univariate analysis frequently occur together. DISCUSSION. We studied the prevalence of SSI after 3 and 12 months in a prospective 1-year material with standard neurosurgical procedures and found it to be 4.3% and 4.9%, respectively. The analysis of the results showed that a combination of parameters indicating a longer and more complicated procedure predicted the development of SSI. Our conclusion is that the prevention of SSI has to be done at many levels, especially with patients undergoing long surgical procedures. PMID:24588653

Abu Hamdeh, Sami; Lytsy, Birgitta; Ronne-Engström, Elisabeth

2014-04-01

67

Learning to See the Body: Supporting Instructional Practices in Laparoscopic Surgical Procedures  

E-print Network

with others) in order to use the images in practice. Seeing the body during surgery is a complex processLearning to See the Body: Supporting Instructional Practices in Laparoscopic Surgical Procedures'Evry-Val-d'Essonne Ã?vry, France amine.chellali@ibisc.fr 3 Department of Surgery Cambridge Health Alliance / Harvard

Paris-Sud XI, Université de

68

Image Guided Surgical Interventions Surgeons have traditionally performed procedures to treat diseases by  

E-print Network

with the developments in imaging modalities, endoscopic surgery has advanced with the introduction of rigid and flexible. This limitation has confined endoscopic surgery to areas where a natural body cavity or physical space canImage Guided Surgical Interventions Surgeons have traditionally performed procedures to treat

Dupont, Pierre

69

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

Microsoft Academic Search

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

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

1996-01-01

70

Partial fingertip necrosis following a digital surgical procedure in a patient with primary Raynaud's phenomenon.  

PubMed

Raynaud's phenomenon is a common clinical disorder consisting of recurrent, long-lasting and episodic vasospasm of the fingers and toes often associated with exposure to cold. In this article, we present a case of partial fingertip necrosis following digital surgical procedure in a patient with primary Raynaud's phenomenon. PMID:25200107

Uygur, Safak; Tuncer, Serhan

2014-12-01

71

Surgical treatment for plantar fasciitis  

Microsoft Academic Search

The results of surgical treatment of 16 patients with plantar fasciitis were reviewed. The indication for surgery was intolerable heel pain despite previous conservative measures. Patients requiring surgical treatment constituted only 7% of overall patients treated for plantar fasciitis. The surgical procedure involved an open medial partial plantar fascia release from the calcaneus and excision of calcaneal spur.A questionnaire about

A. A. Faraj; M. Z. Querishe

2002-01-01

72

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

PubMed

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

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

2012-01-01

73

Variation in selected childhood surgical procedures: the case of tonsillectomy and management of middle ear disease.  

PubMed

We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years of age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P < 0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P < 0.01) from 53 to 60%. We found significant (P < 0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasing. PMID:8286158

Close, G R; Rushworth, R L; Rob, M I; Rubin, G L

1993-12-01

74

Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures  

PubMed Central

INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20%) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance. PMID:21484052

Fleury, Anna Maria; da Silva, Antonio Carlos; de Castro Pochini, Alberto; Ejnisman, Benno; de Lira, Claudio Andre Barbosa; dos Santos Andrade, Marilia

2011-01-01

75

Complications of laparoscopic versus open bariatric surgical interventions in obesity management.  

PubMed

With the epidemic of obesity fast spreading its grasp throughout the world, the medical professionals of diverse facilities need to be called on for better management to prevent its further progression. In particular, the gastroenterologists have a major role to play in all aspects of obese patient care. They should be able to recognize and treat obesity and associated disorders through the understanding and assessment of the various benefits and risks linked with a particular type of obesity treatment option. While treating these problems, a better understanding of the physiologic and anatomic alterations that might be associated with the treatment procedure and the weight loss-linked problems in association with the method of surgical intervention need to be weighed. Morbid obesity has been efficaciously treated by bariatric surgery promoting weight loss considerably and reducing the obesity-associated risks such as certain cancers, diabetes, cardiovascular disease, and all-cause mortality. Bariatric surgery has been performed traditionally through open method or, the more recent and popular form, laparoscopically that involves only a small incision in the abdomen. The laparoscopic bariatric surgery has become the surgical method of choice since its introduction in 1993 and has immediately crossed open surgery in terms of popularity. Drastic numbers came out when the two methods were compared for their applicability during a 3-year period in the United States. Only 6,000 reported open gastric bypass surgeries were recorded, but the number soared to nearly 16,000 for laparoscopic gastric bypass surgeries. The laparoscopic method has been found to be associated with much reduced complications and hospital stay along with lower cases of mortality as suggested by small randomized controlled trials and observational studies. However, these facts need to be reassessed through large-sized controlled trials and population-based studies. In addition, the previously ignored complications associated with laparoscopic methods should be studied in detail. Since the cases of obesity have been ever increasing and bariatric surgery is also gaining in popularity, it is important that the safest procedure should be identified. The main objective of this review was to compare the benefits and risks associated with open versus laparoscopic mode of bariatric surgery with a greater focus on the laparoscopic method. Although there are few reviews that have compared the two methods, none have focused on the complications of the two approaches. All these aspects have been dealt in detail here. PMID:24906233

Yin, Jian; Hou, Xuhui

2014-11-01

76

Open surgical biopsy for nonpalpable breast lesions detected on screening mammography.  

PubMed

The aim of this retrospective clinical study was the analysis of histologic findings of nonpalpable breast lesions managed by open surgical biopsy. A series of 630 women underwent 664 preoperative localizations of nonpalpable, mammographically detected breast lesions during the last 10-year period. Indications for biopsy were (1) clustered microcalcifications, (2) solid mass, and (3) radiologic parenchymal distortion. The lesions were localized preoperatively using hook-wire methods, and all biopsies were performed under general anesthesia. Histopathology revealed carcinoma in 172 (25.9%) cases; noninvasive in 114 (66.3%) cases and infiltrating in 58 (33.7%) cases. The highest malignancy rate was found in cases with microcalcifications (112 carcinomas out of 323 cases, 34.7%). Lymph node invasion was present in 25% of patients with invasive cancers. The hook-wire localization of nonpalpable breast lesions is a simple, accurate and safe method for detection of early breast cancers. Frozen section is feasible and accurate in the majority of these lesions, and therefore, diagnostic and therapeutic one-step surgical procedures could be performed. PMID:15991535

Markopoulos, C; Kouskos, E; Revenas, K; Mantas, D; Antonopoulou, Z; Kontzoglou, K; Nikiteas, N; Kyriakou, V

2005-01-01

77

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

Microsoft Academic Search

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

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

2009-01-01

78

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

PubMed Central

Background Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003–2012, and to identify risk factors for complex sternal site infections. Methods Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease. PMID:24916690

2014-01-01

79

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

PubMed

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

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

2008-12-01

80

Early Amplatzer occluder closure of a postinfarct ventricular septal defect as a bridge to surgical procedure.  

PubMed

The management of postinfarction ventricular septal defects represents a challenge to both cardiologists and surgeons due to the high morbidity and mortality rate. We report the case of a 79-year-old patient who developed an apical rupture of the ventricular septum, nine days after an anterior myocardial infarction. As the patient was in cardiogenic shock and developed acute pulmonary edema we chose to perform a percutaneous closure of the septal defect using an Amplatzer occluder (AO). Despite the incomplete closure, the placement of the device greatly improved the patient's clinical condition allowing the delay of the surgical procedure, which could be performed ten days later with an excellent result. PMID:17669918

Costache, Victor S; Chavanon, Olivier; Bouvaist, Hélène; Blin, Dominique

2007-08-01

81

Extended Open Transgastric Necrosectomy (EOTN) as a Safer Procedure for Necrotizing Pancreatitis  

PubMed Central

The treatment of infected necrotizing pancreatitis has evolved from time to time and the success of surgical intervention depends on the timing of necrosectomy. Bacterial infection occurs in 40–70% of patients with necrotizing pancreatitis. Infection is the main risk factor for mortality among patients with pancreatic necrosis. Timely intervention is generally required for pancreatic necrosis but is now deferred until four weeks after disease onset in order to permit encapsulation and demarcation of the necrotic material. Demarcation facilitates necrosectomy and reduces complications related to the drainage and debridement procedures. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Direct endoscopic necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of walled-off necrosis. The pancreas is approached through the posterior wall of stomach and debridement is done. PMID:25177603

Nidoni, Ravindra; Baloorkar, Ramakanth; Sindgikar, Vikram; Shankar, Bharat

2014-01-01

82

Bilateral Pulmonary Endarterectomy and Bentall Procedure Completed in One Surgical Session  

PubMed Central

We describe the performance, in one surgical session, of bilateral pulmonary endarterectomy and a button-technique Bentall operation in a 68-year-old man. The patient had chronic thromboembolic pulmonary hypertension and an ascending aortic aneurysm with moderate aortic regurgitation. The procedures were concurrently completed during short periods of systemic circulatory arrest, with antegrade cerebral perfusion maintained through the brachiocephalic artery at a flow rate of 10 mL/min/kg. The patient's cerebral perfusion was monitored with use of near-infrared spectroscopy, to prevent symmetric bilateral values from falling below 20% of the base value. The patient experienced no multiorgan failure or neurologic sequelae and, by the 6th postoperative day, improved from New York Heart Association functional class IV to class I. The reliable maintenance of continuous antegrade cerebral perfusion made the lengthy combined operation feasible, with low risk. The use of near-infrared spectroscopy enabled real-time monitoring of the patient's cerebral blood flow. Our experience shows the possibility of safely performing lengthy or multiple procedures in one surgical session. PMID:23109784

Ricci, Davide; Cavozza, Corrado; Scoti, Peppino; Mercogliano, Domenico; Minzioni, Gaetano; Medici, Dante

2012-01-01

83

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

PubMed Central

AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding. METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed. RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05). CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered. PMID:24409071

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

2013-01-01

84

Bilateral pulmonary endarterectomy and Bentall procedure completed in one surgical session.  

PubMed

We describe the performance, in one surgical session, of bilateral pulmonary endarterectomy and a button-technique Bentall operation in a 68-year-old man. The patient had chronic thromboembolic pulmonary hypertension and an ascending aortic aneurysm with moderate aortic regurgitation. The procedures were concurrently completed during short periods of systemic circulatory arrest, with antegrade cerebral perfusion maintained through the brachiocephalic artery at a flow rate of 10 mL/min/kg. The patient's cerebral perfusion was monitored with use of near-infrared spectroscopy, to prevent symmetric bilateral values from falling below 20% of the base value. The patient experienced no multiorgan failure or neurologic sequelae and, by the 6th postoperative day, improved from New York Heart Association functional class IV to class I.The reliable maintenance of continuous antegrade cerebral perfusion made the lengthy combined operation feasible, with low risk. The use of near-infrared spectroscopy enabled real-time monitoring of the patient's cerebral blood flow. Our experience shows the possibility of safely performing lengthy or multiple procedures in one surgical session. PMID:23109784

Ricci, Davide; Cavozza, Corrado; Scoti, Peppino; Mercogliano, Domenico; Minzioni, Gaetano; Medici, Dante

2012-01-01

85

[Surgical procedures in selected proctological patients with local anesthesia. Study of 150 cases].  

PubMed

Experience in the treatment of 150 patients with anorectal disorders and disorders of the sacrococcygeal region who were operated on with local anesthesia at the University Hospital, ABC Medical School, São Bernardo do Campo, SP, Brazil, from March 1995 to March 1998. The anesthesia technique, the operations carried out and the tolerance to the procedure are reported. Intraoperative morbidity was 10.6% (16 patients), and postoperative morbidity was 6% (nine patients). The age of patients was between 15 and 92 years old, with mean age 42 years old; 58% of patients were male and 42% female. Surgical mean time was 45 minutes and the patients remained in the hospital for a mean time of 8 hours. All of patients was instructed about the anesthesia technique, their advantages and disadvantages, and only with their permit the surgery was programmed. Hospitalization was required in five patients (3.3%). The anesthesia technique employed was the same for all patients. Upon survey, 96.7% of the patients stated they did not feel pain during the surgery and that they would go through the procedure again. The authors conclude the surgical treatment of anorectal disorders and disorders of the sacrococcygeal region with local anesthesia is viable and safe, and in addition, is well accepted by the patients. PMID:11245158

Henriques, A C; Horta, S H; Pezzolo, S; Waisberg, J; Boratto, S F; Helal, S; Gomes, M; Speranzini, M B

2000-01-01

86

1 External Graduate Open Day Nov 2012 Application Procedures  

E-print Network

1 External Graduate Open Day Nov 2012 Application Procedures and a DPhil at Oxford Dr Nick Green Graduate Open Day Nov 2012 OVERVIEW : A DPHIL IN ORGANIC CHEMISTRY AT OXFORD APPLICATION PROCESS · What do are made to the University, not to the Department. · By all means make informal contact with potential

Wallace, Mark

87

Revision open anterior approaches for spine procedures  

Microsoft Academic Search

Background contextAnterior exposure has become an increasingly popular procedure for the general and vascular surgeon due to the increased use of anterior lumbar interbody fusion and artificial disc replacement for the treatment of many spinal problems.

Andrew A. Gumbs; Scott Hanan; James J. Yue; Rahul V. Shah; Bauer Sumpio

2007-01-01

88

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

Microsoft Academic Search

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

Ines Kappstein; F. D. Daschner

1991-01-01

89

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

PubMed Central

Background: Approach for surgical treatment of thoracolumbar tuberculosis has been controversial. The aim of present study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the surgical treatment of thoracic and thoracolumbar tuberculosis. Materials and Methods: 70 patients with spinal tuberculosis treated surgically between Jan 2001 and Dec 2006 were included in the study. Thirty four patients (group I) with mean age 34.9 years underwent anterior debridement, decompression and instrumentation by anterior transthoracic, transpleural and/or retroperitoneal diaphragm cutting approach. Thirty six patients (group II) with mean age of 33.6 years were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Various parameters like blood loss, surgical time, levels of instrumentation, neurological recovery, and kyphosis improvement were compared. Fusion assessment was done as per Bridwell criteria. Functional outcome was assessed using Prolo scale. Mean followup was 26 months. Results: Mean surgical time in group I was 5 h 10 min versus 4 h 50 min in group II (P>0.05). Average blood loss in group I was 900 ml compared to 1100 ml in group II (P>0.05). In group I, the percentage immediate correction in kyphosis was 52.27% versus 72.80% in group II. Satisfactory bony fusion (grades I and II) was seen in 100% patients in group I versus 97.22% in group II. Three patients in group I needed prolonged immediate postoperative ICU support compared to one in group II. Injury to lung parenchyma was seen in one patient in group I while the anterior procedure had to be abandoned in one case due to pleural adhesions. Functional outcome (Prolo scale) in group II was good in 94.4% patients compared to 88.23% patients in group I. Conclusion: Though the anterior approach is an equally good method for debridement and stabilization, kyphus correction is better with posterior instrumentation and the posterior approach is associated with less morbidity and complications. PMID:22448054

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

2012-01-01

90

Multifactor Screener in OPEN: Scoring Procedures  

Cancer.gov

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

91

Current concepts on trochleoplasty procedures for the surgical treatment of trochlear dysplasia.  

PubMed

Trochleoplasty is a surgical procedure, whose goal is to change the abnormal shape of the femoral trochlea in patients with recurrent patellar dislocation. Such surgeries that aim to reshape the articular surface of a bone without damaging it are quite unique in orthopaedic surgery. Although in the beginning, trochleoplasty was reserved for the refractory cases where previous surgery has failed, the last years it became more and more popular because of a better knowledge of anatomy and biomechanics and a greater availability of instruments. The roots of the deepening trochleoplasty could be found in the previous century when the first surgeons tried to directly remove the dysplastic bone with pioneer interventions but with devastating consequences. Since then, multiple procedures have been described and are analysed in this review; each one with its unique features, advantages and pitfalls. Regardless of the technique used, the very recent bibliography presents very encouraging results from the application of trochleoplasty with other procedures in a selected population with severe trochlear dysplasia and recurrent patellar dislocation, in whom the benign neglect of dysplasia would lead to unfavourable results. Level of evidence IV. PMID:24752539

Ntagiopoulos, Panagiotis G; Dejour, David

2014-10-01

92

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)

2001-01-15

93

Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures.  

PubMed

Despite the effectiveness and safety of anesthetics, some unanswered questions remain concerning their toxicity and effects on cellular redox balance. To test for possible toxic effects of balanced anesthesia maintained with the volatile anesthetic sevoflurane, we evaluated oxidative stress during and after general anesthesia in 15 adult patients without comorbidities who underwent elective minor surgical procedures. Venous blood samples were collected at baseline, before anesthesia (t0); after anesthesia induction and immediately before surgery (t1); 2h after the beginning of anesthesia (t2); and on the day following surgery (t3). Antioxidant defense was determined by fluorometry. Oxidative stress markers included oxidative DNA damage, evaluated by the alkaline comet assay, and plasma malondialdehyde (MDA), assessed by high performance liquid chromatography (HPLC). No increase in oxidized DNA damage or antioxidant defense was observed. Plasma MDA increased only at t3 compared with t2. Balanced sevoflurane-maintained anesthesia appears neither to damage DNA nor to alter redox status. PMID:25308703

Orosz, José Eduardo B; Braz, Leandro G; Ferreira, Ana Lucia A; Amorim, Rosa Beatriz; Salvadori, Daisy Maria F; Yeum, Kyung-Jin; Braz, José Reinaldo C; Braz, Mariana G

2014-10-01

94

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

PubMed

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

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

2014-01-01

95

Non-photorealistic rendering of virtual implant models for computer-assisted fluoroscopy-based surgical procedures  

NASA Astrophysics Data System (ADS)

Surgical navigation systems visualize the positions and orientations of surgical instruments and implants as graphical overlays onto a medical image of the operated anatomy on a computer monitor. The orthopaedic surgical navigation systems could be categorized according to the image modalities that are used for the visualization of surgical action. In the so-called CT-based systems or 'surgeon-defined anatomy' based systems, where a 3D volume or surface representation of the operated anatomy could be constructed from the preoperatively acquired tomographic data or through intraoperatively digitized anatomy landmarks, a photorealistic rendering of the surgical action has been identified to greatly improve usability of these navigation systems. However, this may not hold true when the virtual representation of surgical instruments and implants is superimposed onto 2D projection images in a fluoroscopy-based navigation system due to the so-called image occlusion problem. Image occlusion occurs when the field of view of the fluoroscopic image is occupied by the virtual representation of surgical implants or instruments. In these situations, the surgeon may miss part of the image details, even if transparency and/or wire-frame rendering is used. In this paper, we propose to use non-photorealistic rendering to overcome this difficulty. Laboratory testing results on foamed plastic bones during various computer-assisted fluoroscopybased surgical procedures including total hip arthroplasty and long bone fracture reduction and osteosynthesis are shown.

Zheng, Guoyan

2007-03-01

96

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

PubMed Central

Patients with severe panfacial injuries usually require long-term airway management. Nasal intubation may be contraindicated in case of nasoorbitoethmoidal fractures and also there may be a need for intraoperative and short-term postoperative intermaxillary fixation to achieve optimum reduction of fractures. The need for unobstructed access to the perinasal area during bimaxillary orthognathic procedures is felt many a time and to avoid a tracheostomy with its attending morbidity, many techniques have evolved that involve a submandibular/transmylohyoid or submental approach for temporary oroendotracheal intubation. In this article, we present our experience of patients by using submental/transmylohyoid route for endotracheal intubation. technique gives the surgeon and the anesthetist comfortable control over their respective domains, is easy to learn and implement in the operating protocol with no added costs. How to cite the article: Prakash VJ, Chakravarthy C, Attar AH. Submental/transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: A review. J Int Oral Health 2014;6(3):125-8. PMID:25083048

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

2014-01-01

97

Laparoscopic Partial Nephrectomy: Initial Experience and Comparison to the Open Surgical Approach  

Microsoft Academic Search

During an 18-month period, 6 laparoscopic partial nephrectomies were attempted, 4 of which were successful. The surgical technique was modified and improved between cases aided by new laparoscopic instrumentation, such as the argon beam coagulator and the 7.5 MHz. ultrasonic sector scanning system. In a retrospective comparison between laparoscopic and open partial nephrectomy, estimated blood loss was 525 ml. for

Howard N. Winfield; James F. Donovan; Greg O. Lund; Karl J. Kreder; Kenneth E. Stanley; Bruce P. Brown; Stefan A. Loening; Ralph V. Clayman

1995-01-01

98

Litigious consequences of open and laparoscopic biliary surgical mishaps  

Microsoft Academic Search

Three hundred six injuries or complications coincident to 296 laparoscopic cholecystectomies were analyzed for the nature\\u000a and extent of injuries and litigious outcomes that followed. The data were drawn from 31 member companies of the Physician\\u000a Insurers Association of America, a trade association that initiated the study. The outcomes were compared to 261 contemporaneous\\u000a open cholecystectomy claims. Biliary tract injuries

James G. Chandler; C. Randle Voyles; Tammy L. Floore; Lori A. Bartholomew

1997-01-01

99

RESEARCH Open Access Efficient procedures for the numerical simulation  

E-print Network

RESEARCH Open Access Efficient procedures for the numerical simulation of mid-size RNA kinetics for simulating the kinetic folding of RNAs by numerically solving the chemical master equation have been the Gillespie algorithm, that will allow numerical simulations of mid-size (~ 60­150 nt) RNA kinetics in some

Barash, Danny

100

Use of Surgical Procedures and Adjuvant Therapy in Rectal Cancer Treatment  

PubMed Central

Objective To assess the use of surgical procedures by tumor location and compliance with adjuvant therapy recommendations by tumor stage. The study was conducted in a population-based setting to identify target patient groups for improved care. Summary Background Data Rectal cancer therapy potentially involves similar patients receiving different treatments. Low anterior resection (LAR), sparing the anal sphincter, and abdominoperineal resection (APR), ablating the anal sphincter, offer equivalent local recurrence and survival rates but may differ in quality of life measurements. The 1990 NIH Consensus Conference recommended that patients with stage II and III rectal cancer receive radiation and chemotherapy in conjunction with surgical resection, but this is not uniformly applied. To interpret the use of these therapies, information on tumor location in the rectum, which is rarely known in population-based studies, is necessary. Patient, hospital, or surgeon characteristics may influence which procedure is performed and whether adjuvant therapy is given. Methods Information about primary, invasive rectal adenocarcinomas diagnosed between 1994 to 1996 in 13 California counties was obtained from the regional cancer registry. Tumor location, determined from abstracted medical text, was divided into the upper, middle, and lower rectum. Hospitals were characterized by teaching status, number of beds, and cancer center designation. Surgeons were categorized as general or colorectal surgeons. Factors associated with a higher use of LAR versus APR in patients with middle and lower rectum tumors and factors associated with a higher use of NIH-recommended therapy in patients with stage II and III disease were separately analyzed. Results Among 637 eligible patients, APR was used in 22% of those with middle rectum tumors and 55% of those with lower rectum tumors. Factors significantly associated with a higher use of LAR included female gender, middle rectum location, and treatment in a major teaching hospital versus a nonteaching hospital. Recommended therapy was received by 44% of patients with stage II disease and 60% of those with stage III disease. Factors significantly associated with higher compliance with NIH recommendations included age younger than 60 versus older than 75, age 60 to 75 years versus older than 75, tumor location in the middle or lower rectum versus the upper rectum, stage III disease, and treatment at a teaching hospital versus a nonteaching hospital. Conclusions Patients with similar rectal cancers receive different treatments independent of tumor stage or location. This may result in more APRs performed for middle and lower rectum tumors than necessary and less adequate treatment for stage II and III tumors than recommended. PMID:11685027

Schroen, Anneke T.; Cress, Rosemary D.

2001-01-01

101

Development of a mass spectrometry sampling probe for chemical analysis in surgical and endoscopic procedures.  

PubMed

A sampling probe based on ambient desorption ionization was designed for in vivo chemical analysis by mass spectrometry in surgical and endoscopic procedures. Sampling ionization of analytes directly from tissue was achieved by sealing the sampling tip against the tissue surface without allowing leakage of the auxiliary gas used for desorption ionization. The desorbed charged species were transferred over a long distance (up to 4 m) through a flexible tube of internal diameter as small as 1/16 in. to the inlet of the mass spectrometer used for analysis. The conditions used for desorption electrospray ionization (DESI) were optimized to achieve biocompatibility for clinical applications while obtaining adequate efficiency for the analysis. This optimization involved the removal of high voltage and use of pure water as a spray solvent instead of the organic solvents or aqueous mixtures normally used. Improved sensitivity was achieved under these conditions by increasing the gas flow rate in the transfer tube. The destructive effect on tissue surfaces associated with typical desorption ionization was avoided by altering the local gas dynamics in the sample area without compromising the overall analysis efficiency. PMID:24251679

Chen, Chien-Hsun; Lin, Ziqing; Garimella, Sandilya; Zheng, Lingxing; Shi, Riyi; Cooks, R Graham; Ouyang, Zheng

2013-12-17

102

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. PMID:19538712

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

2009-01-01

103

Comparison of the laryngeal mask (LMA™) and laryngeal tube (LT®) with the new perilaryngeal airway (CobraPLA®) in short surgical procedures  

Microsoft Academic Search

Summary Background and objective: We compared the laryngeal mask airway (LMA™) and the laryngeal tube (LT®) with the newly introduced perilaryngeal airway (CobraPLA®, PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. Methods: After premedication, 90 ASA I-II patients awaiting short surgical procedures were randomized to receive,

A. Turan; G. Kaya; O. Koyuncu; B. Karamanlioglu; Z. Pamukçu

2006-01-01

104

Ultrasound-guided radiofrequency thermal ablation of liver tumors: Percutaneous, laparoscopic, and open surgical approaches  

Microsoft Academic Search

Only 10% to 20% of patients with primary and colorectal metastatic liver tumors are candidates for curative surgical resection.\\u000a Even after curative treatment, tumors recur commonly in the liver. As a less invasive therapy, radiofrequency thermal ablation\\u000a (RFA) of primary, metastatic, and recurrent liver tumors was performed under percutaneous, laparoscopic, or open intraoperative\\u000a ultrasound guidance. The safety and local control

Junji Machi; Shinji Uchida; Kenneth Sumida; Whitney M. L. Limm; Scott A. Hundahl; Andrew J. Oishi; Nancy L. Furumoto; Robert H. Oishi

2001-01-01

105

Metabolic and behavioral deficits following a routine surgical procedure in rats  

Microsoft Academic Search

To test the hypothesis that functional metabolic deficits observed following surgical brain injury are associated with changes in cognitive performance in rodents, we performed serial imaging studies in parallel with behavioral measures in control animals and in animals with surgical implants. Memory function was assessed using the novel object recognition (NOR) test, administered 3 days prior to and 3, 7, 14

David B. Frumberg; Marion S. Fernando; Dianne E. Lee; Anat Biegon; Wynne K. Schiffer

2007-01-01

106

Intraoperative sonography during open partial nephrectomy for renal cell cancer: does it alter surgical management?  

PubMed

OBJECTIVE. The purpose of this study is to evaluate whether intraoperative ultrasound (IOUS) during open partial nephrectomy alters the surgical management for renal cell cancer (RCC). MATERIALS AND METHODS. One hundred ninety-eight consecutive patients undergoing IOUS during open partial nephrectomy for RCC were selected for retrospective review of clinical and imaging data. Patient age and sex, the local extent of the primary lesion, and the presence of additional lesions were recorded. Ultrasound findings were compared with preoperative CT or MRI to determine whether the IOUS findings changed surgical management. Summary statistics were performed to assess what percentage of patients with additional IOUS findings had a change in their surgical management. The Kaplan-Meier method was used to estimate 5-year overall survival (OS) and event-free survival (EFS) rates for all patients. Patients were followed for 9-12 years to assess survival and measure recurrence rates. RESULTS. Twenty-one of 198 patients (10.6%; 95% CI, 6.7-15.8%) had additional findings on IOUS not seen on preoperative imaging. As a result, surgery was modified in 15 of these 21 patients (71.4%; 95% CI, 47.8-88.7%). The 5-year OS rate was 81%, and the EFS rate was 76% for the whole group; most deaths were due to unrelated causes. There was no statistically significant difference in OS (p = 0.867) and EFS (p = 0.069) rates among patients who had a change of management because of additional lesions seen by IOUS. CONCLUSION. IOUS performed during open partial nephrectomy for resection of RCC shows additional findings compared with preoperative cross-sectional imaging that may alter surgical management. PMID:25247947

Bhosale, Priya R; Wei, Wei; Ernst, Randy D; Bathala, Tharakeswara K; Reading, Rhoda M; Wood, Christopher G; Bedi, Deepak G

2014-10-01

107

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

Cancer.gov

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

108

An Event-Driven Framework for the Simulation of Complex Surgical Procedures  

E-print Network

]. In addition, finite state machines have been used to control simulations of digital actors in video games specific physical actions in surgical simulations (such as fundoplication), and to objectively rate

Salisbury, Kenneth

109

Risk of angioedema following invasive or surgical procedures in HAE type I and II – the natural history  

PubMed Central

Background Hereditary angioedema (HAE), caused by deficiency in C1-inhibitor (C1-INH), leads to unpredictable edema of subcutaneous tissues with potentially fatal complications. As surgery can be a trigger for edema episodes, current guidelines recommend preoperative prophylaxis with C1-INH or attenuated androgens in patients with HAE undergoing surgery. However, the risk of an HAE attack in patients without prophylaxis has not been quantified. Objectives This analysis examined rates of perioperative edema in patients with HAE not receiving prophylaxis. Methods This was a retrospective analysis of records of randomly selected patients with HAE type I or II treated at the Frankfurt Comprehensive Care Centre. These were examined for information about surgical procedures and the presence of perioperative angioedema. Results A total of 331 patients were included; 247 underwent 700 invasive procedures. Of these procedures, 335 were conducted in 144 patients who had not received prophylaxis at the time of surgery. Categories representing significant numbers of procedures were abdominal (n = 113), ENT (n = 71), and gynecological (n = 58) procedures. The rate of documented angioedema without prophylaxis across all procedures was 5.7%; in 24.8% of procedures, the presence of perioperative angioedema could not be excluded, leading to a maximum potential risk of 30.5%. Predictors of perioperative angioedema could not be identified. Conclusion The risk of perioperative angioedema in patients with HAE type I or II without prophylaxis undergoing surgical procedures ranged from 5.7% to 30.5% (CI 3.5–35.7%). The unpredictability of HAE episodes supports current international treatment recommendations to consider short-term prophylaxis for all HAE patients undergoing surgery. PMID:23968383

Aygören-Pürsün, E; Martinez Saguer, I; Kreuz, W; Klingebiel, T; Schwabe, D

2013-01-01

110

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

PubMed

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

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

2014-06-01

111

Comparison of standard surgical debridement versus the VERSAJET Plus™ Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized controlled trial.  

PubMed

The aim of this study was to assess the efficacy of an alternative debridement technology in the treatment of Gustilo & Anderson grade III A and III B open tibia fractures. The objective was to explore whether improvements to the debridement using tangential hydrosurgery (VERSAJET™ Plus Smith & Nephew) could reduce the number of debridement episodes and the days before closure. A pilot scale randomized controlled trial was conducted against conventional surgery. A total of 40 patients were recruited. Sixteen patients received hydrosurgery and 24 patients were treated with standard surgical debridement. Baseline characteristics were well balanced. There was significant evidence (p < 0.001) that VERSAJET patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio standard: VERSAJET = 1.747). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for VERSAJET and 5 days (95% CI 4 days, 8 days) for standard debridement, although the difference was not statistically significant (p = 0.275). There were no instances of post-operative infection. PMID:25356370

Oosthuizen, Beyers; Mole, Trevor; Martin, Robin; Myburgh, Johannes G

2014-01-01

112

Comparison of standard surgical debridement versus the VERSAJET Plus(TM) Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized controlled trial  

PubMed Central

The aim of this study was to assess the efficacy of an alternative debridement technology in the treatment of Gustilo & Anderson grade III A and III B open tibia fractures. The objective was to explore whether improvements to the debridement using tangential hydrosurgery (VERSAJET™ Plus Smith & Nephew) could reduce the number of debridement episodes and the days before closure. A pilot scale randomized controlled trial was conducted against conventional surgery. A total of 40 patients were recruited. Sixteen patients received hydrosurgery and 24 patients were treated with standard surgical debridement. Baseline characteristics were well balanced. There was significant evidence (p < 0.001) that VERSAJET patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio standard: VERSAJET = 1.747). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for VERSAJET and 5 days (95% CI 4 days, 8 days) for standard debridement, although the difference was not statistically significant (p = 0.275). There were no instances of post-operative infection.

Oosthuizen, Beyers; Mole, Trevor; Martin, Robin; Myburgh, Johannes G

2014-01-01

113

Management of Combined Open Fractures of Thumb Metacarpal and Trapezium (Surgical Tip)  

PubMed Central

Management of an unusual injury of combined open fractures of the first metacarpal shaft and trapezium due to crush injury in a 21-year-old man was reported in this paper. Surgical management included irrigation, debridement, and reduction of the first metacarpal fracture followed by external fixation extending from the first metacarpal to the distal radius and primary wound closure. After 1 year of surgery, follow-up functional and radiographic evaluations were satisfactory, and most of the daily activities were pain-free. PMID:18780063

Cilli, Feridun; Mahirogullari, Mahir; Ozyurek, Selahattin

2007-01-01

114

Surgical wound infection surveillance in general surgery procedures at a teaching hospital in Pakistan  

Microsoft Academic Search

Background: A surveillance system was established at the Aga Khan University Hospital in Karachi, Pakistan, to determine surgical wound infection (SWI) rates, trends, and risk factors; and to compare rates with those reported by the National Nosocomial Infection Surveillance (NNIS) system of the Centers for Disease Control and Prevention. Methods: Surveillance was performed from January 1997 to December 1999. Risk

Turab Pishori; Amna Rehana Siddiqui; Mushtaq Ahmed

2003-01-01

115

Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center  

PubMed Central

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3 ± (18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4 ± 10.8?mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352?mLs and duration was 175?min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.

Akinbami, Babatunde O.

2014-01-01

116

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

PubMed Central

Background Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients. Methods A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35?±?7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504?±?1842 days. Results Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. Conclusions In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results. PMID:24661344

2014-01-01

117

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

Microsoft Academic Search

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

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

1995-01-01

118

Medical tongue piercing - development and evaluation of a surgical protocol and the perception of procedural discomfort of the participants  

PubMed Central

Background A system providing disabled persons with control of various assistive devices with the tongue has been developed at Aalborg University in Denmark. The system requires an activation unit attached to the tongue with a small piercing. The aim of this study was to establish and evaluate a safe and tolerable procedure for medical tongue piercing and to evaluate the expected and perceived procedural discomfort. Methods Four tetraplegic subjects volunteered for the study. A surgical protocol for a safe insertion of a tongue barbell piercing was presented using sterilized instruments and piercing parts. Moreover, post-procedural observations of participant complications such as bleeding, edema, and infection were recorded. Finally, procedural discomforts were monitored by VAS scores of pain, changes in taste and speech as well as problems related to hitting the teeth. Results The piercings were all successfully inserted in less than 5 min and the pain level was moderate compared with oral injections. No bleeding, infection, embedding of the piercing, or tooth/gingival injuries were encountered; a moderate edema was found in one case without affecting the speech. In two cases the piercing rod later had to be replaced by a shorter rod, because participants complained that the rod hit their teeth. The replacements prevented further problems. Moreover, loosening of balls was encountered, which could be prevented with the addition of dental glue. No cases of swallowing or aspiration of the piercing parts were recorded. Conclusions The procedure proved simple, fast, and safe for insertion of tongue piercings for tetraplegic subjects in a clinical setting. The procedure represented several precautions in order to avoid risks in these susceptible participants with possible co-morbidity. No serious complications were encountered, and the procedure was found tolerable to the participants. The procedure may be used in future studies with tongue piercings being a prerequisite for similar systems, and this may include insertion in an out-patient setting. PMID:24684776

2014-01-01

119

Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study  

Microsoft Academic Search

Background  Implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of\\u000a surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from\\u000a the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece\\u000a used in different surgical disciplines that provides an air- and

Hans Christoph Bock; Joseph Cohnen; Naureen Keric; Sven Rainer Kantelhardt; Alf Giese

2011-01-01

120

Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection  

PubMed Central

AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection. METHODS: Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor’s location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals’ rates and incidence of incisional hernias) and (4) costs. RESULTS: Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias. CONCLUSION: Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors’ location and the post-operative hernias. PMID:24707154

Lorenzon, Laura; La Torre, Marco; Ziparo, Vincenzo; Montebelli, Francesco; Mercantini, Paolo; Balducci, Genoveffa; Ferri, Mario

2014-01-01

121

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

PubMed

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

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

2014-06-01

122

Nail-Patella Syndrome in Saudi Arabia With New Features and Surgical Procedures: The First Described Study  

PubMed Central

The purpose of this study was to reveal the occurrence of nail-patella syndrome (NPS) in Saudi Arabia together with the detection of abnormal attachment of lateral meniscus in the left knee and new surgical procedures applied to the right and left knee, reported for the first time in this study. This was a case study of a 23-year-old young man presenting with bilateral knee pain, giving way and locking since the age of 15 years. Clinically, most of the NPS features were noted, including ocular problems. The complex features affected both knees, especially the previous attempted surgeries for recurrent dislocation of patellae. Deficient ligaments were reconstructed using the Leeds-Keio ligament, starting with the right knee and continuing with the left knee 6 months later. Early and late follow-up showed favorable outcome of surgery revealed as independent ambulation and stable right and left knees. In conclusion, NPS, although rare, presents a complex problem and unexpected surgical outcome, and we recommend this procedure with close follow-up. PMID:15266233

Juma, Abdullah H. A

2004-01-01

123

[Diagnostic and therapeutic procedures in fecal incontinence in general practice of the surgically educated proctologist].  

PubMed

Age related, about 10% of the general population suffer from faecal incontinence. In a surgical, proctological office diagnosis is possible with carefully taken history, physical examination, digital examination of the anorectum, rigid rectosigmoidoscopy, and anoscopy. Together with special examinations (endoanal ultrasound, electromyography, pudendal nerve terminal motor latency [PNTML], anorectal manometry, defaecography, transit time of the colon) the plan for medical and surgical treatment can be made. The basic medical conservative therapy consists of regulating the form of stool (high fibre diet and/or loperamid), training of the sphincter and pelvic muscles electrical stimulation or biofeedback training. Outpatient surgery is possible for small prolapsing tumors of the lower rectum or anal canal, hemorrhoids grade 2 or segmental anal prolapse. Inpatient surgery is needed for any form of reconstruction of the sphincter or the sensitive area of the anal canal, post- and preanal repair, anal and rectal prolapse, (dynamic) gracilis sphincteroplasty, or for a terminal stoma in those patients, whose uncontrolled incontinence cannot be managed otherwise. After surgery it is needed to continue the medical therapy (regulating the bowel movements, biofeedback training, electrical stimulation of the sphincter). PMID:8967212

Bock, J U; Jongen, J

1996-01-01

124

Open surgical repair for chronic type B aortic dissection: a systematic review  

PubMed Central

Background The treatment of chronic type B aortic dissection (CBAD) remains complicated. Thoracic endovascular aortic repair (TEVAR) has supplanted open surgical repair (OSR) as the preferred surgical treatment for CBAD. Despite TEVAR’s superior short-term results, much less is understood about its long-term outcomes. As much of the understanding of OSR originates from historical report, contemporary series, with modern surgical techniques and technologies, may present an alternative to TEVAR. The present systematic review will assess the short- and long-term outcomes of historic and contemporary series of OSR for CBAD. Methods Electronic searches were performed using six databases from their inception to March 2014. Relevant studies with OSRs for chronic type B dissection were identified. Data were extracted by two independent reviewers and analyzed according to predefined clinical endpoints. Studies were sub-classified into the pre-endovascular (historic series) and endovascular era (contemporary series) depending on whether the majority of cases were performed after 1999. Results Nineteen studies were identified for inclusion for quantitative analysis. Pooled short-term mortality was 11.1% overall, and 7.5% in the nine contemporary studies. Stroke, spinal cord ischemia, renal dysfunction, and reoperation for bleeding were 5.9%, 4.9%, 8.1%, and 8.1%, respectively, for the contemporary series. Absolute late reintervention was identified in 13.3% of patients overall, and in 11.3% of patients in the contemporary series. Aggregated survival at 1-, 3-, 5-, and 10-years of all patients were 82.1%, 74.1%, 66.3%, and 50.8%, respectively. Conclusions OSR for chronic type B dissection in the contemporary era offers acceptable results. Management approaches should be considered carefully, taking into account both short-term and long-term complications. More research is required to clarify specific indications for OSR and TEVAR in chronic type B dissections. PMID:25133097

Tian, David H.; De Silva, Ramesh P.; Wang, Tom

2014-01-01

125

Surgical procedures for urethral diverticula in women in the United States, 1979–1997  

Microsoft Academic Search

The objective of this study was to describe national rates of surgery for urethral diverticula in women. Data from the National Hospital Discharge Survey (NHDS), a federal database that samples inpatient hospitals in the United States, were analyzed from 1979 to 1997 for diagnosis and procedure codes using the ICD-9-CM classification system. The difference between the median age-adjusted rates from

Lara J. Burrows; Nancy L. S. Howden; Leslie Meyn; Anne M. Weber

2005-01-01

126

Expansive open-door laminoplasty secured with titanium miniplates is a good surgical method for multiple-level cervical stenosis  

PubMed Central

Background Laminoplasty is an effective procedure for treating cervical spondylotic myelopathy (CSM). Little information is available regarding the surgical outcomes of expansive open-door laminoplasty (EOLP) when securing with titanium miniplates without bone grafting. This study is aimed to elucidate the efficacy of and problems associated with EOLP secured with titanium miniplates without bone grafting, thereby enhancing future surgical outcomes. Methods This is a retrospective study. The study participants comprised 104 patients who underwent cervical EOLP secured with titanium miniplates without bone graft for CSM treatment between August 2005 and March 2011. The clinical results were evaluated based on the Japanese Orthopedic Association (JOA) and Nurick scores. The radiographic outcomes were determined based on plain film and magnetic resonance imaging findings, which were assessed and compared. Results Lateral cervical spine X-rays exhibited improvement in the Pavlov ratio of the spinal canal at 1 day postoperation, and this ratio did not change at 1 year postoperation. The mean cervical curvature from C2 to C7 decreased 0.21°?±?10.09° and the mean cervical range of motion was deteriorated by 35% at 12 months (P?surgical method for treating most patients with CSM. PMID:25142174

2014-01-01

127

Closed Hyperthermic Intraperitoneal Chemotherapy with Open Abdomen: a Novel Technique to Reduce Exposure of the Surgical Team to Chemotherapy Drugs  

Microsoft Academic Search

Background  Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of\\u000a great concern. During closed-abdomen HIPEC, operating room staff are not exposed to drugs, but the distribution of the heated\\u000a liquid within the abdomen is not optimal. With open-abdomen HIPEC, the opposite is true. Although the open-abdomen method\\u000a is potentially more effective, it has

Laurent Benoit; Nicolas Cheynel; Pablo Ortega-Deballon; Giovanni Di Giacomo; Bruno Chauffert; Patrick Rat

2008-01-01

128

Mechanical Effects of Autogenous Osteochondral Surgical Grafting Procedures and Instrumentation on Grafts of Articular Cartilage  

Microsoft Academic Search

Purpose: To analyze the mechanical effects of autogenous osteochondral grafting procedures on articular cartilage.Methods: The intensity, duration, and interval (indexes of stiffness, surface irregularity, and thickness) of the cartilage were assessed in a porcine model using an ultrasonic measurement system. In 7 of 12 knees, 6-mm-diameter plugs were harvested from the donor knees and grafted into 5-mm recipient holes at

Hiroshi Kuroki; Yasuaki Nakagawa; Koji Mori; Ken Ikeuchi; Takashi Nakamura

2004-01-01

129

Short-term survival and effects of transmitter implantation into western grebes using a modified surgical procedure.  

PubMed

Two pilot trials and one study in a closely related grebe species suggest that Western grebes (Aechmophorus occidentalis) will not tolerate intracoelomic transmitter implantation with percutaneous antennae and often die within days of surgery. Wild Western grebes (n = 21) were captured to evaluate a modified surgical technique. Seven birds were surgically implanted with intracoelomic transmitters with percutaneous antennae by using the modified technique (transmitter group), 7 received the same surgery without transmitter implantation (celiotomy group), and 7 served as controls (only undergoing anesthesia). Modifications included laterally offsetting the body wall incision from the skin incision, application of absorbable cyanoacrylate tissue glue to the subcutaneous space between the body wall and skin incisions, application of a waterproof sealant to the skin incision after suture closure, and application of a piece of porcine small intestine submucosa to the antenna egress. Survival did not differ among the 3 groups with 7 of 7 control, 6 of 7 celiotomy, and 6 of 7 transmitter birds surviving the 9-day study. Experimental birds were euthanized at the end of the study, and postmortem findings indicated normal healing. Significant differences in plasma chemistry or immune function were not detected among the 3 groups, and only minor differences were detected in red blood cell indices and plasma proteins. After surgery, the birds in the transmitter group spent more time preening tail feathers than those in the control and celiotomy groups. These results demonstrate that, in a captive situation, celiotomy and intracoelomic transmitter implantation caused minimal detectable homeostatic disturbance in this species and that Western grebes can survive implantation of intracoelomic transmitters with percutaneous antennae. It remains to be determined what potential this modified surgical procedure has to improve postoperative survival of Western grebes that are intracelomically implanted with transmitters with percutaneous antennae and released into the wild. PMID:22950313

Gaydos, Joseph K; Massey, J Gregory; Mulcahy, Daniel M; Gaskins, Lori A; Nysewander, David; Evenson, Joseph; Siegel, Paul B; Ziccardi, Michael H

2011-09-01

130

Anatomical variations of the human sural nerve and its role in clinical and surgical procedures.  

PubMed

The sural nerve is the most commonly nerve used in nerve transplantation, and so the aim of this study was to determine the variations of the sural nerve in the back of the leg, its relations to the calcaneal tendon and lateral malleolus, and determine the patterns of its distribution on the dorsum of the foot. Twenty-four Egyptian legs and feet were dissected. The results showed that the sural communicating nerve connected with the sural nerve in 87.5%. The predominant site of union between these two nerves was in the lower one-third of the leg and ankle region (62%). There was only one right leg that the sural nerve passed through the gastrocnemius. The small saphenous vein passed along the medial side of the sural nerve in 100%. The sural nerve crossed the lateral border of the calcaneal tendon in 50%. The distance between the sural nerve and insertion of calcaneal tendon was 16 + 7 mm in 91.7%. There were four types of pattern of innervation of the toes by the sural nerve. The predominant pattern was type I (45.8%), where the lateral side of the little toe was supplied by the sural nerve alone. The second pattern was type IV (29.2%), where the lateral 2 ½ toes were supplied by the sural nerve alone. These findings are important for sural nerve biopsy and grafts, surgical repair of the calcaneal tendon, and regional anesthesia of the foot. PMID:20949489

Eid, Essam M; Hegazy, Ahmed M S

2011-03-01

131

Intraocular Lens-Shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety When Treating Dense Nuclear Cataracts  

PubMed Central

Objective To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts. Methods Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out. Results The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05). Conclusions Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT02138123). Trial Registration ClinicalTrials.gov NCT02138123 PMID:25401512

Chen, Weirong; Qu, Bo; Zhang, Xinyu; Lin, Zhuoling; Chen, Jingjing; Liu, Yizhi

2014-01-01

132

Medical Robots Surgical Assistants  

E-print Network

1 Medical Robots Surgical Assistants · Efficacy of Procedure ­ Accuracy ­ Longevity ­ Invasiveness · Augment human capabilities ­ Enabling new procedures ­ Time under anaesthetic #12;2 Surgical Robots) ­ Sensei (Hansen Medical) Autonomous Surgical Robots Robodoc.com #12;3 Guided Surgical Robots Makosurgical

Pulfrey, David L.

133

A technique for administering xenon gas anesthesia during surgical procedures in mice.  

PubMed

Carrying out invasive procedures in animals requires the administration of anesthesia. Xenon gas offers advantages as an anesthetic agent compared with other agents, such as its protection of the brain and heart from hypoxia-induced damage. The high cost of xenon gas has limited its use as an anesthetic in animal experiments, however. The authors designed and constructed simple boxes for the induction and maintenance of xenon gas and isoflurane anesthesia in small rodents in order to minimize the amount of xenon gas that is wasted. While using their anesthesia delivery system to anesthetize pregnant mice undergoing caesarean sections, they measured the respiratory rates of the anesthetized mice, the survival of the pups and the percentages of oxygen and carbon dioxide within the system to confirm the system's safety. PMID:25333593

Ruder, Arne Mathias; Schmidt, Michaela; Ludiro, Alessia; Riva, Marco A; Gass, Peter

2014-10-21

134

The influence of different surgical procedures on hypertension after repair of coarctation.  

PubMed

We measured resting and exercise haemodynamics, as well as 24-hour ambulatory blood pressure, so as to study the influence on development of hypertension in children after repair of coarctation by either construction of a subclavian flap or end-to-end anastamosis. The patients in both groups were studied a mean time of 13 years after surgery. Thus, we divided 43 children who had undergone surgical repair of coarctation, and who were not on antihypertensive therapy, into a group of 22 patients who had undergone subclavian flap repair, with a mean age of 14 plus or minus 2.6 years, and another group of 21 patients undergoing end-to-end anastomosis, with a mean age of 13.5 plus or minus 3.9 years. We examined blood pressure at rest and during exercise, along with the measurement of cardiac output using impedance cardiography, and during 24-hour ambulatory monitoring. We recorded systolic and diastolic blood pressures, pulse pressure, cardiac output and total peripheral vascular resistance at rest and at peak exercise. During ambulatory monitoring, we measured mean pressures over 24 hours, in daytime and nighttime, 24-hour pulse pressure, and 24-hour mean arterial pressure. Student's t test was used to judge significance, accepting this when p was less than 0.05. The group repaired using the subclavian flap showed significantly disadvantageous differences for diastolic blood pressure at rest, systolic blood pressure at peak exercise and for 24-hour systolic and diastolic blood pressure, 24-hour mean arterial pressure, and daytime and nighttime systolic blood pressure during ambulatory monitoring. Our findings suggest that, after repair using the subclavian flap in comparison to end-to-end anastomosis, patients show a higher incidence of late hypertension, both during exercise and ambulatory monitoring. The data indicate different residual aortic stiffnesses, these being lower after end-to-end anastomosis, which may be due to the greater resection of the abnormal aortic tissue when coarctation is repaired using the latter technique. PMID:16164785

Giordano, Ugo; Giannico, Salvatore; Turchetta, Attilio; Hammad, Fatma; Calzolari, Flaminia; Calzolari, Armando

2005-10-01

135

NIH Child Care Programs Inclement Weather -Opening and Closure Procedures  

E-print Network

are expected to report for work on time. The NIH Child Care Program MAY open no more than ONE hour later than. The NIH Child Care Program MAY open no more than ONE hour later than they would normally open. 5. "Federal to the media when a disruption occurs after the workday begins. Announcement What Announcement Means NIH Child

Baker, Chris I.

136

[Nerve transfer in brachial plexus injuries--comparative analysis of surgical procedures].  

PubMed

Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79%) of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70.1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50.1% for intercostal and/or spinal accessory nerve transfer, 64.5% for plexo-plexal nerve transfer, 81.7% for regional nerve transfer, and 87.1% for combine nerve transfer. PMID:14619714

Rasuli?, L; Samardzi?, M; Grujici?, D; Bascarevi?, V

2003-01-01

137

Open reduction or epiphysiodesis for slipped upper femoral epiphysis. A comparison of Dunn's operation and the Heyman-Herndon procedure.  

PubMed

Forty-eight consecutive patients (53 hips) were treated for moderate or severe slips of the upper femoral epiphysis between 1974 and 1984; 46 patients (96%) returned for clinical and radiological assessment at a mean of five years after operation. Twenty-three patients (23 hips) underwent a Dunn's open reduction and 25 patients (30 hips) were treated by epiphysiodesis and surgical osteoplasty as advocated by Heyman and Herndon. The results of the two methods of treatment are compared. Analysis revealed that 11 hips with moderate slip (30 degrees to 50 degrees) treated by the Heyman-Herndon procedure did significantly better than the 18 hips with severe slip (greater than 50 degrees) treated by the same method. Furthermore, when these hips with severe slip were compared to the hips treated by Dunn's open reduction, all of which were displaced greater than 50 degrees, the latter fared significantly better. The authors conclude that the Heyman-Herndon procedure gave consistently good results for moderate slips, but Dunn's open reduction gave better results for hips with severe slips. PMID:3680334

Szypryt, E P; Clement, D A; Colton, C L

1987-11-01

138

Incisional Surgical Site Infection after Elective Open Surgery for Colorectal Cancer  

PubMed Central

Background. The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer. Methods. We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development. Results. A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4). Conclusions. The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI. PMID:24800067

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

2014-01-01

139

Open-loop recycling: Criteria for allocation procedures  

Microsoft Academic Search

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

Tomas Ekvall; Anne-Marie Tillman

1997-01-01

140

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

PubMed Central

Background Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications. Methods A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis. Results Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications. Conclusions The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration. PMID:25075222

2014-01-01

141

Mastectomy -- The Surgical Procedure  

MedlinePLUS Videos and Cool Tools

X Search About Breast Cancer View About Breast Cancer Facts & Statistics View Facts & Statistics What is Breast Cancer View What is Breast Cancer Breast Anatomy Ductal Carcinoma in Situ Invasive Breast Cancers ...

142

Comparison of the incisions for the open surgical treatment of gluteal muscle contracture.  

PubMed

Gluteal muscle contracture is not very common, but cases are still seen in China. Open surgical treatment is considered as an efficient method to treat this disease. However, the type of incision that can provide best results is yet to be determined. The authors therefore compared various incisions to determine the better one. In this retrospective study, patients who underwent surgery with a traverse straight incision, a curved incision, a longitudinal straight incision, or an 'S'-shaped incision above the greater trochanter were enrolled and divided into four groups: A, B, C, and D. In each group, the patients were divided into different levels according to a specific standard. The four groups were compared in terms of incision length, postoperative drainage amounts, wound healing rates, visual analog scale scores, and improvement in the degree of range of motion (ROM). During the follow-up period, the validity of the results, complications, and recurrent cases were evaluated. In our study, incision length and visual analog scale score of the four groups showed no significant differences (P>0.05). Wound healing rates, drainage amount, improvement in ROM, validity of the results, and recurrences in group D were significantly the best (P<0.05). No significant differences in wound healing rates, drainage amount, and improvement in ROM were found in groups A, B, and C. In terms of validity of the results and 1-year recurrence, no significant difference was observed between groups A and B; however, these factors were better than those in group C. We concluded that the 'S'-shaped incision above the greater trochanter is the most efficient among the incisions described in this study. This incision has the following advantages: clear exposure, less damage, high safety rate, excellent results, and low recurrence rate. PMID:24887050

Xu, Jian; Geng, Xiang; Muhammad, Hassan; Wang, Xu; Huang, Jia-Zhang; Zhang, Chao; Ma, Xin

2014-09-01

143

Surgical commissurotomy of the aortic valve: Outcome of open valvotomy in neonates with critical aortic stenosis  

Microsoft Academic Search

Early intervention is necessary in neonates with critical aortic stenosis. The advent of alternate therapy, particularly balloon aortic valvuloplasty, requires a reappraisal of the traditional surgical approach, including the efficacy of intiail transvalvar gradient reduction and freedom from recurrence of obstruction in the longer term. This report describes a series of 33 consecutive infants who underwent surgical aortic valvotomy in

Hans Peter Gildein; Sabine Kleinert; Robert G. Weintraub; James L. Wilkinson; Tom R. Karl; Roger B. B. Mee

1996-01-01

144

174478-2014-EN Member states -Supply contract -Contract notice -Open procedure 1/5  

E-print Network

procedure 1/5 24/05/2014 S100 http://ted.europa.eu/TED Member states - Supply contract - Contract notice - Open procedure Supplement to the Official Journal of the European Union 1/5 This notice in TED website: http://ted.europa.eu/udl?uri=TED:NOTICE:174478-2014:TEXT:EN:HTML United Kingdom-Didcot: Mirrors 2014/S

Crowther, Paul

145

182127-2014-EN Member states -Supply contract -Additional information -Open procedure 1/1  

E-print Network

procedure 1/1 31/05/2014 S104 http://ted.europa.eu/TED Member states - Supply contract - Additional information - Open procedure Supplement to the Official Journal of the European Union 1/1 This notice in TED website: http://ted.europa.eu/udl?uri=TED:NOTICE:182127-2014:TEXT:EN:HTML United Kingdom-Didcot: Mirrors

Crowther, Paul

146

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. PMID:24116028

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

2013-01-01

147

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

PubMed Central

Introduction Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation. Methods We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Results Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions The initial development of the CAPE workstation demonstrated integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution. PMID:24406592

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

2014-01-01

148

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

MedlinePLUS

... contrast CT (computed tomography) imaging to determine if acute stroke patients are candidates for clot-busting drugs. CT is quick, inexpensive, and readily available. If the stroke is determined to be ischemic (due to a blood clot), the interventional radiologist ...

149

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

Microsoft Academic Search

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

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

2001-01-01

150

Matching bacteriological and medico-administrative databases is efficient for a computer-enhanced surveillance of surgical site infections: retrospective analysis of 4,400 surgical procedures in a French university hospital.  

PubMed

Objective.?Our goal was to estimate the performance statistics of an electronic surveillance system for surgical site infections (SSIs), generally applicable in French hospitals. Methods.?Three detection algorithms using 2 different data sources were tested retrospectively on 9 types of surgical procedures performed between January 2010 and December 2011 in the University Hospital of Nantes. The first algorithm was based on administrative codes, the second was based on bacteriological data, and the third used both data sources. For each algorithm, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. The reference method was the hospital's routine surveillance: a comprehensive review of the computerized medical charts of the patients who underwent one of the targeted procedures during the study period. Setting.?A 3,000-bed teaching hospital in western France. Population.?We analyzed 4,400 targeted surgical procedures. Results.?Sensitivity results varied significantly between the three algorithms, from 25% (95% confidence interval, 17-33) when using only administrative codes to 87% (80%-93%) with the bacteriological data and 90% (85%-96%) with the combined algorithm. Fewer variations were observed for specificity (91%-98%), PPV (21%-25%), and NPV (98% to nearly 100%). Overall, performance statistics were higher for deep SSIs than for superficial infections. Conclusions.?A reliable computer-enhanced SSI surveillance can easily be implemented in French hospitals using common data sources. This should allow infection control professionals to spend more time on prevention and education duties. However, a multicenter study should be conducted to assess the generalizability of this method. PMID:25333426

Leclère, Brice; Lasserre, Camille; Bourigault, Céline; Juvin, Marie-Emmanuelle; Chaillet, Marie-Pierre; Mauduit, Nicolas; Caillon, Jocelyne; Hanf, Matthieu; Lepelletier, Didier

2014-11-01

151

[Comparison of various methods of surgical hernia repair].  

PubMed

Over the last 15 years, a number of different procedures for hernia repair have been developed. Apart from the open techniques, with or without the use of a prosthetic mesh or mesh plug, endoscopic procedures such as transabdominal preperitoneal (TAPP), and totally endoscopic preperitoneal (TEPP), hernioplasty are now established operations. In the present paper, the common open surgical procedures are compared with the minimally invasive repairs with regard to practicability, postoperative wound pain and complications, mobilization, recurrence rates and cosmesis. In the view of the authors, the standard method for inguinal hernial repair is the open Lichtenstein procedure or the Rutkow patch and plug method. PMID:15957857

Benz, S; Hopt, U T

2005-05-19

152

A comparative study on the efficacy of a commercial fibrin adhesive (Tisseel®) vis-?-vis silk suture on wound closure following periodontal surgical procedures  

PubMed Central

Aims and Objectives: To evaluate the efficacy of fibrin adhesive sealant (Tisseel®), a human biological tissue adhesive, as compared to conventional suture placement in pocket elimination and mucogingival surgical procedures. Materials and Methods: The study sample consisted of 25 patients (10 male and 15 female patients), in the age group of 25-40 years, with localized periodontitis in relation to the anterior region of the maxilla and mandible. They were divided into three surgical groups: Group I, Group II and Group III. Each of these groups was further divided into control and experimental groups. In all the control groups, the flaps/grafts were approximated with 4-0 black braided silk. In the experimental groups, the flaps/grafts were approximated with fibrin adhesive sealant (Tisseel?). Clinical parameters were taken pre-operatively.operatively and post-operatively on the 1st, 2nd, 3rd, 7th, and 10th, day. Results: The Fibrin Adhesive System (FAS) showed superior results in all the parameters measured, i.e., hemostasis, fixation of tissues, reduction in plaque and gingival index and probing depth postoperatively. Conclusion: The results of this study indicate that periodontal surgery using FAS enhances various periodontal regenerative surgical procedures. PMID:21731248

Manimegalai, A.G.

2010-01-01

153

Comparative analysis of curative effect of CT-guided stem cell transplantation and open surgical transplantation for sequelae of spinal cord injury  

PubMed Central

Background This study compared the clinical efficacies, advantages and disadvantages of two transplantation approaches for treating spinal cord injury: open surgical exploration combined with local stem cell transplantation (referred to as open surgical transplantation) and local stem cell transplantation by CT-guided puncture (referred to as CT-guided transplantation). Methods The patients were divided into the following three groups to perform a retrospective controlled study: Group A included nine patients who underwent open surgical transplantation, Group B included nine patients who underwent CT-guided transplantation, and Group C included nine patients who did not receive stem cell transplantation. The Abbreviated Injury Scale (AIS), the American Spinal Injury Association (ASIA) score and the motor evoked potentials (MEP) examination were utilized to compare the differences in the clinical efficacies. The advantages and disadvantages of the two transplantation approaches were also compared, including the surgical risks, the possibility of repeating the operation, the interval between surgery and rehabilitation exercises and the scope of conditions suitable for the operation. Results Whether evaluated by the AIS grading scale, the ASIA score or the MEP results, there were significant differences in the clinical efficacy among the three patient groups. Group B exhibited the best clinical outcome, followed by Group A, and Group C fared the worst. The CT-guided transplantation had the advantages of lower surgical risk, the potential to repeat the operations within a short time-frame and a short interval between surgery and rehabilitation exercise compared with the open surgical transplantation. The conditions that are suitable for CT-guided transplantation versus the conditions suitable for open surgical transplantation are not identical. The application scopes for the two approaches had their respective strengths. Conclusions CT-guided stem cell transplantation was confirmed as a safe and effective approach to treat sequelae of spinal cord injury with the advantages of simpler operation, minimal invasion, less adverse reaction and quicker recovery. Trial registration Clinical trials registration number: ChiCTR-TNRC-12002477. PMID:24355001

2013-01-01

154

Comparison of surgical procedures and percutaneous drainage in the treatment of liver hydatide cysts: a retrospective study in an endemic area  

PubMed Central

Introduction: Surgical procedures are still the golden standard option in the treatment of liver cystic echinococcosis. However, minimal invasive technics like percutaneous drainage are rising trends. We aimed to compare the efficacy of surgical and percutaneous options in the treatment of liver hydatidosis in an endemic area. Methods: Patients who underwent surgical or percutaneous procedures for hydatid disease between January 2007 and December 2012 were retrospectively evaluated. Recurrence rates, hospital stay time, and related factors were analyzed. Results: There were 44 (35.5%) male and 80 (64.5%) female patients in this study. Eighty two patients (Group I) had undergone surgery (66.1%) and 42 patients (Group II) had undergone percutaneous drainage (33.9%). The mean cyst size was 7.28 ± 2.51 cm in Group I and 8.76 ± 3.30 cm in Group II. Nine recurrences (7.3%) were detected during study. Five of the recurrences were in Group II (11.9%) and four (4.9%) of them were in Group I. The mean length of hospital stay of all patients was 5.42 ± 3.16 days. Discussion: Percutaneous drainage techniques can be a good alternative to surgery in selected patients. In complicated cases like cystobiliary fistula, surgery is superior to percutaneous approaches. The hospital stay time, recurrence rate and postoperative complications were not enhanced when compared to percutaneous treatment in our study. Despite all controversy about the low morbidity after percutaneous treatment, surgical approach is still a preferable option in patients with liver hydatidosis when it is performed by experienced surgeons. PMID:25232421

Akkucuk, Seckin; Aydogan, Akin; Ugur, Mustafa; Yetim, Ibrahim; Davran, Ramazan; Oruc, Cem; Kilic, Erol; Temiz, Muhyittin

2014-01-01

155

Feline onychectomy and elective procedures.  

PubMed

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

2002-05-01

156

Unusual causes of reduced mouth opening and it's suitable surgical management: Our experience.  

PubMed

Reduced mouth opening is a common clinical problem and many individuals experience it at least once in his or her life and most dental practitioners see patients with restricted mouth opening quite often. It can occur due to a variety of underlying conditions which may involve complex factors. Hence, it is essential for the clinician to thoroughly investigate and examine these cases for proper diagnosis and its appropriate management. PMID:22442560

Gupta, Sunil Kumar; Rana, Amar S; Gupta, Deepak; Jain, Gaurav; Kalra, Puneet

2010-01-01

157

Unusual causes of reduced mouth opening and it's suitable surgical management: Our experience  

PubMed Central

Reduced mouth opening is a common clinical problem and many individuals experience it at least once in his or her life and most dental practitioners see patients with restricted mouth opening quite often. It can occur due to a variety of underlying conditions which may involve complex factors. Hence, it is essential for the clinician to thoroughly investigate and examine these cases for proper diagnosis and its appropriate management. PMID:22442560

Gupta, Sunil Kumar; Rana, Amar S.; Gupta, Deepak; Jain, Gaurav; Kalra, Puneet

2010-01-01

158

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

1999-01-01

159

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. PMID:21861878

2011-01-01

160

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

PubMed Central

Indications for liver surgery to treat primary and secondary hepatic malignancies are broadening. Utilizing data from B-mode or 2-dimensional intraoperative ultrasound, it is often challenging to replicate the findings from preoperative CT or MRI scans. Additional data from more recently developed image-guidance technology, which registers preoperative axial imaging to a 3-dimensional real-time model, may be used to improve operative planning, locate difficult to find hepatic tumors, and guide ablations. Laparoscopic liver procedures are often more challenging than their open counterparts. Image-guidance technology can assist in overcoming some of the obstacles to minimally invasive liver procedures by enhancing ultrasound findings and ablation guidance. This manuscript describes a protocol that evaluated an open image-guidance system, and a subsequent protocol that directly compared, for validation, a laparoscopic with an open image-guidance system. Both protocols were limited to ablations within the liver. The laparoscopic image-guidance system successfully creates a 3-D model at both 7 and 14 mm Hg that is similar to the open 3-D model. Ultimately, improving intraoperative image guidance can help expand the ability to perform both laparoscopic and open liver surgeries. PMID:23645420

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

2013-01-01

161

Surgical Treatment of Perianal Fistulizing Crohn's Disease: From Lay-Open to Cell-Based Therapy—An Overview  

PubMed Central

Background. Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.

2014-01-01

162

Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25?cmH?O: prospective, blind, and randomised study.  

PubMed

To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60?cmH?O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25?cmH?O, L group) and high (at 60?cmH?O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25?cmH?O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334. PMID:24778598

Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

2014-01-01

163

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

PubMed Central

Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used “standard practice” surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions. Citation: Redline S; Amin R; Beebe D; Chervin RD; Garetz SL; Giordani B; Marcus CL; Moore RH; Rosen CL; Arens R; Gozal D; Katz ES; Mitchell RB; Muzumdar H; Taylor HG; Thomas N; Ellenberg S. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. SLEEP 2011;34(11):1509-1517. PMID:22043122

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

2011-01-01

164

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

2007-01-01

165

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. PMID:24109569

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

2013-01-01

166

Diagnostic arthroscopy and longitudinal open lateral releaseA four year follow-up study to determine predictors of surgical outcome  

Microsoft Academic Search

The purpose of this study was as follows: 1) to review our previous findings regarding surgical outcome fol lowing open retinacular release but now at a mean followup of 4 years, 2) to test the validity of the correc tion of patellar \\

Robert B. Dzioba

1990-01-01

167

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

PubMed Central

Background There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period. Methods Data were collected in the form of a prospective registry from a community hospital after specific Institutional Review Board approval was obtained. The analysis included consecutive adult patients being surgically treated for degenerative conditions of the lumbar spine, with either an MIS or open approach for two-level instrumented lumbar fusion. Patient outcomes and costs were collected for the perioperative period. Hospital operating costs were grouped by hospitalization/operative procedure, transfusions, reoperations, and residual events (health care interactions). Results One hundred and one open posterior lumbar interbody fusion (Open group) and 109 MIS patients were treated primarily for stenosis coupled with instability (39.6% and 59.6%, respectively). Mean total hospital costs were $27,055.53 for the Open group and $24,320.16 for the MIS group. This represents a statistically significant cost savings of $2,825.37 (10.4% [95% confidence interval: $522.51–$5,128.23]) when utilizing MIS over traditional Open techniques. Additionally, residual events, complications, and blood transfusions were significantly more frequent in the Open group, compared to the MIS group. Conclusions/level of evidence Utilizing minimally invasive techniques for instrumented spinal fusion results in decreased hospital operating costs compared to similar open procedures in the early perioperative period. Additionally, patient benefits of minimally invasive techniques include significantly less blood loss, shorter hospital stays, lower complication rate, and a lower number of residual events. Long-term outcome comparisons are needed to evaluate the efficacy of the two treatments. Level of evidence: III Clinical relevance This work represents a true cost-of-operating comparison between open and MIS approaches for lumbar spine fusion, which has relevance to surgeons, hospitals and payers in medical decision-making. PMID:22952415

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

2012-01-01

168

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. PMID:16684362

O'Malley, Sue P

2006-01-01

169

A modification of the Hynes procedure--a surgical innovation in the treatment of mature hypertrophic scars in children.  

PubMed

In 1957, Hynes first described the shaving and grafting procedure for the treatment of mature hypertrophic scars (HTSs). This procedure involved excision of mature HTS using a scalpel blade followed by split-skin grafting (SSG). We have modified this technique through the novel application of Versajet™ (Smith & Nephew, Hull, UK) for the sub-total excision of mature HTS with SSG. To date, this modified technique has shown excellent cosmetic results. A review of cases and an example of the technique is provided. PMID:21596480

Slocombe, Paul D; Simons, Megan A; Kimble, Roy M

2011-11-01

170

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

PubMed Central

Background Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively. Patients and methods We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003–2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006–2009 (group B). Results In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner. Interpretation Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center. PMID:24032521

2013-01-01

171

Abstract--Minimally invasive surgical procedures like biopsies require the insertion of a needle to reach a specific  

E-print Network

, these errors can be caused by the brain shifting when the skull is drilled, measurement errors due are a common medical procedure mainly used for a better pathology diagnosis. They represent a medical test to reach a specific tissue from where samples are taken. This process is affected by a number of errors

172

Surgical treatment of large median incisional hernia using the prosthetic mesh introduced behind the rectus abdominis muscle sheath procedure (Rives-Stoppa procedure)  

PubMed Central

Abstract A number of 77 large incisional hernias located on the midline of the abdomen were operated following Rives-Stoppa procedure, in a period of five years (2006-2011), in the Surgery Clinic I of the University Hospital Bucharest. The characteristics of the study group were mean age - 62 years, predominance of females - 63 cases (82%), the rate of obesity - 26 observations (34%). Immediate postoperative morbidity was represented by (no. cases): thrombophlebitis (3), prolonged postoperative ileus (6), seroma (12) extended hematic drainage (5), hematoma (4). There were no fatalities. Late postoperative morbidity (no. cases) registered granulomas (4) and recurrence (2). We obtained good and very good results in 71 cases (92%).

Gangur?, AG; Palade, R?

2014-01-01

173

Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery  

PubMed Central

Objective The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Method This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. Results We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium. PMID:25337310

Jannati, Yadollah; Bagheri-Nesami, Masoumeh; Sohrabi, Maryam; Yazdani-Cherati, Jamshid; Mazdarani, Shahrzad

2014-01-01

174

Low frequency of adenylate kinase release into cerebrospinal fluid during balanced, normotensive anaesthesia and a non-orthognathic surgical procedure.  

PubMed

Activity of strictly intracellular enzymes in the cerebrospinal fluid (CSF) may indicate leakage from dysfunctional brain cells. Increased activity of adenylate kinase (AK) in the CSF is indicative of brain cell injury arising from several sources, among them orthognathic surgery. The mechanism in the latter case is obscure, but the use of an oscillating saw which generates vibrations, and the site of surgery close to the brain may be contributing factors. Anaesthesia may also play a role. In the present study, CSF-AK activity was measured after hysterectomy and was compared with activity after orthognathic surgery in two other studies. Four of 19 patients (21%) in the present study expressed pathological activity, compared with 34 of 47 (72%) orthognathic patients in the two other studies. No firm conclusion may be drawn from historical comparisons, and the difference in activity seen between the two types of surgery might not necessarily be the result of surgical factors. Until this is investigated further, however, we conclude that there may be a difference in postoperative CSF-AK activity between orthognathic and lower abdominal surgery. PMID:9100164

Enlund, M; Mentell, O; Edmark, L; Ronquist, G

1997-01-01

175

Surgical treatment of large median incisional hernia using the prosthetic mesh introduced behind the rectus abdominis muscle sheath procedure (Rives-Stoppa procedure).  

PubMed

A number of 77 large incisional hernias located on the midline of the abdomen were operated following Rives-Stoppa procedure, in a period of five years (2006-2011), in the Surgery Clinic I of the University Hospital Bucharest. The characteristics of the study group were mean age - 62 years, predominance of females - 63 cases (82%), the rate of obesity - 26 observations (34%). Immediate postoperative morbidity was represented by (no. cases): thrombophlebitis (3), prolonged postoperative ileus (6), seroma (12) extended hematic drainage (5), hematoma (4). There were no fatalities. Late postoperative morbidity (no. cases) registered granulomas (4) and recurrence (2). We obtained good and very good results in 71 cases (92%). PMID:25408767

Gangur?, Ag; Palade, R?

2014-09-15

176

The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population.  

PubMed

Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used "standard practice" surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions. PMID:22043122

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

2011-11-01

177

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure An Analysis of the Modified Blalock-Taussig Shunt and Right Ventricle-to-Pulmonary Artery Shunt Surgical Eras  

Microsoft Academic Search

Background—The Norwood procedure for stage 1 palliation of hypoplastic left heart syndrome is performed with either the modified Blalock-Taussig (MBTS) or the right ventricle-to-pulmonary artery (RVPA) shunt. In our institution, surgical practice changed from use of the MBTS to use of the RVPA shunt in 2002. We analyzed survival and mental and psychomotor outcomes of the 2 consecutive surgical eras.

Joseph Atallah; Irina A. Dinu; Ari R. Joffe; Charlene M. T. Robertson; Reg S. Sauve; John D. Dyck; David B. Ross; Ivan M. Rebeyka

2010-01-01

178

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

PubMed Central

We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm2. Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures. PMID:23413120

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

2012-01-01

179

Regional anaesthesia for surgical repair in selected open globe injuries in adults  

PubMed Central

Purpose To determine whether the combination of topical, intracameral and facial nerve blocks would produce adequate analgesia for repair of open globe injuries without increasing intraocular tension. Methods A comparison of combined O’Brien’s block (facial nerve block), topical ropivacaine and intracameral lignocaine versus peribulbar block in 100 randomly selected cases of traumatic corneal rupture. Patients were randomly divided in two groups of 50 each based on those receiving the combined approach (Group T) and those undergoing peribulbar block (Group P). Patients were excluded if there was rupture with significant scleral extension, the interval between trauma and presentation greater than 2 h, presence of hypopyon, rupture with significant corneal oedema, expulsion of intraocular contents with a collapsed globe and monocular cases. The effect of the anaesthetic was compared by patient comfort and surgeon comfort, the incidence of vitreous prolapse and the requirement of incremental sedation. The Student’s “t” test, the “Z” test, and Chi Square tests were used where appropriate. P < 0.05 was considered statistically significant. Results The average patient comfort in Group P was 5.67% greater than Group T (P > 0.05). The average surgeon comfort and patient comfort between groups were similar (P > 0.05, both comparisons). Incremental sedation was required in 16% of patients in Group T compared to 8% in Group P (P = 0.218363). The total sedation dosage required for each group was similar. The incidence of vitreous prolapse was statistically significantly higher by 14% in Group P compared to Group T (P = 0.03731). Conclusions Our combined technique proved as efficacious as peribulbar block in providing adequate local anaesthesia and reducing the incidence of vitreous prolapse. We recommend greater use of this technique for repair of open globe injuries especially in locations where full time anaesthesia services are not available. PMID:23964185

Chakraborty, Arunangshu; Bandyopadhyay, Samir K.; Mukhopadhyay, Somnath

2012-01-01

180

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

PubMed

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

2013-08-01

181

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

PubMed Central

Background: We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Materials and Methods: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. Results: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H2O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable. Conclusion: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H2O were more in PLMA group which indicates its better suitability for controlled ventilation. PMID:24803754

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

2014-01-01

182

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

PubMed Central

Background Studies have shown that 4% of hospitalized patients suffer from an adverse event caused by the medical treatment administered. Some institutions have created systems to encourage medical workers to report these adverse events. However, these systems often prove to be inadequate and/or ineffective for reviewing the data collected and improving the outcomes in patient safety. Objective To describe the Web-application Duke Surgery Patient Safety, designed for the anonymous reporting of adverse and near-miss events as well as scheduled reporting to surgeons and hospital administration. Software architecture DSPS was developed primarily using Java language running on a Tomcat server and with MySQL database as its backend. Results Formal and field usability tests were used to aid in development of DSPS. Extensive experience with DSPS at our institution indicate that DSPS is easy to learn and use, has good speed, provides needed functionality, and is well received by both adverse-event reporters and administrators. Discussion This is the first description of an open-source application for reporting patient safety, which allows the distribution of the application to other institutions in addition for its ability to adapt to the needs of different departments. DSPS provides a mechanism for anonymous reporting of adverse events and helps to administer Patient Safety initiatives. Conclusion The modifiable framework of DSPS allows adherence to evolving national data standards. The open-source design of DSPS permits surgical departments with existing reporting mechanisms to integrate them with DSPS. The DSPS application is distributed under the GNU General Public License. PMID:17472749

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

2007-01-01

183

Treatment of failures related to articulation material in THA. A comprehensive algorithm of surgical options and open questions.  

PubMed

Total hip arthroplasty is considered one of the greatest advances in health care of the last century. More than one million THAs are estimated to be performed annually and an increasing number of revisions are expected in the future. Osteolysis and loosening are still the main reasons for failure, justifying the use of low-wear bearings.The aim of this paper is to describe the mode of failure of the different couplings (polyethylene, cross-linked PE, metal, ceramic) and the options of treatment considering the various scenarios that the surgeon has to face nowadays in the case of failure related to articulation material. A comprehensive algorithm of treatment strategies is proposed based on the best current evidence and on the authors' experience.Periodical follow-up, indications for early revision, selection of proper surgical techniques and tribology are suggested. Nowadays, few rules are strongly recommended: trying to avoid any metal in case of failure of metal-on-metal; to avoid metal in fracture of ceramic; never to mix metals or ceramics from different manufactures. We aim to address a great number of open questions. There is still need for further research and evidences in this essential field of orthopaedic surgery. PMID:24970035

Zagra, Luigi; Maccario, Camilla; Mondini, Andrea; Bianchi, Luca

2014-01-01

184

Comparative clinical study of the effect of LLLT in the immediate and late treatments of hypoesthesia due to surgical procedures  

NASA Astrophysics Data System (ADS)

We evaluated the effect of LLLT in 68 patients who presented hypoesthesia due to odontological surgery procedures: dental implant surgeries (N=51); extraction of impacted lower third molars (N=10); endodontics in lower first molars (N=7). Lesions treated within 30 days after the nerve injury had occurred were part of the immediate group, and lesions with more than 30 days from the occurrence of the injury were part of the late group. Treatments were carried out with an infrared diode laser of 40 mW-830nm, continuous wave emission, spot size 3 mm2, and a total dosage of 18 joules per session in a contact mode of application, 20 sessions altogether. The efficacy of laser therapy in peripheral nerve regeneration is also related to the degree of the peripheral nerve lesion, and not only to the lesion duration. LLLT resulted in neurosensory functional improvement in both immediate and late treatments of hypoesthesia.

Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Pinheiro, Antonio L. B.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Takamoto, Marcia; Siqueira, Jose T.; Dias, Pedro; Campos, Roberto A. d. C.

2002-06-01

185

Free software, Open source software, licenses. A short presentation including a procedure for research software and data dissemination  

E-print Network

Free software, Open source software, licenses. A short presentation including a procedure for research software and data dissemination T. Gomez-Diaz CNRS, Universit�e Paris-Est, Laboratoire d to revisit the basic concepts in software distribution such as free software, open source software, licenses

186

Advantages of open repair of a foveal tear of the triangular fibrocartilage complex via a palmar surgical approach.  

PubMed

Foveal tears of the triangular fibrocartilage complex (TFCC) can be repaired via a palmar surgical approach. Unlike the dorsal approach, in this method the floor of the extensor carpi ulnaris tendon subsheath and the dorsal superficial limb of the radioulnar ligament do not hinder the view of the fovea. Patients with a fresh or chronic TFCC foveal tear and a positive ulnar fovea sign with its dorsal styloid insertion remaining intact are candidates for this procedure. During operation, the shoulder is positioned at 90 degrees of abduction, and the elbow is flexed at 90 degrees on an arm board. A 4 cm curved skin incision along the flexor carpi ulnaris tendon is made on the anterior aspect of the ulnar fovea. The ulnar fovea is exposed through a transverse capsulotomy of the distal radioulnar joint. The ulnocarpal joint distal to the TFCC is also exposed between the extensor carpi ulnaris tendon subsheath and the ulnotriquetrum ligament. After curettage of the scar tissues at the fovea, the lifted TFCC is sutured onto the fovea using a suture anchor technique. PMID:19956042

Moritomo, Hisao

2009-12-01

187

Surgical Instrument Restraint in Weightlessness  

NASA Technical Reports Server (NTRS)

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 of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

2000-01-01

188

Modula-2 input\\/output procedure using polymorphic and open-ended data type extensions (abstract only)  

Microsoft Academic Search

The Modula-2 language does not include special statements or standard procedures for handling input and output as in other languages. By extending Modula-2 to include a polymorphic structure, called a variant data type(1), and allowing open-ended structures, it is possible to define procedures that have a function and syntax similar to the I\\/O statements and procedures of other languages. The

Thomas R. Leap

1987-01-01

189

Surgical strategies for treating patients with pineal region tumors.  

PubMed

Optimal management of pineal region tumors depends on securing an accurate histologic diagnosis to facilitate management customized to the nuances of specific pathologies. As an initial step, surgical intervention by either stereotactic biopsy or open surgery is necessary to obtain tissue for pathologic examination. Stereotactic biopsy has the benefit of relative ease and minimal morbidity but is associated with greater likelihood of diagnostic inaccuracy compared to open surgery where more extensive tissue sampling is possible. The role of surgical debulking in the management of pineal tumors is clearly defined for some tumors but is less evident for others. Among the one third of pineal tumors that are benign or low grade, complete surgical resection is achievable and constitutes optimal management with excellent long-term recurrence-free survival. The benefits of aggressive surgical resection among malignant tumors are less clear but several studies have correlated degree of tumor removal with improved outcome. Advances in technology, surgical technique, and post-operative care have minimized surgical complications, however all surgical procedures in the pineal region, including both stereotactic biopsy and open surgery, are potentially hazardous. Advanced judgment, experience, and expertise are necessary to achieve rates of success sufficient to justify aggressive management. Management strategies using stereotactic biopsy, endoscopy, and radiosurgery can also provide favorable outcomes in some cases. Selective incorporation of these innovations can be expected to improve the already highly favorable outcome for all pineal region tumors. PMID:15527093

Bruce, Jeffrey N; Ogden, Alfred T

2004-01-01

190

Surgical Mesh  

MedlinePLUS

... July 13, 2011. Information on Surgical Mesh for Hernia Repairs Information on Surgical Mesh for Pelvic Organ ... Stress Urinary Incontinence Information on Surgical Mesh for Hernia Repairs FDA wants to inform you about complications ...

191

The influence of surgical procedure and the effect of chemotherapy on nodal and distant metastases of human malignant melanomas that have been grafted into nude mice.  

PubMed

Malignant melanoma of the oral mucosa is common in Japan. The effects on metastasis of puncturing the tumor before surgery or using chemotherapy after extirpation of the tumor were studied using animal models. G-361 cells were transplanted subcutaneously into mice. In half the animals, the subcutaneous tumor was punctured with an 18G needle twice a week from 2 weeks after transplantation until death. In the other mice, the subcutaneous tumor was extirpated 6 weeks after transplantation; the animals were killed 2 weeks later. Dimethyl triazeno imidazole carboxamide (DTIC) or cisplatin (CDDP) were injected into the peritoneal cavity 3 days before extirpation or during extirpation. Metastases to the axilla lymph node and the lung were examined in both groups. The animals that received puncturing developed lymph node and pulmonary metastasis earlier and more frequently than those without puncturing. 50% of mice that received no anticancer agent, had lymph node and pulmonary metastases after tumor extirpation. Preoperative DTIC or CDDP reduced the frequency of metastasis to 25-35%. DTIC or CDDP administration during extirpation, significantly reduced the metastasis rate to 7-10%. Prognosis for oral melanoma patients may be better when surgery and postoperative chemotherapy are performed simultaneously without preoperative surgical procedures. PMID:19962277

Oguni, A; Umeda, M; Shigeta, T; Takahashi, H; Komori, T

2010-01-01

192

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

Federal Register 2010, 2011, 2012, 2013

...Open Burning Rules; Rule 0100 Open Burning Requirements, Baker, Clatsop, Crook, Curry, Deschutes, Gilliam, Grant, Harney...0170 Open Burning Requirements, Coos, Douglas, Jackson and Josephine Counties; Rule 0180 Open Burning Requirements, Letter...

2013-04-25

193

Electrocautery-Ignited Surgical Field Fire Caused by a High Oxygen Level during Tracheostomy  

PubMed Central

Tracheostomy is a relatively common surgical procedure that is performed easily in an operating room or intensive care unit. Open tracheostomy is needed in patients requiring prolonged ventilation when percutaneous tracheostomy is inappropriate. Sometimes, it is difficult to achieve bleeding control in the peritracheal soft tissue, and in such cases, we usually use diathermy. However, the possibility of an electrocautery-ignited surgical field fire can be overlooked during the procedure. This case report serves as a reminder that the risk of a surgical field fire during tracheostomy is real, particularly in patients requiring high-oxygen therapy. PMID:25346908

Kim, Myung-Su; Lee, Jang-Hoon; Lee, Dong-Hyup; Lee, Young Uk; Jung, Tae-Eun

2014-01-01

194

Comparison of Laparoscopic and Open Surgery for Total Rectal Prolapse  

Microsoft Academic Search

Purpose. Total rectal prolapse is a devastating disorder causing constipation and anal incontinence. We compared open and laparoscopic surgical approaches in a limited series. Methods. The subjects of this study were 23 patients who underwent laparoscopic procedures (LP group) and 17 patients who underwent open procedures (OP group) for rectal prolapse. We assessed the preoperative colonic transit time, postoperative pain

Sezai Demirbas; M. Levhi Akin; Murat Kalemoglu; Ibrahim Ogün; Tuncay Çelenk

2005-01-01

195

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.

1983-08-01

196

Conscious sedation for surgical procedures  

MedlinePLUS

... may be used for are: Breast biopsy Dental prosthetic or reconstructive surgery Minor bone fracture repair Minor ... Your blood pressure will be checked with an arm cuff about every 15 minutes. You should be ...

197

Surgical Procedures for Vestibular Dysfunction  

MedlinePLUS

... the parts of the inner ear that sense gravity and motion changes. The hearing organ (cochlea) is ... from the parts of the ear that sense gravity and motion changes. Cochlear dialysis Cochlear dialysis is ...

198

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

PubMed

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

2012-05-01

199

[Analysis of surgical procedures on the vena saphena magna in the Czech Republic and an effect of Detralex during its stripping].  

PubMed

The aim of this clinical study was to compare the degree of postoperative pain (VAS--10 cm, quality of life questionnaire CIVIQ and patient diary) between two groups of patients: patients treated with Detralex 14 days before and 14 days after the stripping of greater saphenous vein (GSV) and patients not treated with Detralex. In addition, the two groups were also compared for the incidence of symptoms associated with chronic venous insufficiency (CVI) (using the VAS scale: edema, tired and heavy legs, cramps, itching sensation), size of hematoma, use of analgesics and overall efficacy of the treatment. Clinical study included 181 patients from 15 medical centers throughout the Czech Republic. High ligation and partial stripping of greater saphenous vein on one lower extremity was performed in all patients (short stripping from groin to knee). Patients were randomly assigned in two groups: patients treated with Detralex (92) and patients not treated with Detralex (89). Patients in the first group were treated with Detralex for the period of 1 month. Degree of pain and patient's health condition were evaluated by the physician during D-14 (14 days prior to the surgery), D7 and D14 (7 and 14 days after the surgery) visits using the 10-cm visual analog scale VAS. The results indicate that Detralex reduced the intensity of postoperative pain, which resulted in decreased consumption of analgesics. Hematoma was smaller in patients already using Detralex 14 days prior to the scheduled stripping procedure. These patients also showed significant improvement of CVI symptoms and the quality of life of patients with CVI. High quality venoactive drugs administered 14 days prior to the surgery improve postoperative course in patients indicated for surgical treatment of varices. PMID:16218350

Veverková, L; Kalac, J; Jedlicka, V; Wechsler, J

2005-08-01

200

Surgical history.  

PubMed

The importance of surgical history for surgeons and students of this field of knowledge is undeniable. Knowing surgical history makes us aware of findings and discoveries we never knew before. Surgical history helps us in defining how surgery evolved through the centuries and mostly how those observations have shaped surgical thought. In this writing, I introduce my own observations of the field and explain how I grew to learn and appreciate the evolution of surgical history through my own personal experience. And, as important, at least for me, I narrate my observations as to how my education and contributions to the discipline shaped my knowledge of surgical history. PMID:20001807

Toledo-Pereyra, Luis H

2009-01-01

201

Predicting the need for muscle flap salvage after open groin vascular procedures: A clinical assessment tool.  

PubMed

Abstract Groin wound complications after open vascular surgery procedures are common, morbid, and costly. The purpose of this study was to generate a simple, validated, clinically usable risk assessment tool for predicting groin wound morbidity after infra-inguinal vascular surgery. A retrospective review of consecutive patients undergoing groin cutdowns for femoral access between 2005-2011 was performed. Patients necessitating salvage flaps were compared to those who did not, and a stepwise logistic regression was performed and validated using a bootstrap technique. Utilising this analysis, a simplified risk score was developed to predict the risk of developing a wound which would necessitate salvage. A total of 925 patients were included in the study. The salvage flap rate was 11.2% (n = 104). Predictors determined by logistic regression included prior groin surgery (OR = 4.0, p < 0.001), prosthetic graft (OR = 2.7, p < 0.001), coronary artery disease (OR = 1.8, p = 0.019), peripheral arterial disease (OR = 5.0, p < 0.001), and obesity (OR = 1.7, p = 0.039). Based upon the respective logistic coefficients, a simplified scoring system was developed to enable the preoperative risk stratification regarding the likelihood of a significant complication which would require a salvage muscle flap. The c-statistic for the regression demonstrated excellent discrimination at 0.89. This study presents a simple, internally validated risk assessment tool that accurately predicts wound morbidity requiring flap salvage in open groin vascular surgery patients. The preoperatively high-risk patient can be identified and selectively targeted as a candidate for a prophylactic muscle flap. PMID:24666001

Fischer, John P; Nelson, Jonas A; Shang, Eric K; Wink, Jason D; Wingate, Nicholas A; Woo, Edward Y; Jackson, Benjamin M; Kovach, Stephen J; Kanchwala, Suhail

2014-12-01

202

Non-transectional Open Gastric Bypass as the Definitive Bariatric Procedure for 61 Patients with BMI of 70 and Higher  

Microsoft Academic Search

Background  Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and\\u000a then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients\\u000a to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity.\\u000a \\u000a \\u000a \\u000a Methods  Office records of 61 patients with body mass

Gus J. Slotman

2010-01-01

203

Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up  

Microsoft Academic Search

Background  Many surgical procedures have been reported for rotator cuff tears. We adopted the modified transosseous-equivalent procedure,\\u000a also termed “surface-holding repair with transosseous sutures,” and demonstrated that this procedure has a biomechanical advantage\\u000a regarding the concentration of stress on the tendon stump. This study aimed to evaluate the clinical and structural outcomes\\u000a of this technique, which has been demonstrated by postoperative

Hiroshi Yamaguchi; Naoki Suenaga; Naomi Oizumi; Yoshihiro Hosokawa; Fuminori Kanaya

204

Surgical navigation in reconstruction.  

PubMed

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

2013-05-01

205

Multiscale Surgical Telerobots  

SciTech Connect

A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

2002-01-23

206

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. PMID:22949997

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

2012-01-01

207

Surgical or percutaneous hepatic artery cannulation for chemotherapy.  

PubMed

The principle underlying administration of hepatic arterial chemotherapy (HACT) is to increase the local concentration of cytotoxic chemotherapy while limiting systemic toxicity. The chemotherapy agent is infused into the hepatic artery distal to branches that serve the stomach, duodenum, and pancreas. The intra-arterial catheter is connected to a subcutaneously implanted reservoir to allow repeated sessions of chemotherapy. Percutaneous placement is now a reliable and reproducible technique in the hands of well-trained interventional radiologists. Hepatic arterial cannulation by an open surgical approach is currently reserved for cases where the decision for HACT is made in the course of an hepatic surgical procedure. PMID:24582544

De Baere, T; Mariani, P

2014-04-01

208

Modification of tibial slope after medial opening wedge high tibial osteotomy: clinical study and mathematical modelling  

Microsoft Academic Search

A prospective non-randomized non-comparative study involved 30 patients who underwent a medial opening wedge high tibial osteotomy\\u000a for medial knee osteoarthritis using a specific surgical procedure. The tibial slope was calculated pre-operatively and at\\u000a a mean follow-up of 14 months. A mathematical model of the surgical procedure was developed in order to plan the height of\\u000a the medial opening wedge and

Elhadi Sariali; Y. Catonne

2009-01-01

209

Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction.  

PubMed

From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 +/- 3.8 mm, maximally open mouth: 10.4 +/- 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the "sniffing position" is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints. PMID:20526442

Ito, Hiroshi; Kawaai, Hiroyoshi; Yamazaki, Shinya; Suzuki, Yosuke

2010-01-01

210

Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction  

PubMed Central

From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints. PMID:20526442

Ito, Hiroshi; Kawaai, Hiroyoshi; Yamazaki, Shinya; Suzuki, Yosuke

2010-01-01

211

Nonequilibrium cryopreservation of rabbit embryos using a modified (sealed) open pulled straw procedure.  

PubMed

The study was designed to evaluate the efficiency of a modified (sealed) open pulled straw (mOPS) method for cryopreserving rabbit embryos by vitrification or rapid freezing. An additional objective was to determine whether the mOPS method could cause the vitrification of a cryoprotectant solution generally used in rapid freezing procedures. Two consecutive experiments of in vitro and in vivo viability were performed. In Experiment 1, the in vitro viability of rabbit embryos at the morula, compacted morula, early blastocyst and blastocyst stages was assessed after exposure to a mixture of 25% glycerol and 25% ethylene glycol (25GLY:25EG: vitrification solution) or 4.5 M (approximately 25% EG) ethylene glycol and 0.25 M sucrose (25EG:SUC: rapid freezing solution). Embryos were loaded into standard straws or mOPS and plunged directly into liquid nitrogen. The mOPS consisted of standard straws that were heat-pulled, leaving a wide opening for the cotton plug and a narrow one for loading embryos by capillarity. The embryos were aspirated into the mOPS in a column positioned between two columns of cryoprotectant solution separated by air bubbles. The mOPS were then sealed with polyvinyl-alcohol (PVA) sealing powder. The vitrification 25GLY:25EG solution became vitrified both in standard straws and mOPS, whereas the rapid freezing 25EG:SUC solution crystallized in standard straws, but vitrified in mOPS. The total number of embryos cryopreserved was 1695. Embryos cryopreserved after exposure to each solution in mOPS showed higher rates (88.2%) of survival immediately after thawing and removal of the cryoprotectant than those cryopreserved in 0.25 ml standard straws (78.8%; P < 0.0001). After culture, the developmental stage of the cryopreserved embryos significantly affected the rates of development to the expanded blastocyst stage. Regardless of the cryoprotectant used, lower rates of in vitro development were obtained when the embryos were cryopreserved at the morula stage, and higher rates achieved using embryos at blastocyst stages. Based on the results of Experiment 1, the second experiment was performed on blastocysts using the mOPS method. Experiment 2 was designed to evaluate the in vivo viability of cryopreserved rabbit blastocysts loaded into mOPS after exposure to 25GLY:25EG or 25EG:SUC. Embryos cryopreserved in mOPS and 25GLY:25EG solution gave rise to rates of live offspring (51.7%) not significantly different to those achieved using fresh embryos (58.5%). In conclusion, the modified (sealed) OPS method allows vitrification of the cryoprotectant solution at a lower concentration of cryoprotectants than that generally used in vitrification procedures. Rabbit blastocysts cryopreserved using a 25GLY:25EG solution in mOPS showed a similar rate of in vivo development after thawing to that shown by fresh embryos. PMID:12374124

López-Béjar, M; López-Gatius, F

2002-11-01

212

Surgical Management of Hemorrhoids  

PubMed Central

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

Agbo, S. P.

2011-01-01

213

[Endoscopic forehead lifting: surgical anatomy and technique].  

PubMed

Endoscopic forehead lifting is a widely accepted treatment for brow ptosis. The procedure safely and effectively corrects horizontal forehead rhytids, brow ptosis, upper eyelid dermatochalasis and periorbital crow's feet. The result is a refreshed and more open facial expression. A thorough understanding of basic facial anatomy is the key to successful cosmetic surgery. The procedure is based on a subperiostal and preperiosteal mobilisation of the temporal and frontal soft tissues and a detachment of the periosteum of the orbital rim. An upper eyelid blepharoplasty and selective incomplete or complete myotomies of the corrugator and procerus muscles may be incorporated in the operation. Most surgeons prefer to fixate the elevated soft tissue planes to the calvarium by sutures, titanium or resorbabale polyglactid anchors. While initial enthusiasm for this procedure seems to be declining in several countries, few ENT-surgeons are familiar with this technique in Europe. This article reviews the surgical anatomy of the forehead and temporoparietal region by means of cadaver dissection and describes the surgical procedure for German speaking readers. PMID:17294146

Scheithauer, M O; Tasman, A J

2007-03-01

214

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. PMID:16495690

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

2006-01-01

215

Outcome after cholecystectomy for symptomatic gall stone disease and effect of surgical access: laparoscopic v open approach  

Microsoft Academic Search

The pre and postoperative symptoms and outcome after surgery in patients with symptomatic gall stone disease were evaluated by a detailed self administered postal questionnaire. The survey was conducted in two groups: 80 patients treated by laparoscopic cholecystectomy and an age matched cohort of patients who had conventional open cholecystectomy. The overall response rate on which the data were calculated

G C Vander Velpen; S M Shimi; A Cuschieri

1993-01-01

216

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

PubMed

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

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

2013-05-01

217

3D Surgical Simulation  

PubMed Central

This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

2009-01-01

218

Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open restrictive procedures  

Microsoft Academic Search

An estimated 2% of men and 6% of women in the United States are morbidly obese. These patients have a mortality rate that\\u000a is six to twelve times greater than their normal-weight peers. In these extreme cases of overweight, only surgical intervention\\u000a can produce substantial and sustained weight loss. However, up to 20% of these patients will require reoperation for

J. de Csepel; R. Nahouraii; M. Gagner

2001-01-01

219

Open wedge high tibial osteotomy using fractioned drill osteotomy: a surgical modification that lowers the complication rate  

Microsoft Academic Search

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n=89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n=43) a

S. Flierl; D. Sabo; K. Hornig; L. Perlick

1996-01-01

220

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.

2007-03-01

221

[Surgical lung biopsy: Indications and therapeutic implications].  

PubMed

Surgical biopsy of lung parenchyma can be used to establish a diagnosis in interstitial lung disease both of acute and chronic presentation. The present article summarizes the current indications, the therapeutic implications, the different surgical techniques and postoperative complications of the procedure. Common controversies and problems related to surgical lung biopsy are also presented. PMID:22425502

Radu, D M; Macey, J; Bouvry, D; Seguin, A; Valeyre, D; Martinod, E

2012-04-01

222

Surgical sentinel lymph node biopsy in early breast cancer. Could it be avoided by performing a preoperative staging procedure? A pilot study  

PubMed Central

Summary Background The aim of this pilot trial was to study the feasibility of sentinel node percutaneous preoperative gamma probe-guided biopsy as a valid preoperative method of assessment of nodal status compared to surgical sentinel lymph node biopsy. Material/Methods This prospective study enrolled 10 consecutive patients without evidence of axillary lymph node metastases at preoperative imaging. All patients underwent sentinel node occult lesion localization (SNOLL) using radiotracer intradermic injection that detected a “hot spot” corresponding to the sentinel node in all cases. Gamma probe over the skin detection with subsequent ultrasonographically guided needle biopsy of the sentinel node were performed. The percutaneous needle core histopathological diagnosis was compared to the results of the surgical biopsy. Results Preoperative sentinel node identification was successful in all patients. Conclusions The combination of preoperative gamma probe sentinel node detection and ultrasound-guided biopsy could represent a valid alternative to intraoperative sentinel node biopsy in clinically and ultrasonographically negative axillary nodes, resulting in shorter duration of surgery and lower intraoperative risks. PMID:22936189

Testori, Alberto; Meroni, Stefano; Moscovici, Oana Codrina; Magnoni, Paola; Malerba, Paolo; Chiti, Arturo; Rahal, Daoud; Travaglini, Roberto; Cariboni, Umberto; Alloisio, Marco; Orefice, Sergio

2012-01-01

223

A qualitative analysis of health professionals' job descriptions for surgical service delivery in Uganda  

PubMed Central

Background The ever increasing demand for surgical services in sub-Saharan Africa is creating a need to increase the number of health workers able to provide surgical care. This calls for the optimisation of all available human resources to provide universal access to essential and emergency surgical services. One way of optimising already scarce human resources for health is by clarifying job descriptions to guide the scope of practice, measuring rewards/benefits for the health workers providing surgical care, and informing education and training for health professionals. This study set out to determine the scope of the mandate to perform surgical procedures in current job descriptions of surgical care health professionals in Uganda. Methods A document review was conducted of job descriptions for the health professionals responsible for surgical service delivery in the Ugandan Health care system. The job descriptions were extracted and subjected to a qualitative content data analysis approach using a text based RQDA package of the open source R statistical computing software. Results It was observed that there was no explicit mention of assignment of delivery of surgical services to a particular cadre. Instead the bulk of direct patient related care, including surgical attention, was assigned to the lower cadres, in particular the medical officer. Senior cadres were assigned to perform predominantly advisory and managerial roles in the health care system. In addition, a no cost opportunity to task shift surgical service delivery to the senior clinical officers was identified. Conclusions There is a need to specifically assign the mandate to provide surgical care tasks, according to degree of complexity, to adequately trained cadres of health workers. Health professionals’ current job descriptions are not explicit, and therefore do not adequately support proper training, deployment, defined scope of practice, and remuneration for equitable surgical service delivery in Uganda. Such deliberate assignment of mandates will provide a means of increasing surgical service delivery through further optimisation of the available human resources for health.

2014-01-01

224

Surgical management of gastrointestinal stromal tumors: a single center experience  

PubMed Central

Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer. PMID:24729813

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

2014-01-01

225

Accounting for severity in surgical morbidity rates  

Microsoft Academic Search

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

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

2004-01-01

226

Design for wind comfort in The Netherlands: Procedures, criteria and open research issues  

Microsoft Academic Search

A code for the assessment of wind comfort and wind danger in the built environment in the Netherlands is presented. The code is not another legal building requirement, but a helping hand to include wind comfort in a building programme. It regulates technical procedures and some quality control. A decision scheme indicates which building plans need professional assessment by wind

Eddy Willemsen; Jacob A. Wisse

2007-01-01

227

The Surgical Treatment for Atrial Fibrillation: Ablation Technology and Surgical Approaches  

PubMed Central

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

2013-01-01

228

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

PubMed

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

2013-07-01

229

Variation in Surgical Readmissions and Relationship to Quality of Hospital Care  

PubMed Central

Background Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Methods Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. Results There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Conclusion Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals. PMID:24047062

Tsai, Thomas C.; Joynt, Karen E.; Orav, E. John; Gawande, Atul A.; Jha, Ashish K.

2014-01-01

230

Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction  

PubMed Central

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

Thiruchelvam, Nikesh

2014-01-01

231

Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer  

PubMed Central

Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results. PMID:24212633

Karapanos, Konstantinos; Nomikos, Iakovos N.

2011-01-01

232

Open-area seclusion in the long-term treatment of aggressive and disruptive psychotic patients, an introduction to a ward procedure.  

PubMed

The clinical rationale and procedure of "open-area seclusion" as a treatment modality with psychotic patients is presented. This standard procedure was originally introduced as an alternative to arbitrary measures in response to aggressive and disruptive behavior. The seclusion area is locked, but the patient is never locked up alone in any single room. The method of open-area seclusion is composed of four overlapping phases: (1) assisting the patient to the seclusion area, (2) time for a "calming down" process, (3) debriefing, and (4) reintegration. Verbal confrontation is central in enhancing the secluded patient's reality-testing, for reinforcing responsibility for one's own behavior, and for encouraging alternative problem-solving. A step-by-step description of the procedure of open-area seclusion is presented and illustrated by a case history. PMID:7770561

Bjørkly, S

1995-02-01

233

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

PubMed

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

2013-10-01

234

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. PMID:20129303

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

2010-01-01

235

Endoscopy-MR Image Fusion for Image Guided Procedures  

PubMed Central

Minimally invasive endoscope based abdominal procedures provide potential advantages over conventional open surgery such as reduced trauma, shorter hospital stay, and quick recovery. One major limitation of using this technique is the narrow view of the endoscope and the lack of proper 3D context of the surgical site. In this paper, we propose a rapid and accurate method to align intraoperative stereo endoscopic images of the surgical site with preoperative Magnetic Resonance (MR) images. Gridline light pattern is projected on the surgical site to facilitate the registration. The purpose of this surface-based registration is to provide 3D context of the surgical site to the endoscopic view. We have validated the proposed method on a liver phantom and achieved the surface registration error of 0.76 ± 0.11?mm. PMID:24298281

Huang, Xishi; Ren, Jing

2013-01-01

236

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

PubMed

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

2012-01-01

237

Surgical access to separate branches of the cat vestibular nerve  

NASA Technical Reports Server (NTRS)

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

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

1981-01-01

238

Surgical management of adrenocortical tumours.  

PubMed

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

Miller, Barbra S; Doherty, Gerard M

2014-05-01

239

[Surgical management of visceral heterotaxy syndrome].  

PubMed

Surgical management of the heterotaxy syndrome including asplenia or polysplenia is still challenging, because they have not only congenital heart defects but also gastrointestinal abnormalities. In most cases, they are Fontan candidates, however, indications and procedures of surgical strategy toward Fontan operation are quite difficult because of cardiac complications or abdominal manifestations. We mentioned indications, surgical technique, peri- and post-operative managements of asplenia syndrome with our experiences and results. PMID:22868426

Fujimoto, Y; Sakamoto, K

2012-07-01

240

Coralline hydroxyapatite implants for use in the treatment of surgically created subchondral defects in the horse  

E-print Network

as cancellous bone grafts in the surgical management of surgically created subchondral defects in the distal third metacarpal bones of the horse. The implants could be expected to replace cancellous bone grafts for many surgical procedures thus eliminating... as cancellous bone grafts in the surgical management of surgically created subchondral defects in the distal third metacarpal bones of the horse. The implants could be expected to replace cancellous bone grafts for many surgical procedures thus eliminating...

Gillis, John Patrick

2012-06-07

241

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair  

PubMed Central

Background and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy. PMID:23477173

Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, Burak

2012-01-01

242

Surgical video systems.  

PubMed

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

1995-11-01

243

Photodigitizing procedures  

NASA Astrophysics Data System (ADS)

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

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

1984-02-01

244

Surgical Procedure for Reversal of Nipple Piercing  

Microsoft Academic Search

Body piercing of the nipples for adornment with jewelry has increased worldwide. Many patients later regret their decision\\u000a and request reversal along with a desire to maintain their ability to breast feed. The surgeon must remove the epithelial\\u000a tunnel with minimum damage to adjacent ducts. The simple technique described uses the patient’s jewelry post as a guide and\\u000a a common

R. Sadove; M. A. Clayman

2008-01-01

245

Girdlestone resection arthroplasty following failed surgical procedures  

Microsoft Academic Search

We retrospectively reviewed 43 patients who had undergone Girdlestone resection arthroplasty of the hip after failed total hip replacement or failed operations for hip trauma between 1990 and 2002. The indications were peri-prosthetic infection, aseptic loosening, recurrent dislocation and failed internal fixation for femoral neck fractures. Twenty-five patients died with an overall mortality of 58%. Out of 18 survivors, four

H. Sharma; J. De Leeuw; D. I. Rowley

2005-01-01

246

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. PMID:22536529

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

2012-01-01

247

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

...aeration, submerged aeration rates, biomass concentration, concentrations of organic...and outlet HAP concentrations and the biomass concentration are obtained for the open...outlet HAP concentrations; and (3) The biomass concentration in the open biological...

2014-07-01

248

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

PubMed

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

Kuratani, Toru

2014-05-01

249

Providing surgical care in Somalia: A model of task shifting  

PubMed Central

Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves in Somalia, on-site training by expatriate surgeons and anesthesiologists will be re-established. Until then, the best way MSF has found to support surgical care in Somalia is continue to support in a "remote" manner. PMID:21762491

2011-01-01

250

Surgical treatment for liver cancer  

PubMed Central

Primary liver cancer is amongst the commonest tumors worldwide, particularly in parts of the developing world, and is increasing in incidence. Over the past three decades, surgical hepatic resection has evolved from a high risk, resource intensive procedure with limited application, to a safe and commonly performed operation with a range of indications. This article reviews the approach to surgical resection for malignancies such as hepatocellular cancer, metastatic liver deposits and neuroendocrine tumors. Survival data after resection is also reviewed, as well as indications for curative resection. PMID:20180230

Tsim, Nicole C; Frampton, Adam E; Habib, Nagy A; Jiao, Long R

2010-01-01

251

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

PubMed Central

Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ. PMID:23556553

2013-01-01

252

Management of the nasal tip by open rhinoplasty.  

PubMed

Open rhinoplasty has acquired widespread recognition in the surgical community in recent years. For many years, traditional closed rhinoplasty was the only possibility for correction of most deformities of the nose. Although it is not the only alternative to difficult nasal problems, the wide exposure achieved with the open technique, the excellent results obtained in the management of the tip and its use as a training procedure for residents, accounts for the new resurgence of the popularity of the technique. PMID:8842904

Raspall, G; González-Lagunas, J

1996-06-01

253

[Possibilities of surgical therapy of lymphedema].  

PubMed

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

2013-04-01

254

Ambulatory surgical hemorrhoidectomy—A solution to postoperative urinary retention?  

Microsoft Academic Search

PURPOSE: The most frequent complication of surgical hemorrhoidectomy is urinary retention. This study evaluates the incidence of urinary retention in a series of patients undergoing surgical hemorrhoidectomy in an ambulatory setting. METHODS: The records of all patients undergoing anorectal surgical operative procedures during the calendar year 1990 were reviewed, with particular emphasis on urinary retention and other postoperative complications. RESULTS:

Stuart D. Hoff; H. Randolph Bailey; Donald R. Butts; Ernest Max; Kenneth W. Smith; Luis F. Zamora; Gary B. Skakun

1994-01-01

255

Haptics in minimally invasive surgical simulation and training  

Microsoft Academic Search

Haptics is a valuable tool in minimally invasive surgical simulation and training. We discuss important aspects of haptics in MISST, such as haptic rendering and haptic recording and playback. Minimally invasive surgery has revolutionized many surgical procedures over the last few decades. MIS is performed using a small video camera, a video display, and a few customized surgical tools. In

C. Basdogan; S. De; Jung Kim; Manivannan Muniyandi; Hyun Kim; M. A. Srinivasan

2004-01-01

256

Open-heart surgery in Jehovah's Witness patients  

Microsoft Academic Search

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

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

1996-01-01

257

[Surgical treatment of duodenal ulcer].  

PubMed

The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology. PMID:12731191

Lese, M; Naghi, I; Pop, C

2001-01-01

258

Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique  

Microsoft Academic Search

BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS: From 1977 through 1998, a combination of an intra-articular elevation and

G. M. M. J. Kerkhoffs; M. V. Rademakers; M. Altena; R. K. Marti

2009-01-01

259

Surgical smoke evacuation systems.  

PubMed

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

1999-09-01

260

Simulation in Surgical Education  

PubMed Central

The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

de Montbrun, Sandra L.; MacRae, Helen

2012-01-01

261

Surgical innovation as sui generis surgical research.  

PubMed

Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients. PMID:24242289

Lotz, Mianna

2013-12-01

262

Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system - a retrospective analysis from Southern China  

PubMed Central

Background The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method Methods We retrospectively included 843 patients from March 2006 to November 2012, of whom 88 had laparoscopic radical nephrectomy (LRN), 526 had open radical nephrectomy (ORN), 42 had laparoscopic partial nephrectomy (LPN), and 187 had open partial nephrectomy (OPN). A modified Clavien classification system was applied to quantify complications of nephrectomy. Fisher’s exact or chi-square test were used to compare complication rates between laparoscopic and open approaches. Results The overall complication rate was 19.31%, 30.04%, 35.71%, and 36.36% in LRN, ORN, LPN, and OPN, respectively. More Grade II complications (odds ratio?=?2.593, 95% CI 1.172 to 5.737, P?=?0.010) and longer postoperation hospital stay (9.2 days and 7.6 days, P?surgical approach (LRN/ORN) (P?=?0.036), age (P?=?0.044), height (P?=?0.020), systolic pressure (P?=?0.012), fasting blood glucose level (P?=?0.032), and blood loss during operation (P?=?0.011) were significant predictors for grade II complications in radical nephrectomy. LPN had similar complication rates compared with OPN. Conclusions In conclusion, LRN had the advantages of less grade II complications and shorter postoperation hospital stay than ORN. Older age and more blood loss during operation would also contribute to more grade II complications in radical nephrectomy. PMID:25081928

2014-01-01

263

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

2008-02-29

264

Restoring accommodation: surgical technique and preliminary evaluation in rabbits  

NASA Astrophysics Data System (ADS)

Purpose. To evaluate an innovative surgical technique for phaco-ersatz, a cataract surgery designed to restore accommodation. Techniques for very small capsulorhexis as well as the refilling procedure were developed. This study evaluates the feasibility and reproducibility of the surgical technique. Methods. The right eye of 8 NZW rabbits (~ 2 Kg) were operated following the ARVO Statements for the Use of Animals in Ophthalmic and Vision Research. The surgery is begun by making a small peripheral capsulorhexis of about 1 mm using. The lens content is then removed. The lens is then refilled with a novel in situ polymerizable gel and the corneal incision is closed using one 10/0 Nylon interrupted stitch. Results. The capsulorhexis technique was succesfully performed and reproducible in all animals. The average size of the capsulorhexis opening was 1. 2 mm (+/-0.14). Lens material removal and refilling of the capsular bag with an in situ polymerizable material was also performed in each trial study. Conclusion. This surgical technique seemed feasible and reproducible.

Tahi, Hassan; Chapon, Pascal F.; Hamaoui, Marie; Lee, William E.; Holden, Brien; Parel, Jean-Marie A.

1999-06-01

265

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

PubMed

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

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

2014-07-01

266

Fenestration Labioreduction of the Labium Minus: A New Surgical Intervention Concept  

PubMed Central

Objectives. To test applicability of the new surgical concept for labioreduction of the labia minora. Study Design. The observational, prospective, case series study was designed. Subjects. Three consecutive subjects were included. Methods. The application of new surgical intervention was tested. Main Outcome Measures. A primary outcome measured applicability of the fenestration labioplasty and secondary measures was used to evaluate surgical resolution of medical, emotional, and social symptoms; aesthetic outcomes; and potential complications. Results. Symptomatic, asymmetrical, and enlarged labia minora were associated with aesthetic dissatisfaction from deformations of the labia minora. The new operation was applied easily and without complications. The procedure reduced height and length, accomplished symmetries, preserved natural color and contour, and accomplished the labium minus expected appearance. Postoperatively, physical, emotional, social symptoms and signs resolved, pleasing surgical outcomes exceeded subjects' aesthetic expectations. Meaningfully, self-image and self-confidence improved in all subjects. No feelings of regrets were reported. Emotional tensions were reduced, social openness improved, intimate interaction increased, and their body image perception improved following the operation. Conclusion. In this study group, fenestration labioreduction with inferior flap transposition was easy to execute without complications and the method was reproducible; the new operation achieves pleasing aesthetic results and the procedure improves physical, emotional, and social wellbeing. PMID:24693445

Ostrzenski, Adam

2014-01-01

267

Current Surgical Options for the Management of Pediatric Glaucoma  

PubMed Central

Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging. PMID:23738051

Morales, Jose; Al Shahwan, Sami; Al Odhayb, Sami; Al Jadaan, Ibrahim; Edward, Deepak P.

2013-01-01

268

Guide to Surgical Specialists  

MedlinePLUS

... ACS/APDS/ASE Resident Prep Curriculum Medical Student Simulation-Based Surgical Skills Curriculum Educational Programs SESAP SESAP ... ACS/APDS/ASE Resident Prep Curriculum Medical Student Simulation-Based Surgical Skills Curriculum Cancer Education Cancer Education ...

269

Surgical Treatment of Rectal Prolapse  

PubMed Central

Rectal prolapse is defined as a protrusion of the rectum beyond the anus. Although rectal prolapse was recognized as early as 1500 BC, the optimal surgical procedure is still debated. The varied operative procedures available for treating rectal prolapsed can be confusing. The aim of treatment is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. In elderly and high-risk patients, perineal approaches, such as Delorme's operation and Altemeier's operation, have been preferred, although the incidence of recurrence and the rate of persistent incontinence seem to be high when compared with transabdominal procedures. Abdominal operations involve dissection and fixation of the rectum and may include a rectosigmoid resection. From the late twentieth century, the laparoscopic procedure has been applied to the treatment of rectal prolapse. Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy with artificial material, and resection of the sigmoid colon with colorectal anastomosis with or without rectopexy. The choice of surgery depends on the status of the patient and the surgeon's preference. PMID:21431090

2011-01-01

270

Three-piece Inflatable Penile Prosthesis: Surgical Techniques and Pitfalls  

PubMed Central

Penile prosthesis surgery plays a vital role in the treatment of erectile dysfunction (ED). As far as outcome is concerned, it is one of the most rewarding procedures for both patients and surgeons. We describe our surgical technique for implantation of the three-piece inflatable penile prosthesis and point out the major surgical pitfalls accompanying this procedure and their specific management. The psychological outcome of penile prosthesis surgery is also discussed. Different surgical approaches are available when performing the procedure. A number of procedure-related problems can be encountered and a thorough knowledge of these is of paramount importance. Penile prosthesis surgery has a favorable psychological outcome. Surgery for implantation of an inflatable penile prosthesis is a rewarding procedure, with a high yield of patient satisfaction. Urologists should have thorough understanding of the surgical pitfalls peculiar to this procedure and their management. PMID:22413049

Al-Enezi, Ahmad; Al-Khadhari, Sulaiman; Al-Shaiji, Tariq F.

2011-01-01

271

Optimal surgical options for descending necrotizing mediastinitis of the anterior mediastinum.  

PubMed

The mortality rates from descending necrotizing mediastinitis (DNM) are between 25 and 40 % mainly because of delayed diagnosis and inappropriate surgical treatment. This study was undertaken to examine two surgical options for DNM and determine the optimal surgical option for DNM of the anterior mediastinum. Fifteen cases of DNM of the anterior mediastinum, January 2001 and October 2010, were retrospectively reviewed. Eleven were anterosuperior mediastinitis, with infection located above the tracheal bifurcation and four had infections involving the entire anterior mediastinum. Depending on the location of mediastinitis, open drainage of the submandibular and neck abscesses, in addition to other surgical treatments, was performed. If the infection was anterosuperior, transcervical mediastinal drainage or thoracotomy was performed. If the entire anterior mediastinum was involved, necrotic tissue was removed with thoracoscopic via subxiphoid incision, the bilateral pleurae were opened for drainage, and a tunnel connecting the neck incision and the subxiphoid incision through the whole anterior mediastinum was made for drainage. The anterosuperior mediastinitis cases were treated with either transcervical mediastinal drainage (n = 8) or thoracotomy (n = 3). Patients healed after an average of 24.5 and 20.0 days in the hospital, respectively. For the four other cases, one patient died of septic shock, while the other three patients were healed after and an average of 43.3 days in the hospital. Mortality rate was 6.7 %. The surgical procedure used to treat DNM should be selected according to the location of the infection. DNM involving the anterosuperior mediastinum can be treated by transcervical mediastinal drainage. If anterosuperior mediastinitis spreads to the side of the trachea, open thoracotomy is a suitable therapy. If the entire anterior mediastinum is involved, debridement and drainage of the anterior mediastinum should be performed with a thoracoscope via the subxiphoid incision. PMID:24696071

Guan, Xin; Zhang, Wei Jie; Liang, Xi; Liang, Xiang; Wang, Feng; Guo, Xiang; Zhou, Yaodong

2014-09-01

272

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. PMID:7826158

Sugarbaker, P H

1995-01-01

273

Isolated Frontal Sinusitis Treated Using an Anterior-to-Ethmoidal Bulla Surgical Approach.  

PubMed

Traditional frontal sinus surgery is associated with a significant trauma. Herein, we have discussed the feasibility, technique, and efficacy of a minimally invasive anterior-to-ethmoidal bulla surgical approach performed under nasal endoscopy to treat isolated frontal sinusitis. Fifteen patients with isolated frontal sinusitis underwent the anterior-to-ethmoidal bulla surgical procedure under general anesthesia. The opening of the frontal sinus was located by frontal mini-trephination in 1 patient. The effects of the operation were evaluated by regular postoperative follow-up. The average postoperative follow-up period was 12.7 months (range 6-24 months). The postoperative symptom of headache was completely resolved in all 15 patients, and 12 patients had good opening of the frontal sinus and complete epithelization was observed by nasal endoscopy. The frontal sinus of 3 patients was not opened, but these patients did not show subjective symptoms. The anterior-to-ethmoidal bulla surgical approach is ideal for isolated frontal sinusitis. PMID:24894981

Ji, Jun-Feng; Cheng, You; Wang, Tian-You; Wu, Kun-Min; Jiang, Man-Jie; Cheng, Wei; Wang, Zhi-Yi; Xue, Fei; Zhang, Yong; Wang, Qiu-Ping

2014-11-01

274

A computerized bioskills system for surgical skills training in total knee replacement.  

PubMed

Although all agree that the results of total knee replacement (TKR) are primarily determined by surgical skill, there are few satisfactory alternatives to the 'apprenticeship' model of surgical training. A system capable of evaluating errors of instrument alignment in TKR has been developed and demonstrated. This system also makes it possible quantitatively to assess the source of errors in final component position and limb alignment. This study demonstrates the use of a computer-based system to analyse the surgical skills in TKR through detailed quantitative analysis of the technical accuracy of each step of the procedure. Twelve surgeons implanted a posterior-stabilized TKR in 12 fresh cadavers using the same set of surgical instruments. During each procedure, the position and orientation of the femur, tibia, each surgical instrument, and the trial components were measured with an infrared coordinate measurement system. Through analysis of these data, the sources and relative magnitudes of errors in position and alignment of each instrument were determined, as well as its contribution to the final limb alignment, component positioning and ligament balance. Perfect balancing of the flexion and extension gaps was uncommon (0/15). Under standardized loading, the opening of the joint laterally exceeded the opening medially by an average of approximately 4 mm in both extension (4.1 +/- 2.1 mm) and flexion (3.8 +/- 3.4 mm). In addition, the overall separation of the femur and the tibia was greater in flexion than extension by an average of 4.6 mm. The most significant errors occurred in locating the anterior/posterior position of the entry point in the distal femur (SD = 8.4 mm) and the correct rotational alignment of the tibial tray (SD = 13.2 degrees). On a case-by-case basis, the relative contributions of errors in individual instrument alignments to the final limb alignment and soft tissue balancing were identified. The results indicate that discrete steps in the surgical procedure make the largest contributions to the ultimate alignment and laxity of the prosthetic knee. Utilization of this method of analysis and feedback in orthopaedic training is expected rapidly to enhance surgical skills without the risks of patient exposure. PMID:17315769

Conditt, M A; Noble, P C; Thompson, M T; Ismaily, S K; Moy, G J; Mathis, K B

2007-01-01

275

Ethical issues in surgical innovation.  

PubMed

Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients. PMID:24728580

Miller, Megan E; Siegler, Mark; Angelos, Peter

2014-07-01

276

[Surgical treatment of pulmonary echinococcosis].  

PubMed

The experience of surgical treatment of the pulmonary echinococcosis (PE) at 515 patients is generalized. Character of operative intervention at PE depends on cyst's localization and presence of complications. The method of echinococcectomy with the cappitonnage of fibrous capsule, which is the most effective method of PE surgical treatment, is expounded. The methods of fibrous capsule anti-parasitogenic treatment are described: chemical (10% solution of sodium chloride, chlorhexidinum, betalin), physical (laser radiation, stream of hot air), being most effective, simple and accessible. The methods of videothoracoscopic (VTO) and video-assisted echinococcectomy (VAE), at which application permits the rehabilitation period of patients diminishes considerably, are expounded. The amount of postoperative complications at VTO and VAE made 16.7%, at open echinococcectomy--2.7%. Lethality was 0.2% (one patient died). PMID:19048820

Shipulin, P P; Ba?dan, V I; Chetverikov, S G; Martyniuk, V A; Ba?dan, V V; Koziar, O N

2008-07-01

277

Surgical treatment and prognosis of gastric cancer in 2 613 patients  

Microsoft Academic Search

AIM: To analyze the factors influencing the prognosis of patients with gastric cancer after surgical treatment, in order to optimize the surgical procedures. METHODS: A retrospective study of 2 613 consecutive patients with gastric cancer was performed. Of these patients, 2 301 (88.1%) received operations; 196 explorative laparotomy (EL), 130 by-pass procedure (BPP), and 1 975 surgical resection of the

Xiang-Fu Zhang; Chang-Ming Huang; Hui-Shan Lu; Xing-Yuan Wu; Chuang Wang; Guo-Xian Guang; Jian-Zhong Zhang; Chao-Hui Zheng

278

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

PubMed

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

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

2011-01-01

279

Surgical management of inguinal hernia.  

PubMed

The Lichtenstein repair is now the gold standard for open hernia repairs. This repair is easier to learn and easy to implement for the average general surgeon. Open mesh repairs are not the end-all in hernia operations, however, and surgeons must retain the knowledge for open tissue-based procedures. Laparoscopic inguinal hernia repair is a safe alternative to open repair for inguinal hernias but is much more operator dependent. Open mesh repair has a lower recurrence rate when compared with TEP or TAPP repairs for less experienced laparoscopists. Laparoscopic repair has a quicker return to work, is associated with less postoperative pain, and has a better cosmetic result. It is more difficult to learn, however, and hospital costs are higher. Surgeons need to look at their own numbers and experience to decide which approach is better given the clinical situation based on their proficiency with the various techniques. PMID:17163110

Reuben, Brian; Neumayer, Leigh

2006-01-01

280

Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital  

PubMed Central

Background: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital. Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times. Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%), and none were directly related to the robotic system. Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot. PMID:21845067

Sait, Khalid H

2011-01-01

281

Jannin P, Raimbault M, Morandi X, Riffaud L and Gibaud B. Models of Surgical Procedures for Multimodal Image-Guided Neurosurgery, Journal of Computer Aided Surgery, 2003;8(2):98-106  

E-print Network

for Multimodal Image-Guided Neurosurgery, Journal of Computer Aided Surgery, 2003;8(2):98-106 Models of Surgical.M.,L.R.) Abstract Objective: Improvement of the planning stage in image-guided surgery requires a better manuscript, published in "Computer Aided Surgery 8, 2 (2003) 98-106" #12;Jannin P, Raimbault M, Morandi X

Boyer, Edmond

282

Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial  

PubMed Central

Introduction Among surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents. Methods and analysis This study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (?18?years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18?years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30?days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test. Ethics and dissemination This will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected to be available in 2016/2017 and will be disseminated using an integrated and end-of-grant knowledge translation strategy. Trial registration number ClinicalTrials.gov identifier NCT01836237. PMID:25146716

Bressan, Alexsander K; Roberts, Derek J; Edwards, Janet P; Bhatti, Sana U; Dixon, Elijah; Sutherland, Francis R; Bathe, Oliver; Ball, Chad G

2014-01-01

283

Alveolar Antral Artery: Review of Surgical Techniques Involving this Anatomic Structure  

PubMed Central

Introduction: The horizontal bony canal in the lateral maxillary wall is the site of anastomosis between the arterial branches from the posterior superior alveolar artery (PSAa) and the infraorbital artery. This anatomic structure is known as the ‘alveolar antral artery’. Materials and Methods: We performed a literature review. The anatomic location of the alveolar antral artery in the lateral maxillary sinus wall was researched and its importance in surgical procedures routinely performed on this bony wall discussed. Results: This artery can be accidentally involved during surgical procedures on the lateral maxillary sinus wall, such as open sinus lift surgery, horizontal osteotomy of the maxilla, Le Fort I fracture treatment, and Caldwell-Luc surgeries. Conclusion: The alveolar antral artery is an important anatomic structure in the lateral maxillary sinus wall. A preoperative cone beam computed tomography (CBCT) scan can be used as a good diagnostic procedure to reduce surgical complications in suspected cases as well as conditions that may involve this artery. PMID:24744995

Rahpeyma, Amin; Khajehahmadi, Saeedeh

2014-01-01

284

Unusual presentation of caustic ingestion and its surgical treatment: a case report.  

PubMed

Treatment and reconstruction of oral scar contracture, is always a challenging procedure to restore structure and functions of the oral cavity. We present a case of a patient with limited mouth opening who sustained extensive oral scar contracture with complete adhesion of tongue to floor of mouth following ingestion of caustic soda without his knowledge 4 years back. We performed a surgical release of the scar contractures from buccal mucosa on both sides, along with a release of the tongue from the floor of the mouth, followed by reconstruction of all sites using split skin grafts. Adequate mouth opening and tongue movement was achieved. There was a follow up period of 1 month with excellent mouth opening and tongue function. PMID:22379326

Gupta, Sunil Kumar; Rana, A S; Gupta, Deepak; Jain, Gaurav; Kalra, Puneet

2011-03-01

285

Surgical Management for Peyronie's Disease  

PubMed Central

Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations. PMID:23658860

Segal, Robert L.

2013-01-01

286

Pleural lipoma: a non-surgical lesion?  

PubMed Central

Pleural lipomas are benign tumours that develop at the expense of adipose tissues, and they never evolve towards liposarcoma. Located usually at the mediastinal, bronchial and pulmonary levels, a pleural situation is extremely rare. Chest X-rays usually detect them and computed tomography scans confirm the diagnosis. As complications occur, a wait-and-see policy is common. We report our pleural lipoma surgical exeresis experience since 1999. We have operated on five cases of pleural lipomas among nearly 1800 cases of thoracic exeresis: three male and two female patients, without obesity (in all cases, body mass index (BMI) < 28). The mean age was 54.6 years (range 35–72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas. PMID:22371386

Jayle, Christophe; Hajj-Chahine, Jamil; Allain, Geraldine; Milin, Serge; Soubiron, Laurent; Corbi, Pierre

2012-01-01

287

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

Microsoft Academic Search

Postoperative vasoplegic syndrome (PVS) is a frequent complication and can affect the early postoperative course. Our study investigated the incidence and risk factors of PVS after on-pump isolated coronary artery grafting bypass (CABG) and on-pump open-heart surgery.A total of 629 patients underwent on-pump cardiac surgery from November 21, 2005, to June 9, 2006, at our institution. Of those, 334 patients

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

2011-01-01

288

Surgical castration of subadult giraffe (Giraffa camelopardalis).  

PubMed

Surgical castration of giraffe (Giraffa camelopardalis) has not been commonly performed. Large domestic animal castration has a significant complication rate that includes postoperative mortality. Documentation of castration techniques and complications in large domestic animals occurs regularly. However, literature describing castration experiences with large zoo mammals is sparse. In addition, a suitable anesthetic regimen for surgical castration of giraffe has not been confirmed. Open castration using an emasculator plus ligation was performed in three subadult giraffe weighing 555-711 kg. Scrotal incisions were left open and healed in about 6 wk. One animal developed scrotal dermatitis. No other complications occurred. As slow scrotal healing can increase the risk of ascending infection, partial or complete scrotal closure for giraffe may warrant consideration. Experiences with these animals also suggest that closed or modified closed castration may be considered for giraffe of this size. Thiafentanil, medetomidine, and ketamine plus local lidocaine provided suitable anesthesia for surgical castration. PMID:20063827

Borkowski, Rose; Citino, Scott; Bush, Mitch; Wollenman, Paul; Irvine, Brenda

2009-12-01

289

[Acute paraproctitis: choice of surgical treatment].  

PubMed

Experience in surgical treatment of more than 16 thousand patients with acute paraproctitis is discussed. In most cases the distal part of the main purulent passage comes out of the cavity of the abscess into the rectal lumen inside the sphincter. This makes possible in most cases simultaneous elimination of the inner opening of the paraproctitis in the anal canal. PMID:7723254

Alf, I M; An, V K; NIkolina, E M; Studenkova, A V; Polukarov, V A; Chakhvashvili, R I

1994-10-01

290

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

2001-01-01

291

Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes  

PubMed Central

Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies. PMID:22111022

Renato, Seracchioli; Mohamed, Mabrouk; Serena, Solfrini; Giulia, Montanari; Giulia, Ferrini; Giulia, Giovanardi; Diego, Raimondo; Riccardo, Schiavina

2011-01-01

292

Surgical management of severe rigid tuberculous kyphosis of dorsolumbar spine  

Microsoft Academic Search

To assess the effectiveness of deformity correction and safety of the two major corrective spinal surgical procedures, 35\\u000a patients, aged 14–47 years, were placed into two groups according to procedures performed. Sixteen patients (group A) had\\u000a four-stage procedures including initial halo-pelvic distraction after anterior release and a subsequent three procedural steps\\u000a plus brace. Nineteen patients (group B) had one-set two-stage procedures:

Myung-Sang Moon; Sung-Soo Kim; Bong-Jin Lee; Jeong-Lim Moon; Young-Wan Moon

2011-01-01

293

Surgical approaches to the treatment of obesity  

Microsoft Academic Search

Bariatric surgery, through its efficacy and improved safety, is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Established procedures, such as Roux-en-Y gastric bypass and adjustable gastric banding, account for more than 80% of bariatric surgical procedures globally. Sleeve gastrectomy has emerged as a stand-alone

Nora E. Straznicky; Elisabeth A. Lambert; Markus P. Schlaich; Gavin W. Lambert; John B. Dixon

2011-01-01

294

Multimodal augmented reality system for surgical microscopy  

NASA Astrophysics Data System (ADS)

Image-guided, computer-assisted neurosurgery has emerged to improve localization and targeting, to provide a better anatomic definition of the surgical field, and to decrease invasiveness. Usually, in image-guided surgery, a computer displays the surgical field in a CT/MR environment, using axial, coronal or sagittal views, or even a 3D representation of the patient. Such a system forces the surgeon to look away from the surgical scene to the computer screen. Moreover, this kind of information, being pre-operative imaging, can not be modified during the operation, so it remains valid for guidance in the first stage of the surgical procedure, and mainly for rigid structures like bones. In order to solve the two constraints mentioned before, we are developing an ultrasoundguided surgical microscope. Such a system takes the advantage that surgical microscopy and ultrasound systems are already used in neurosurgery, so it does not add more complexity to the surgical procedure. We have integrated an optical tracking device in the microscope and an augmented reality overlay system with which we avoid the need to look away from the scene, providing correctly aligned surgical images with sub-millimeter accuracy. In addition to the standard CT and 3D views, we are able to track an ultrasound probe, and using a previous calibration and registration of the imaging, the image obtained is correctly projected to the overlay system, so the surgeon can always localize the target and verify the effects of the intervention. Several tests of the system have been already performed to evaluate the accuracy, and clinical experiments are currently in progress in order to validate the clinical usefulness of the system.

Garcia Giraldez, Jaime; Talib, Haydar; Caversaccio, Marco; Gonzalez Ballester, Miguel A.

2006-03-01

295

Surgical smoke and ultrafine particles  

PubMed Central

Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine (<100 nm) and accumulation mode particles (< 1 ?m). Epidemiological and toxicological studies have shown that exposure to particulate air pollution is associated with adverse cardiovascular and respiratory health effects. Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc.) was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3) of particles in the diameter range of 10 nm to 1 ?m. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure. PMID:19055750

Bruske-Hohlfeld, Irene; Preissler, Gerhard; Jauch, Karl-Walter; Pitz, Mike; Nowak, Dennis; Peters, Annette; Wichmann, H-Erich

2008-01-01

296

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

NASA Astrophysics Data System (ADS)

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

Meinel, G.

2011-08-01

297

Therapeutic procedures for submucosal tumors in the gastrointestinal tract  

PubMed Central

This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However, benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor, imatinib. PMID:17659670

Ponsaing, Laura Graves; Hansen, Mark Berner

2007-01-01

298

Debridement of vaginal radiation ulcers using the surgical Ultrasonic Aspirator  

SciTech Connect

The surgical Ultrasonic Aspirator (USA) is a fairly new surgical instrument used for an increasingly wide range of procedures. This paper introduces a new application: debridement of vulvovaginal necrotic ulcers resulting from intracavitary radiation therapy. The ultrasonic aspirator allowed removal of the soft, necrotic tissue while preserving underlying healthy, firm tissue and blood vessels.

Vanderburgh, E.; Nahhas, W.A. (Wright State Univ. School of Medicine, Dayton, OH (USA))

1990-10-01

299

Interventional and surgical modalities of treatment for pulmonary arterial hypertension  

Microsoft Academic Search

Beyond medical therapy, different interventional and surgical approaches exist for treatment of pulmonary arterial hypertension (PAH). Atrial septostomy has been applied in patients with lack of response to medical therapy in the absence of other surgical treatment options. With growing experience, procedure-related death rates have been reduced to 5.4%, and the most suitable patient group has been identified among patients

Walter Klepetko; Eckhard Mayer; Julio Sandoval; Elbert P Trulock; Jean-Luc Vachiery; Phillippe Dartevelle; Joanna Pepke-Zaba; Stuart W Jamieson; Irene Lang; Paul Corris

2004-01-01

300

Predicting Surgical Site Infections in Real-Time Akpene Gbegnon  

E-print Network

temperature, larger estimated blood loss (EBL), longer procedure duration, larger transfusion volume, specificPredicting Surgical Site Infections in Real-Time Akpene Gbegnon University of Iowa Hospitals City, IA 52242 1-319-384-7359 john-cromwell@uiowa.edu ABSTRACT Surgical site infections (SSIs

Street, Nick

301

Simulation in surgical training: educational issues and practical implications  

Microsoft Academic Search

Background Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational

Roger Kneebone

2003-01-01

302

Abdominal Aortic Aneurysms in "High-Risk" Surgical Patients  

PubMed Central

Objective To evaluate the early results of endovascular grafting for high-risk surgical candidates in the treatment of abdominal aortic aneurysms (AAA). Summary Background Data Since the approval of endoluminal grafts for treatment of AAA, endovascular repair of AAA (EVAR) has expanded to include patients originally considered too ill for open AAA repair. However, some concern has been expressed regarding technical failure and the durability of endovascular grafts. Methods The University of Alabama at Birmingham (UAB) Computerized Vascular Registry identified all patients who underwent abdominal aneurysm repair between January 1, 2000, and June 12, 2002. Patients were stratified by type of repair (open AAA vs. EVAR) and were classified as low risk or high risk. Patients with at least one of the following classifications were classified as high risk: age more than 80 years, chronic renal failure (creatinine > 2.0), compromised cardiac function (diminished ventricular function or severe coronary artery disease), poor pulmonary function, reoperative aortic procedure, a “hostile” abdomen, or an emergency operation. Death, systemic complications, and length of stay were tabulated for each group. Results During this 28-month period, 404 patients underwent AAA repair at UAB. Eighteen patients (4.5%) died within 30 days of their repair or during the same hospitalization. Two hundred seventeen patients (53%) were classified as high risk. Two hundred fifty-nine patients (64%) underwent EVAR repair, and 130 (50%) of these were considered high-risk patients (including four emergency procedures). One hundred forty-five patients (36%) underwent open AAA repair, including 15 emergency operations. All deaths occurred in the high-risk group: 12 (8.3%) died after open AAA repair and 6 (2.3%) died after EVAR repair. Postoperative length of stay was shorter for EVAR repair compared to open AAA. Conclusions High-risk and low-risk patients can undergo EVAR repair with a lower rate of short-term systemic complications and a shorter length of stay compared to open AAA. Despite concern regarding the durability of EVAR, high-risk patients should be evaluated for EVAR repair before committing to open AAA repair. PMID:12724628

Jordan, William D.; Alcocer, Francisco; Wirthlin, Douglas J.; Westfall, Andrew O.; Whitley, David

2003-01-01

303

A virtual reality model of the clivus and surgical simulation via transoral or transnasal route  

PubMed Central

Background: Neurosurgery in areas with restricted space and complicated anatomy can be greatly aided by the virtual reality (VR) technique. The clivus represents one of such challenging surgical areas, but its VR has not been established. The present study aimed to document a VR model of clival anatomy that may be useful in clival surgery. Methods: High resolution CT angiography and MRI were used. The study included a total of 20 patients who did not have any obvious abnormalities detected in the oral, nasal, and clival areas. The images were fused with a Dextroscope. Results: In the VR model, the key structures such as the clival bone, basilar artery, brainstem, pituitary gland, and paranasal sinuses were clearly observed. The morphology of the clivus and its spatial relationships with the neighboring structures were also illustrated. Visualization of the clival model can be made flexible from various planes, angles, or orientations. In addition, surgical access to the clivus via the transoral route or transnasal route was simulated in detail. Conclusion: The simulation of the VR model offers a straightforward, three-dimensional, interactive understanding of the size and shape of the clivus, and its relationships with the surrounding blood vessels and bones. It also demonstrates simulated operational procedures such as opening the surgical window, measuring the exposure distance and angles, and determining the critical boundaries in relation to key structures such as the brainstem and arteries. Digitalized VR modeling appears to be helpful for understanding the anatomy of the clivus and its surgical approaches. PMID:25419358

Wang, Shou-Sen; Li, Jun-Feng; Zhang, Shang-Ming; Jing, Jun-Jie; Xue, Liang

2014-01-01

304

Concept of the aortic aneurysm repair-related surgical stress: a review of the literature  

PubMed Central

Objective: Abdominal aorta aneurysm (AAA) is a serious threat for human life. AAA repair is a high-risk procedure which results in a severe surgical stress response. We aim to give a conceptual description of the underlying pathophysiology of stress after surgical repair of AAA. Methods: The MEDLINE/PubMed database was searched for publications with the medical subject heading “surgical stress” and keywords “abdominal aortic aneurysms (AAA)”, or “cytokines” or “hormones” or “open repair (OR)” or “endovascular repair (EVAR)”. We restricted our search to English till 2012 and only in cases of abdominal and thoracoabdominal aneurysms (TAAA). Results: We identified 93 articles that were available in English as abstracts or/and full-text articles that were deemed appropriate for our review. Conclusions: Literature highlights no statistical significance for early acute TNF-? production in EVAR and no TNF-? production in OR. IL-6 and IL-8 levels are higher after OR especially when compared with those of EVAR. IL-10 peak was observed during ischemic phase in aneurysm surgical repair. Cortisol and epinephrine levels are higher in OR patients in comparison to EVAR patients. Finally, the incidence of systemic inflammatory response syndrome was significantly higher in OR than EVAR patients. PMID:25356092

Moris, Demetrios N; Kontos, Michalis I; Mantonakis, Eleftherios I; Athanasiou, Antonios K; Spartalis, Eleftherios D; Bakoyiannis, Chris N; Chrousos, George P; Georgopoulos, Sotirios E

2014-01-01

305

Collagen-Glycosaminoglycan Matrix Implantation Promotes Angiogenesis following Surgical Brain Trauma  

PubMed Central

Surgical brain injury (SBI) is unavoidable during many neurosurgical procedures intrinsically linked to postoperative neurological deficits. We have previously demonstrated that implantation of collagen glycosaminoglycan (CG) following surgical brain injury could significantly promote functional recovery and neurogenesis. In this study we further hypothesized that this scaffold may provide a microenvironment by promoting angiogenesis to favor neurogenesis and subsequent functional recovery. Using the rodent model of surgical brain injury as we previously established, we divided Sprague-Dawley male rats (weighting 300–350?g) into three groups: (1) sham (2) surgical injury with a lesion (L), and (3) L with CG matrix implantation (L + CG). Our results demonstrated that L + CG group showed a statistically significant increase in the density of vascular endothelial cells and blood vessels over time. In addition, tissue concentrations of angiogenic growth factors (such as VEGF, FGF2, and PDGF) significantly increased in L + CG group. These results suggest that implantation of a CG scaffold can promote vascularization accompanied by neurogenesis. This opens prospects for use of CG scaffolds in conditions such as brain injury including trauma and ischemia. PMID:25309917

Hsu, Wei-Cherng; Hsiao, Jong-Kai; Chen, Gunng-Shinng; Wang, Jia-Yi

2014-01-01

306

Solutions to Surgical Suite Temperature and Humidity Control  

E-print Network

The demand for lower air temperatures inside the operating room (OR) has placed unrealistic expectations upon existing cued water systems in hospitals. Lower temperatures are required to keep the surgical staff comfortable during extended procedures...

Crooks, K. W.

1996-01-01

307

Surgical treatment of cerebellar metastases  

PubMed Central

Background: Cerebral metastases are a common neurosurgical finding. Surgery confers several advantages to other therapies, including immediate symptomatic improvement, diagnosis, and relief from corticosteroid dependence. Here we evaluate patients with cerebellar metastases who underwent surgery and compare their findings to those in the literature, and address the benefit of avoiding ventriculo-peritoneal shunting in patients undergoing surgery. Methods: We performed a retrospective analysis involving 50 patients with cerebellar metastases who underwent surgical resection. Ventriculo-peritoneal shunts were placed in patients necessitating permanent CSF drainage. We evaluated presentation, diagnosis, complications, and outcome. Results: Our review included 21 males and 29 females, 29 to 82 years of age. Primary tumors included lung (48%), breast (14%), GI (14%), endometrial/ovarian (6%), melanoma (6%), sarcoma (4%), lymphoma (4%), laryngeal (2%), and other (2%). Clinical symptoms at presentation commonly were those secondary to elevated intracranial pressure and were the initial complaint in 34% of patients. Preoperatively, 29 patients were noted to have hydrocephalus. Importantly, 76% of these patients were able to avoid placement of a ventriculo-peritoneal shunt following surgery. Only two complications were noted in our series of 50 patients, including a symptomatic pseudomeningocele and a wound infection. No symptomatic postoperative hematoma developed in any surgical case. Conclusion: A review of the literature has shown a high complication rate in patients undergoing surgical resection of cerebellar metastases. We have shown that surgical resection of cerebellar metastases is a safe procedure and is effective in the treatment of hydrocephalus in the majority of patients harboring cerebellar lesions. PMID:22140644

Ghods, Ali J.; Munoz, Lorenzo; Byrne, Richard

2011-01-01

308

CULTIVATING NETWORKS: IMPLEMENTING SURGICAL  

E-print Network

i CULTIVATING NETWORKS: IMPLEMENTING SURGICAL TELEMEDICINE Margunn Aanestad THE INTERVENTIONAL OF MATHEMATICS AND NATURAL SCIENCES, UNIVERSITY OF OSLO #12;ii CULTIVATING NETWORKS: IMPLEMENTING SURGICAL.2.1 Technology as an actor? 14 3.2.2 Information infrastructures 15 3.2.3 Cultivating, not designing information

Sahay, Sundeep

309

Robotic Surgical Training in an Academic Institution  

PubMed Central

Objective To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background Data Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Methods Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Results Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Conclusion Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely. PMID:11573041

Chitwood, W. Randolph; Nifong, L. Wiley; Chapman, William H. H.; Felger, Jason E.; Bailey, B. Marcus; Ballint, Tara; Mendleson, Kim G.; Kim, Victor B.; Young, James A.; Albrecht, Robert A.

2001-01-01

310

Surgical Management of Urolithiasis in Patients after Urinary Diversion  

PubMed Central

Objective To present our experience in surgical management of urolithiasis in patients after urinary diversion. Patients and Methods Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed. Results The mean stone size was 4.5±3.1 (range 1.5–11.2) cm. The mean operation time was 82.0±11.5 (range 55–120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5°C, and one patient (5%) suffered urine extravasations from percutaneous tract. Conclusions The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience. PMID:25360621

Zhong, Wen; Yang, Bicheng; He, Fang; Wang, Liang; Swami, Sunil; Zeng, Guohua

2014-01-01

311

Surgical ablation for atrial fibrillation.  

PubMed

This paper reviews the history of surgical procedures developed for eradication of atrial fibrillation (AF) during cardiac surgery for structural heart disease, and in patients with AF without other indication for cardiac surgery. Current evidence indicates that, despite their proven efficacy, the Cox-Maze procedure and its modifications require cardiopulmonary bypass and cannot be easily justified in the case of AF without other indication for cardiac surgery. In patients undergoing cardiac surgery for mitral valve disease, concomitant ablation techniques using modifications of the Maze and alternative energy sources appear to be safe and effective in treating AF, especially in non-rheumatic disease. Minimally invasive epicardial ablation has been recently developed and can be performed on a beating heart through small access incision ports. Various techniques combining pulmonary vein isolation, ganglionated plexi ablation, and left atrial lines have been tried. Initial results are promising but further clinical experience is required to establish ideal lesion sets, appropriate energy sources, and the benefit-risk ratio of such an approach in patients without other indication for cardiac surgery. The role of surgical ablation in the current management of AF is under investigation. PMID:22490369

Fragakis, Nikolaos; Pantos, Ioannis; Younis, Jenan; Hadjipavlou, Marios; Katritsis, Demosthenes G

2012-11-01

312

Outcomes using titanium elastic nails for open and closed pediatric tibia fractures.  

PubMed

The authors conducted a retrospective review at their level I trauma center to assess the outcomes of closed vs open pediatric tibial fractures treated with titanium elastic nails. The study group included 38 pediatric patients (median age, 12 years) treated with titanium elastic nails for tibial fractures during a 5-year period. Patient demographics, closed or open injury, Gustilo-Anderson type for open fractures, fracture location, skeletal maturity, time to union, hospital length of stay, number of procedures performed per patient, and complications were recorded. The main outcome measures were time to union and complications. Average follow-up duration was 13 months. Mean time to union was 4 months for closed and 9 months for open fractures (P<.001). Average time to union for type IIIA and IIIB fractures was significantly increased (11 and 12 months, respectively; P=.02). Delayed union (>6 months postoperatively) occurred in 1 (6%) of 17 closed fractures compared with 11 (52%) of 21 open fractures. The average number of surgical procedures for closed fractures was fewer than for open fractures (2 vs 3 procedures, respectively; P=.03). Mean hospital length of stay was shorter for closed than open fractures (3 vs 6 days, respectively; P=.03). Two infections occurred in the open fracture group. Closed and open pediatric tibial shaft fractures can be successfully treated with titanium elastic nails. Open fractures treated with titanium elastic nails have a significantly longer time to union, require additional operative procedures, and result in longer hospital stays. PMID:24992056

Economedes, Demetri M; Abzug, Joshua M; Paryavi, Ebrahim; Herman, Martin J

2014-07-01

313

New surgical modification of fascial closure following endovascular aortic pathology repair  

PubMed Central

Introduction There are clear benefits of percutaneous versus open femoral access for endovascular aortic pathology repair. All closing devices commercially available are expensive. Surgical closure of the femoral artery risks potential prolonged wound healing and as a consequence longer hospital stay. Fascial closure is a technique that remains an interesting option. Aim To evaluate the efficacy of the surgical modification of hemostasis control after endovascular repair of aortic pathology. Material and methods One hundred sixteen common femoral arteries in a group of 58 patients underwent a minimally invasive procedure. Patients suffering from abdominal, thoracic aorta aneurysms, acute thoracic aorta type B dissections and traumatic aortic injury were treated. Results A 1-year period of experience in fascial closure of 116 common femoral arteries was presented in the group of 58 patients undergoing endovascular interventions. Five intraoperative complications were observed and one late. Three primary failures were due to hemorrhage in three arteries, one required open repair and two additional compression after the procedure. Two cases of limb ischemia required surgical correction of artery closure. One limb ischemia was detected 4 weeks later, and was treated conservatively. At 1 year, 92 fascial closures (80%) were in the follow-up and 24 (20%) were lost to follow-up. Conclusions This new modification of fascial closure is a safe and cheap method of arterial closure following endovascular repair of selected aortic pathologies. The usage of two suture lines makes this procedure easy and quick. Fascial closure technique is comparable to other techniques in terms of success and complication rates. PMID:24729815

Maciag, Rafal; Maruszynski, Marek

2013-01-01

314

Complex Common and Internal Iliac or Aortoiliac Aneurysms and Current Approach: Individualised Open-Endovascular or Combined Procedures  

PubMed Central

Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates. PMID:25328706

Kotsis, Thomas; Louizos, Louizos Alexander; Theodoraki, Kassiani

2014-01-01

315

First branchial cleft anomalies: presentation, variability and safe surgical management.  

PubMed

First branchial cleft (FBC) anomalies are uncommon. The aim of this retrospective clinical study is to describe our experience in dealing with these sporadically reported lesions. Eighteen cases presenting with various FBC anomalies managed surgically during an 8-year period at a tertiary referral medical institution were included. Ten were males (56 %) and eight females (44 %) with age range 3-18 years. Anomaly was right-sided in 12 cases (67 %). None were bilateral. Nine patients (50 %) had prior abscess incision and drainage procedures ranging from 1 to 9 times. Two also had previous unsuccessful surgical excisions. Clinical presentations included discharging tract openings in external auditory canal/conchal bowl (n = 9), periauricular (n = 6), or upper neck (n = 4); cystic postauricular, parotid or upper neck swellings (n = 5); and eczematous scars (n = 9). Three distinct anatomical types were encountered: sinuses (n = 7), fistulas (n = 6), and cysts (n = 5). Complete surgical excision required superficial parotidectomy in 11 patients (61 %). Anomaly was deep to facial nerve (FN) in three cases (17 %), in-between its branches in two (11 %) and superficial (but sometimes adherent to the nerve) in remaining cases (72 %). Continuous intraoperative electrophysiological FN monitoring was used in all cases. Two cases had postoperative temporary lower FN paresis that recovered within 2 months. No further anomaly manifestation was observed after 49.8 months' mean postoperative follow-up (range 10-107 months). This study has shown that awareness of different presentations and readiness to identify and protect FN during surgery is essential for successful management of FBC anomalies. Intraoperative electrophysiological FN monitoring can help in that respect. PMID:23192665

Magdy, Emad A; Ashram, Yasmine A

2013-05-01

316

Perioperative and postoperative outcomes of perforated diverticulitis Hinchey II and III: Open Hartmann's procedure vs. laparoscopic lavage and drainage in the elderly.  

PubMed

Hartmann's procedure (HP) is the most performed technique for acute diverticulitis. Laparoscopic lavage and drainage (LLD) is an option evaluated as definitive treatment for diverticulitis Hinchey grade II-III. Aim of the study is to analyze and compare LLD vs HP outcomes. From January 1st 2009 and December 31st 2012 we prospectively enrolled 30 patients with diagnosis of acute diverticulitis Hinchey grade II-III. Fourteen patients underwent to LLD (LLD group, LLDG) and 16 patients to HP (Hartmann group, HG). We evaluated: demographic variables, comorbidities, admission clinical status, radiological imaging, intraoperative outcomes (operative time), postoperative outcomes (admission to ICU, timing of drainage removal, restore of bowel functions, timing of oral solid intake), mortality rate (perioperative and after 12 months) and morbidity rate (surgical, infectious, cardiovascular, renal and systemic complications). Exclusion criteria were: other diseases, colon cancer's suspect or diagnosis, conversion to HP. Patients' mean age was 64.8 years in HG and 62.6 in LLDG. M:F ratio was 6:10 in HG, 8:6 in LLDG. Data showed improved outcomes in LLDG for: total operative time (p < 0.0001), admission to ICU (p 0.0447), restoration of bowel functions (p 0.0035 for gases, p 0.0152 for feces), mobilization (p 0.0087) and length of hospital stay (p 0.0132). According to literature, LLD is related to operative risk, morbidity and mortality rate and length of stay lower than HP. LLD also gives the possibility to avoid stoma. Despite limits of our study, we consider LLD as a "safe and effective" treatment for Hinchey grade II-III acute diverticulitis. PMID:25172780

Gentile, Valentina; Ferrarese, Alessia; Marola, Silvia; Surace, Alessandra; Borello, Alessandro; Ferrara, Yuri; Enrico, Stefano; Martino, Valter; Nano, Mario; Solej, Mario

2014-10-01

317

Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by Magnetic Resonance Imaging  

PubMed Central

Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery. PMID:21073724

2010-01-01

318

Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months  

PubMed Central

Background: Developmental dysplasia of hip (DDH) is a common condition presenting to a pediatric orthopedic surgeon. There is a consensus on the surgical treatment of children with ages ranged from 18 to 24 months where majority agree on open reduction and hip spica. Open reduction was done with an additional pelvic procedure wherever required to get better results and prevent residual acetabular dysplasia (RAD) and early osteoarthritis. Materials and Methods: 35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years). Results: No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI) of 35° and above. These were all from the group where open reduction alone was done. Conclusion: We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.

Ramani, Narasimhan; Patil, Mithun S; Mahna, Madhur

2014-01-01

319

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

PubMed Central

Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their members to examine current preferences in surgeon practice of MIS SI fusion. Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and average length of stay for each approach. Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only available option. Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as possible increase in outcome quality. PMID:24551025

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

2014-01-01

320

Surgical Technology Program Standards.  

ERIC Educational Resources Information Center

This publication contains statewide standards for the surgical technology program in Georgia. The standards are divided into 12 categories: foundations (philosophy, purpose, goals, program objectives, availability, evaluation); admissions (admission requirements, provisional admission requirements, recruitment, evaluation and planning); program…

Georgia Univ., Athens. Dept. of Vocational Education.

321

Conjunctivochalasis: a surgical technique.  

PubMed

Conjunctivochalasis can be surgically corrected when it gives an appearance of a moist eye, produces tearing by mechanical obstruction of the lower punctum, or if it impedes the normal outflow of the lacrimal film. We present a surgical technique that provides a satisfactory anatomical reconstruction, does not leave a deformity, and will not lead to a retraction that could produce a cicatricial ectropion. We stress the importance of a complete ophthalmologic examination to rule out more common causes of tearing. PMID:2630968

Serrano, F; Mora, L M

1989-12-01

322

Congenital heart surgery: surgical performance according to the Aristotle complexity score  

Microsoft Academic Search

Objectives: Aristotle score methodology defines surgical performance as ‘complexity score times hospital survival’. We analysed how this performance evolved over time and in correlation with case volume. Methods: Aristotle basic and comprehensive complexity scores and corresponding basic and comprehensive surgical performances were determined for primary (main) procedures carried out from 2006 to 2009. Surgical case volume performance described as unit

Claudia Arenz; Boulos Asfour; Viktor Hraska; Joachim Photiadis; Christoph Haun; Ehrenfried Schindler; Nicodème Sinzobahamvya

2011-01-01

323

[Surgical treatment of accommodative esotropia].  

PubMed

Since Donders 1862 the treatment of accommodative esotropia is optical: without an hypermetropic correction, the accommodation needed for vision at distance induces a convergence and an accommodative convergence excess at near. But since 130 years, new clinical and physiological research enables us to propose in specific cases a surgical treatment as an alternative to optical treatment. One of the clinical arguments is the low incidence of strabismus in hypermetropic patients: they can see clear at near and at distance without squinting. One of the physiological arguments is the research by J. Semmlow concerning the near triad: his model demonstrates that the system of accommodation and vergence are interconnected: the accommodative system participates to vergence but also the vergence system participates to accommodation, this is less known. The indications, the technique and surgical treatment are exposed. The analysis of the results by G. Gauthier and J.L. Vercher of the "Laboratoire de Contrôles Sensorimoteurs" at Marseille of the measures of the AC/A ratio confirms the model of Semmlow. The vertical syndrome observed in the accommodative squint is supposed to be the most frequent cause of putting the loop of the vergence system open. PMID:7633623

Bérard, P

1994-01-01

324

Comparative Experience of Open and Minimally Invasive Esophagogastric Resection  

Microsoft Academic Search

Background  A minimally invasive approach to esophagogastric cancer resection offers an attractive alternative to traditional open surgery;\\u000a however, concerns regarding feasibility, safety, cost, and outcomes have restricted widespread acceptance of these procedures.\\u000a This study outlines our comparative experiences of both open and minimally invasive esophagectomy over a 4-year period.\\u000a \\u000a \\u000a \\u000a Methods  Surgical outcomes were analyzed and compared between 30 consecutive patients who underwent

Rajeev Parameswaran; Darmarajah Veeramootoo; Rakesh Krishnadas; Martin Cooper; Richard Berrisford; Shahjehan Wajed

2009-01-01

325

Surgical Reconstruction of Radiation Injuries  

PubMed Central

Significance: Patients with cancer receive benefits from radiation therapy; however, it may have adverse effects on normal tissue such as causing radiation-induced ulcer and osteoradionecrosis. The most reliable method to treat a radiation ulcer is wide excision of the affected tissue, followed by coverage with well-vascularized tissue. As usual, radiation-induced skin ulcers are due to therapeutic irradiation for residual cancer or lymph nodes; the locations of radiation ulcers are relatively limited, including the head, neck, chest wall, lumbar, groin, and sacral areas. Thus, suitable reconstructive methods vary according to functional and aesthetic conditions. I reviewed the practices and surgical results for radiation ulcers over the past 30 years, and present the recommended surgical methods for these hard-to-heal ulcers. Recent Advances: At a minimum, flaps are required to treat radiation ulcers. Surgeons can recommend earlier debridement, followed by immediate coverage with axial-pattern musculocutaneous and fasciocutaneous flaps. Free flaps are also a useful soft tissue coverage option. The choice of flap varies with the location and size of the wounds. Critical Issues: The most crucial procedure is the complete resection of the radiation-affected area, followed by coverage with well-vascularized tissue. Future Directions: Recent developments in perforator flap techniques, which are defined as flaps with a blood supply from isolated perforating vessels of a stem artery, have allowed the surgeons to successfully resurface these difficult wounds with reduced morbidity. PMID:24761342

Fujioka, Masaki

2014-01-01

326

Laparoscopic Versus Open Gastric Bypass for Morbid Obesity  

PubMed Central

Objective: To compare laparoscopic versus open gastric bypass procedures with respect to 30-day morbidity and mortality rates, using multi-institutional, prospective, risk-adjusted data. Summary Background Data: Laparoscopic Roux-en-Y gastric bypass for weight loss is being performed with increasing frequency, partly driven by consumer demand. However, there are no multi-institutional, risk-adjusted, prospective studies comparing laparoscopic and open gastric bypass outcomes. Methods: A multi-institutional, prospective, risk-adjusted cohort study of patients undergoing laparoscopic and open gastric bypass procedures was performed from hospitals (n = 15) involved in the Private Sector Study of the National Surgical Quality Improvement Program (NSQIP). Data points have been extensively validated, are based on standardized definitions, and were collected by nurse reviewers who are audited for accuracy. Results: From 2000 to 2003, data from 1356 gastric bypass procedures was collected. The 30-day mortality rate was zero in the laparoscopic group (n = 401), and 0.6% in the open group (n = 955) (P = not significant). The 30-day complication rate was significantly lower in the laparoscopic group as compared with the open group: 7% versus 14.5% (P < 0.0001). Multivariate logistic regression analysis was performed to control for potential confounding variables and showed that patients undergoing an open procedure were more likely to develop a complication, as compared with patients undergoing an laparoscopic procedure (odds ratio = 2.08; 95% confidence interval, 1.33–3.25). Propensity score modeling revealed similar results. A prediction model was derived, and variables that significantly predict higher complication rates after gastric bypass included an open procedure, a high ASA class (III, IV, V), functionally dependent patient, and hypertension as a comorbid illness. Conclusions: Multicenter, prospective, risk-adjusted data show that laparoscopic gastric bypass is safer than open gastric bypass, with respect to 30-day complication rate. PMID:16633001

Hutter, Matthew M.; Randall, Sheldon; Khuri, Shukri F.; Henderson, William G.; Abbott, William M.; Warshaw, Andrew L.

2006-01-01

327

Upside-down stomach - results of mini-invasive surgical therapy  

PubMed Central

Aim The authors evaluate the results of mini-invasive therapy in patients diagnosed with upside-down stomach. Material and methods From 1998 to 2008, a total of 27 patients diagnosed with upside-down stomach were surgically treated at the 1st Department of Surgery, University Hospital Olomouc. Before the operation, patients were examined endoscopically and a barium swallow was performed. In all 27 patients (100%), the operation was performed electively laparoscopically. The principle of the operation in all cases was reposition of the stomach into the abdominal cavity, resection of the hernial sac and hiatoplasty. In addition, in 15 patients (56%) with reflux symptoms or endoscopic findings of reflux oesophagitis, fundoplication in Nissen's modification was also performed. Fundopexy was indicated in 12 patients (44%). Results In all patients (100%), the operation was performed mini-invasively; conversion to an open procedure was never necessary. In 3 cases (11%), the left pleural cavity was opened during the operation; this was treated by introducing a chest drain. The operation mortality in the patient set was zero; morbidity was 11%. A year after the operation, patients were re-examined, and follow-up endoscopy and barium swallow were performed. Conclusions In all patients diagnosed with upside-down stomach, surgical treatment is indicated due to the risk of developing severe complications. Mini-invasive surgical therapy in the hands of an experienced surgeon is a safe procedure which offers patients all the benefits of mini-invasive therapy with promising short- and long-term results. PMID:23255985

Vrba, Radek; Aujesky, Rene; Vomackova, Katherine; Zbrozkova, Lenka

2011-01-01

328

Medical and surgical treatment of obesity.  

PubMed

The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. Medical treatments of obesity include primary prevention, dietary intervention, increased physical activity, behavior modification, and pharmacotherapy. Surgical treatment for obesity is based on the extensive neural-hormonal effects of weight loss surgery on metabolism, and as such is better termed Metabolic Surgery. Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity. PMID:21516910

Kissane, Nicole A; Pratt, Janey S A

2011-03-01

329

A Novel Surgical Template Design in Staged Dental Implant Rehabilitations  

PubMed Central

ABSTRACT Background The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning. Methods This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts. Results This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes. Conclusions Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery. PMID:24422012

Patras, Michael; Martin, William; Sykaras, Nikitas

2012-01-01

330

Fate of pulmonary arteries following Norwood Procedure  

Microsoft Academic Search

Objective: This study evaluated the requirement for surgical reoperation and catheter-based reintervention to central pulmonary arteries (CPAs) following Norwood Procedure (NP). We sought to identify the influence of various surgical techniques employed during NP on subsequent interventions. Methods: Between 1993 and 2004, 226 patients underwent Stage II following NP. Ninety-eight patients (43%) had completion of Fontan circulation (Stage III) and

Massimo Griselli; Simon P. McGuirk; Victor Ofoe; Oliver Stümper; John G. C. Wright; Joseph V. de Giovanni; David J. Barron; William J. Brawn

2006-01-01

331

Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases  

Microsoft Academic Search

OBJECTIVESynovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the efficacy of operative procedures and factors influencing the outcome in our own series of

M Trummer; G Flaschka; M Tillich; C N Homann; F Unger; S Eustacchio

2001-01-01

332

Haptic Force Feedback with an Interaction Model between Multiple Deformable Objects for Surgical Simulations  

Microsoft Academic Search

This paper proposes an interaction model between multiple physically-based deformable objects. The model enables both accurate force feedback and visualization of surgical manipulations (like hold, push and move organs) while approaching the tissues of interest. Accurate force feedback improves surgical realism and enables exact simulation for diagnosis and procedural training. Interaction is represented by mutual iterative procedures of forcible displacement,

Yoshihiro Kuroda; Megumi Nakao; Silke Hacker

2002-01-01

333

Surgical Treatment of the Overweight Patient  

Microsoft Academic Search

Treatment of overweight patients with surgery is increasing at a rapid rate The Nationwide Inpatient Sample from 1998 to 2002 has provided one quantitative estimate of bariatric surgical procedures. Between 1998 and 2002 the number of operations increased from 13,365 to 72,177, a more than 5-fold increase. More than 80% of these were the so-called gastric bypass operation. Several other

George A. Bray

334

Comparison of perioperative morbidity and mortality rates in dogs with noninvasive adrenocortical masses undergoing laparoscopic versus open adrenalectomy.  

PubMed

Objective-To describe the clinicopathologic features of a cohort of dogs with adrenocortical masses that underwent laparoscopic adrenalectomy and to compare perioperative morbidity and mortality rates in these dogs with rates for dogs that underwent open adrenalectomy for resection of similarly sized (maximal diameter, ? 5 cm) adrenocortical masses. Design-Retrospective case series. Animals-48 client-owned dogs that underwent laparoscopic (n = 23) or open (25) adrenalectomy for noninvasive tumors (ie, tumors that did not invade the vena cava or other surrounding organs). Procedures-Medical records were reviewed. History, clinical signs, physical examination findings, clinicopathologic findings, imaging results, and surgical variables were recorded. A 3- or 4-port approach was used for laparoscopic adrenalectomy. Surgical time, perioperative complications, postoperative and overall hospitalization times, and perioperative deaths were recorded and compared between groups. Results-The surgical method for 1 dog was converted from a laparoscopic to an open approach. Perioperative death occurred in no dogs in the laparoscopic group and 2 dogs in the open adrenalectomy group. Surgical time was shorter for laparoscopic (median, 90 minutes; range, 40 to 150 minutes) than for open (median, 120 minutes; range, 75 to 195 minutes) adrenalectomy. Laparoscopic adrenalectomy was associated with shorter hospitalization time and more rapid discharge from the hospital after surgery, compared with the open procedure. Conclusions and Clinical Relevance-With careful patient selection, laparoscopic adrenalectomy was associated with a low complication rate and low conversion rate for resection of adrenocortical masses as well as shorter surgical and hospitalization times, compared with open adrenalectomy. PMID:25313814

Mayhew, Philipp D; Culp, William T N; Hunt, Geraldine B; Steffey, Michele A; Mayhew, Kelli N; Fuller, Mark; Della-Maggiore, Ann; Nelson, Richard W

2014-11-01

335

Open Thoracotomy and Decortication for Chronic Empyema  

PubMed Central

OBJECTIVES Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies. PMID:19061002

Andrade-Alegre, Rafael; Garisto, Juan D.; Zebede, Salomon

2008-01-01

336

Pediatric appendectomy: optimal surgical timing and risk assessment.  

PubMed

Appendicitis is one of the most common pediatric surgical problems. In the older surgical paradigm, appendectomy was considered to be an emergent procedure; however, with changes to resident work hours and other economic factors, the operation has evolved into an urgent and deliberately planned intervention. This paradigm shift in care has not necessarily seen universal buy-in by all stakeholders. Skeptics worry about the higher incidence of complications, particularly intra-abdominal abscess (IAA), associated with the delay to appendectomy with this strategy. Development of IAA after pediatric appendectomy greatly burdens the healthcare system, incapacitates patients, and limits family functionality. The risk factors that influence the development of IAA after appendectomy were evaluated in 220 children admitted to a large urban teaching hospital over a recent 1.5-year period. Preoperative risk factors included in the study were age, sex, weight, ethnicity, duration and nature of symptoms, white cell count, and ultrasound or computed tomography scan findings (appendicolith, peritoneal fluid, abscess, phlegmon), failed nonoperative management, antibiotics administered, and timing. Intraoperative factors included were timing of appendectomy, surgical and pathological findings of perforation, open or laparoscopic procedure, and use of staple or Endoloop to ligate the appendix. Postoperative factors included were duration and type of antibiotic therapy. There were 94 (43%) perforated and 126 (57%) nonperforated appendicitis during the study period. The incidence of postoperative IAA was 4.5 per cent (nine of 220). Children operated on after overnight antibiotics and resuscitation had a significantly lower risk of IAA as compared with children managed by other strategies (P < 0.0003). Of the preoperative factors, only the presence of a fever in the emergency department (P < 0.001) and identification of complicated appendicitis on imaging (P < 0.0001) were significant risk factors for postoperative abscess development. Perforated appendicitis carries a higher risk of development of IAA that is not reduced by an emergent operative or delayed nonoperative management strategy. The timing of appendectomy appears to be an extremely important factor in reducing the incidence of IAA after all presentations of appendectomy. The role of resuscitation and antibiotics in limiting the effects of the inflammatory cascade and development of laboratory markers that accurately measure the latter need to be the focus of further research in this field. PMID:24887730

Burjonrappa, Sathyaprasad; Rachel, Dana

2014-05-01

337

A comparison of open vs laparoscopic adrenalectomy  

Microsoft Academic Search

Background: To compare the outcome of patients who underwent laparoscopic transabdominal adrenalectomy (LA) with those who had open adrenalectomy\\u000a (OA).\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A retrospective review of consecutive adrenalectomies performed by a single surgical team at a university hospital. Outcome\\u000a measurements were operative time, operative blood loss, procedure-related complications, postoperative stay, and return to\\u000a regular activity.\\u000a \\u000a \\u000a \\u000a \\u000a Results: Twenty-nine adrenalectomies were done in

D. C. MacGillivray; S. J. Shichman; F. A. Ferrer; C. D. Malchoff

1996-01-01

338

Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique.  

PubMed

Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons. PMID:24342163

Leanza, V; Intagliata, E; Leanza, G; Cannizzaro, M A; Zanghì, G; Vecchio, R

2013-01-01

339

Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study  

PubMed Central

Background The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study. Methods Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant. Results During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC. Conclusion Under the studied conditions, the authors’ hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture. PMID:24991234

2014-01-01

340

[Change of surgical treatment in benign thyroid gland diseases-- influence of surgical management on perioperative complications].  

PubMed

Since the beginning of 1994 standardized primary radical resection was performed in benign thyroid diseases at the surgical department, Barmherzige Brueder Hospital, Graz. In multinodular euthyroid goiter bilateral lobectomy or near total lobectomy respectively was done. In case of Graves' disease unilateral lobectomy and contralateral near total resection or "en bloc" thyroidectomy was performed. In accordance with literature a significant reduction of recurrent laryngeal nerve paralysis from approximately 9% to 1.2% occurred in our patients if this surgical procedure was performed consequently. Hypocalcemia rate after surgery needing treatment was approximately 1% at the time of demission. PMID:10812464

Hebenstreit, H; Papadi, H; Konrad, G; Seitinger, G; Reisenberger, F J; Kratochvil, A; Berger, A

2000-01-01

341

Surgical emergencies in oncology.  

PubMed

An oncologic emergency is defined as an acute, potentially life threatening condition in a cancer patient that has developed as a result of the malignant disease or its treatment. Many oncologic emergencies are signs of advanced, end-stage malignant disease. Oncologic emergencies can be divided into medical or surgical. The literature was reviewed to construct a summary of potential surgical emergencies in oncology that any surgeon can be confronted with in daily practice, and to offer insight into the current approach for these wide ranged emergencies. Cancer patients can experience symptoms of obstruction of different structures and various causes. Obstruction of the gastrointestinal tract is the most frequent condition seen in surgical practice. Further surgical emergencies include infections due to immune deficiency, perforation of the gastrointestinal tract, bleeding events, and pathological fractures. For the institution of the appropriate treatment for any emergency, it is important to determine the underlying cause, since emergencies can be either benign or malignant of origin. Some emergencies are well managed with conservative or non-invasive treatment, whereas others require emergency surgery. The patient's performance status, cancer stage and prognosis, type and severity of the emergency, and the patient's wishes regarding invasiveness of treatment are essential during the decision making process for optimal management. PMID:24933674

Bosscher, M R F; van Leeuwen, B L; Hoekstra, H J

2014-09-01

342

Surgical treatment of obesity  

Microsoft Academic Search

Obesity is very prevalent. Most treatments fail owing to hard-wired survival mechanisms, linking stress and appetite, which have become grossly maladaptive in the industrial era. Antiobesity (bariatric) surgery is a seemingly drastic, efficacious therapy for this serious disease of energy surfeit. Technical progress during the last two decades has greatly improved its safety. The surgical principles of gastric restriction and\\/or

Erik Näslund; John G Kral

2007-01-01

343

Surgical complications of neuroblastoma resection.  

PubMed

Locally advanced neuroblastomas in infants and very young children often require intricate dissection to separate the tumors from the anatomic structures that they have enmeshed. The rationale for these procedures is based mainly on the premise that near-total resection is almost as effective as total extirpation, given favorable circumstances of age and stage. The principal reason for not undertaking or aborting such resections has been to avoid the fallacy of intentionally sacrificing vital structures, causing serious disability, in circumstances in which cure is either impossible or equally likely to accrue from a lesser procedure. This report describes five surgical mishaps, two of which resulted in postoperative deaths. The potential for these complications was greatest during resection of locally advanced tumors in small babies. We suspect that this hazard is more prevalent than its scarcity in the literature would suggest and that potential for unintended injury should be a prominent factor in the decision to proceed or desist with resection of a large neuroblastoma. PMID:3992477

Azizkhan, R G; Shaw, A; Chandler, J G

1985-05-01

344

Open fenestration for complicated acute aortic B dissection  

PubMed Central

Acute type B aortic dissection (ABAD) is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Visceral, renal, and limb ischemia occur in up to 30% of patients with ABAD and are associated with higher in-hospital mortality. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than total aortic replacement, thus not requiring extracorporeal support and allowing preservation of the intercostal arteries, which results in decreased risk of paraplegia. Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD, particularly for patients with no aortic dilatation. In the current endovascular era, this open technique serves as an alternative option in case of contraindications or failure of endovascular management of complicated ABAD. PMID:25133107

Segreti, Sara; Grassi, Viviana; Lomazzi, Chiara; Cova, Marta; Piffaretti, Gabriele; Rampoldi, Vincenzo

2014-01-01

345

Surgical Treatment of Adult Degenerative Scoliosis  

PubMed Central

The rapid increase of elderly population has resulted in increased prevalence of adult scoliosis. Adult scoliosis is divided into adult idiopathic scoliosis and adult degenerative scoliosis. These two types of scoliosis vary in patient age, curve pattern and clinical symptoms, which necessitate different surgical indications and options. Back pain and deformity are major indications for surgery in adult idiopathic scoliosis, whereas radiating pain to the legs due to foraminal stenosis is what often requires surgery in adult degenerative scoliosis. When selecting a surgical method, major symptoms and underlying medical diseases should be carefully evaluated, not only to relieve symptoms but also to minimize postoperative complications. Surgical options for adult degenerative scoliosis include: decompression alone; decompression and limited short fusion; and decompression coupled with long fusion and correction of deformity. Decompression and limited short fusion can be applied to patients with a small Cobb's angle and normal sagittal imbalance. For those with a large Cobb's angle and positive sagittal imbalance, long fusion with correction of deformity is required. When long fusion is applied, a careful decision regarding the extent of fusion level should be made when selecting L5 or S1 as the distal fusion level and T10 or the thoracolumbar junction as the proximal fusion level. For the fusion extending to the sacrum, restoration of sagittal balance and rigid fixation with additional iliac screws should be considered. Any surgical procedures for adult degenerative scoliosis are known to have relatively high occurrences of complications; therefore, risks and benefits should be meticulously considered before selecting a surgical procedure. PMID:24967054

Kim, Young-Tae; Shin, Sang-hyun; Suk, Se-Il

2014-01-01

346

[Thiel's method of embalming and its usefulness in surgical assessments].  

PubMed

When we assess anatomical problems and the safety and effectiveness for performing a difficult surgical procedure or planning novel surgical approaches, preoperative human dissections are very helpful. However, embalming with the conventional formaldehyde method makes the soft tissue of the cadaver harder than that of a living body. Therefore, the cadaver embalmed with conventional formaldehyde is not appropriate for dissections when assess surgical approaches. Thiel's method is a novel embalming technique, first reported by W. Theil in 1992. This method can preserve color and softness of the cadaver without risk of infections. We have used cadavers embalmed with Thiel's method for preoperative assessments and have confirmed the usefulness of this method especially for the prevention of complications or in assessing surgical approaches. The cadaver embalmed with this method has several advantages over other embalming methods and it might be also useful for the developments of new surgical devices or evaluation of a surgeon's skill. PMID:23016272

Okada, Ryuhei; Tsunoda, Atsunobu; Momiyama, Naoko; Kishine, Naomi; Kitamura, Ken; Kishimoto, Seiji; Akita, Keiichi

2012-08-01

347

Evaluation of the motion of surgical instruments during intraocular surgery  

PubMed Central

Purpose Robot assistance in ocular microsurgery could improve precision, dexterity, save time or prevent complications by task automation, and provide access to ocular surgery in undeserved countries by teleoperation. However, to design robotic devices, the range of motion of surgical instruments needs to be precisely quantified. Methods An electromagnetic tracking system was developed for intraocular surgery in order to quantify the movements of ophthalmic surgeons. Kinematics of surgical steps during phacoemulsification and pars plana vitrectomy procedures were determined by measuring the maximum translation and angular range of motion of intraocular surgical tools in the three planes. Conclusion Important variations in amplitudes of rotation and translation were measured between both hands and between surgical tasks. These parameters may be used to develop a robotic intraocular surgical system or to improve training. PMID:21527954

Hubschman, J-P; Son, J; Allen, B; Schwartz, S D; Bourges, J-L

2011-01-01

348

Surgical management of congenital heart defects: Current trends  

Microsoft Academic Search

Surgical treatment for congenital heart disease has become available over the last five decades. Palliative procedures have\\u000a been designed to improve physiologic abnormalities, for example systemic artery (or venous) to pulmonary artery shunts of\\u000a various types to increase the pulmonary blood flow, pulmonary artery constriction (banding) to decrease the pulmonary blood\\u000a flow, and surgical or transcatheter atrial septostomy to augment

P. S. Chopra; P. Syamasundar Rao

1991-01-01

349

Timing of surgery for common pediatric surgical conditions  

Microsoft Academic Search

Depending upon various factors the surgical procedures in childhood are divided into three groups—immediate, intermediate\\u000a and elective. The timing of surgery is probably the most important factor governing the outcome of surgical correction in\\u000a pediatric surgery. With continuing research and clinical experience our understanding of the various conditions have improved\\u000a and with that has come a change in the optimum

Sandeep Agarwala; D. K. Mitra

1996-01-01

350

An introduction to the practical and ethical perspectives on the need to advance and standardize the intracoelomic surgical implantation of electronic tags in fish  

SciTech Connect

The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish.

Brown, Richard S.; Eppard, M. B.; Murchie, Karen J.; Nielsen, Jennifer L.; Cooke, Steven J.

2011-01-01

351

An introduction to the practical and ethical perspectives on the need to advance and standardize the intracoelomic surgical implantation of electronic tags in fish  

USGS Publications Warehouse

The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish. ?? 2010 Springer Science+Business Media B.V.

Brown, R. S.; Eppard, M. B.; Murchie, K. J.; Nielsen, J. L.; Cooke, S. J.

2011-01-01

352

Definition of a safe-zone in open carpal tunnel surgery: a cadaver study  

Microsoft Academic Search

Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm\\u000a by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was\\u000a designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed\\u000a (8 right, 6

Haluk Ozcanli; Nigar Keles Coskun; Menek?e Cengiz; Nurettin Oguz; Muzaffer Sindel

2010-01-01

353

Force-feedback in Web-based surgical simulators.  

PubMed

There is a growing requirement in the field of surgical training to allow trainees to practice procedures in a way that does not place patients in any risk. Computer based simulators allow students to gain experience and develop three-dimensional awareness in a safe and controlled environment. Typically systems that have been developed to perform this task are, due to their specialist nature, expensive to buy. With the increasing availability of Force-Feedback devices for the gaming market, is there now a cost-effective alternative for surgical simulations? In this paper we investigate the possibility of using such a device as a haptic input tool for surgical simulations. PMID:11317778

Riding, M; John, N W

2001-01-01

354

Recurrence and survival in surgically treated endometrioid endometrial cancer  

Microsoft Academic Search

Introduction  The objective of this study was to evaluate different surgical treatments and radiotherapy on patterns of recurrence and overall\\u000a survival in patients with endometrioid-type endometrial cancer.\\u000a \\u000a \\u000a \\u000a Materials and methods  The retrospective records of 162 patients with endometrioid endometrial cancer were collected. Patients were surgically treated\\u000a from 1997 to 2002. Recurrence and survival were analyzed according to patient age, surgical procedure, lymphadenectomy,

Alex Sanjuán; Teresa Cobo; Georgia Escaramís; Angels Rovirosa; Jaume Ordi; Sonia García; Sandra Hernández; Xavier Caparrós; Aureli Torné; Sergio Martínez Román; Juan Antonio Lejárcegui; Jaume Pahisa

2008-01-01

355

Role of coronoidectomy in increasing mouth opening  

PubMed Central

Aim: To evaluate the effectiveness of coronoidectomy in advanced (stage III-IV) oral submucous fibrosis (OSMF) and temporomandibular joint (TMJ) ankylosis. Materials and Methods: Five patients clinically diagnosed as grade III/IV OSMF (group 1) and seven patients clinically and radiographically confirmed as TMJ ankylosis (group 2) underwent surgery entailing coronoidectomy in addition to conventional surgical procedures required in both the conditions followed by vigorous mouth opening exercises. The results were evaluated using the interincisal distance at maximum mouth opening as the objective outcome over a follow-up period of 2 months. Results: OSMF patients (group I) showed a mean preoperative interincisal opening of 14.40 mm which increased to 24.60 mm after conventional procedures and showed further increment to 35 and 44.80 mm after unilateral and bilateral coronoidectomy, respectively; which was statistically significant (P = 0.043). Follow-up of 2 months showed a gradual increase in mean mouth opening compared to baseline which was also found to be statistically significant (P = 0.043). In TMJ ankylosis patients (group II), preoperative mean mouth opening of 6.71 mm increased to 24.29 mm after conventional procedures, and further to 37.29 mm after unilateral coronoidectomy which was statistically significant (P = 0.018). On subsequent follow-up of 2 months, a gradual increase in mean mouth opening compared to baseline was observed which was statistically significant (P = 0.018). Conclusion: Coronoidectomy is an effective adjunct in increasing intraoperative and stabilizing postoperative mouth opening.

Gupta, Hemant; Tandon, Parul; Kumar, Deepak; Sinha, Vijay Prakash; Gupta, Sumit; Mehra, Hemant; Singh, Jasmeet

2014-01-01

356

[Surgical treatment of morbid obesity].  

PubMed

WHO has listed obesity as a disease condition in its International Classification of Disease since 1979 and has assigned obesity a specific ICD-9, clinical modification code of #278.00, and morbid obesity, code #278.01. About 95% of those conservatively treated for morbid obesity will remain at the same weight or even gain weight during 5 years of follow-up. In 1991 an NIH Consensus Conference Panel convened and recommended that morbidly obese patients be offered an operative treatment for their disease. The weight loss mechanism of the bariatric operations is not clear, but the presumed effects are gastric restriction of food intake, malabsorption of the nutrients achieved by intestinal bypass, and secretion of different neuropeptides, that cause depression of the appetite and change in the metabolic rate. Restrictive operations are considered simpler and safer in terms of surgical performance and short term risks, but their efficacy is inferior to the malabsorptive ones. The latter are larger in regard to surgical extent, may cause more metabolic derangements, but produce more solid and long-lasting weight loss. The operation should be tailored to the candidate taking into consideration sex, age, health-related conditions, medications that are being taken, eating habits, and risks and benefits of every specific procedure. It is advisable that a bariatric surgery candidate undergo a thorough preoperative evaluation by a multidisciplinary team including a surgeon, a dietician, a psychology specialist, an internist or an endocrinologist, and other subspecialties as needed. A bariatric patient should maintain a life-long follow-up. PMID:19264008

Keidar, Andrei; Abu Abeid, Subhi; Lieberman, Gabriela; Bachrach, Rakefet; Zacharovitch, David; Raz, Itamar

2008-11-01

357

Surgical Treatment of Congenital Hallux Varus  

PubMed Central

Background The purpose of this study was to report outcomes of congenital hallux varus deformity after surgical treatment. Methods We evaluated ten feet of eight patients with a congenital hallux varus deformity, including four feet combined with a longitudinal epiphyseal bracket (LEB). There were seven male patients and one female patient with a mean age of 33 months (range, 7 to 103 months) at the time of surgery. Two patients were bilaterally involved. The mean duration of follow-up was 5.9 years (range, 2.3 to 13.8 years). Clinical outcomes were assessed according to the criteria of Phelps and Grogan. Surgical procedures included the Farmer procedure, the McElvenny procedure or an osteotomy at the first metatarsal or proximal phalanx. Results The clinical results were excellent in two feet, good in six and poor in two feet. The LEB was associated with hallux varus in four feet and were treated by osteotomy alone or in conjunction with soft tissue procedure. Conclusions Congenital hallux varus was successfully corrected by surgery with overall favorable outcome. Preoperatively, a LEB should be considered as a possible cause of the deformity in order to prevent recurrent or residual varus after surgery. PMID:24900905

Shim, Jong Sup; Koh, Kyoung Hwan; Lee, Do Kyung

2014-01-01

358

Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group  

Microsoft Academic Search

Purpose  Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for\\u000a prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies\\u000a in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised\\u000a of 9 centers specialized in esophageal surgery, with a combined

Daniel Palmes; Matthias Brüwer; Franz G. Bader; Michael Betzler; Heinz Becker; Hans-Peter Bruch; Markus Büchler; Heinz Buhr; ?. Michael Ghadimi; Ulrich T. Hopt; Ralf Konopke; Katja Ott; Stefan Post; Jörg-Peter Ritz; Ulrich Ronellenfitsch; Hans-Detlev Saeger; Norbert Senninger

359

Surgical Device Engineering  

NSDL National Science Digital Library

This unit focuses on teaching students about the many aspects of biomedical engineering (BME). Students come to see that BME is a broad field that relies on concepts from many engineering disciplines. They also begin to understand some of the special considerations that must be made when dealing with the human body. Activities and class discussions encourage students to think as engineers to come up with their own solutions to some of medical challenges that have been solved throughout the history of BME. Class time iincludes brainstorming and presenting ideas to the class for discussion. Specific activities include examination of the material properties and functions of surgical instruments and prosthetics, a simulation of the training experience of a surgical resident, and an investigation of the properties of fluid flow in vascular tissue.

Techtronics Program

360

Surgical Treatment of Epilepsy  

PubMed Central

Purpose of Review: This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits. Recent Findings: There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy. Summary: Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials. PMID:23739107

Miller, John W.; Hakimian, Shahin

2013-01-01

361

Pelvic Exenteration: Surgical Approaches  

PubMed Central

Although the incidence of local recurrence after curative resection of rectal cancer has decreased due to the understanding of the anatomy of pelvic structures and the adoption of total mesorectal excision, local recurrence in the pelvis still remains a significant and troublesome complication. While surgery for recurrent rectal cancer may offer a chance for a cure, conservative management, including radiation and chemotherapy, remain widely accepted courses of treatment. Recent improvement in imaging modalities, perioperative care, and surgical techniques, including bone resection and wound coverage, have allowed for reductions in operative mortality, though postoperative morbidity still remains high. In this review, the techniques, including surgical approaches, employed for management of locally recurrent rectal cancer are highlighted. PMID:23346506

2012-01-01

362

Surgical Gloves: Current Problems  

Microsoft Academic Search

.   One century ago surgical gloves were introduced to practice as part of the new antiseptic technique and originally to protect\\u000a the hands of the surgeon and his assistants from the harmful dermatologic effects of powerful antiseptics (e.g., carbolic\\u000a acid) in use at that time. Since then, the wearing of gloves during surgery has been standard practice. Furthermore, the protection

Maher O. Osman; Steen L. Jensen

1999-01-01

363

Surgical assessment of musicians.  

PubMed

The art and science of medicine are called into action at a high level when one evaluates and treats the impaired hand of a skilled musician. A surgeon who is conscientious and understanding of the patient and the patient's needs and who is capable of assessing correctly the anatomic and physiologic pathology is most likely to make the proper decision in advising for or against a surgical component of the overall treatment plan. PMID:12852666

Amadio, Peter C

2003-05-01

364

Surgical Education in China  

Microsoft Academic Search

A highly skilled surgical team relies on a standardized training system and the most important subject in the development\\u000a of general surgery in China is to set up standardized education and training systems for surgeons. This article reviews the\\u000a history of the training of residents, delineates the current situation and problems of residency training in general surgery,\\u000a and discusses reform

Bai-Yong Shen; Qian Zhan

2008-01-01

365

The Mayo brothers: an American surgical legacy.  

PubMed

Few in the history of surgery and just as few in the history of medicine can reach the level of clinical visibility as achieved by the Mayo brothers. The brothers changed the face of medicine while they were alive, and their fame and influence continued to grow after their death in 1939. The Mayo American surgical legacy had incredible proportions. The brothers systematically modified the field as few others had done before. They were great surgical innovators who took the surgical techniques of others and added a touch of their own to make the surgical procedure better and more secure. The Mayos were the stars regionally, nationally, and around the world. They attracted attention from their generation and occupied center stage long after. To speak of the Mayos is to speak of the quintessential American values of professionalism, respect, commitment, and caring for their fellow human beings. Their creation, the Mayo Clinic, surpassed the wildest hopes and predictions that anyone could have had regarding their best dreams. PMID:20874478

Toledo-Pereyra, Luis H

2010-10-01

366

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2011 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical...

2011-04-01

367

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical...

2013-04-01

368

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2012 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical...

2012-04-01

369

21 CFR 878.4040 - Surgical apparel.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical...

2014-04-01

370

Surgical Treatment of Prostate Cancer  

Microsoft Academic Search

Excellent cancer control and quality of life outcomes can be achieved by radical prostatectomy. The key, historical developments emphasize the importance of early diagnosis and consistency in surgical technique. Radical prostatectomy can be carried out by a variety of surgical approaches, and each has advantages and disadvantages. Technological development and application will increasingly influence future surgical practice by improving discrimination

Mark R. Feneley; Roger S. Kirby

371

Robotic surgical training.  

PubMed

In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey. PMID:23528718

Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

2013-01-01

372

Cardiac surgical theatre traffic: time for traffic calming measures?  

PubMed

Surgical site infections (SSIs) remain a significant cause of postoperative complications. The risk of death from a medical error in a UK hospital remains one in 300. Increased theatre traffic has been identified as a modifiable determinant of SSI and surgical error. This cross-sectional study for the first time describes the pattern of theatre traffic in a UK cardiac centre. An electronic door counter and galaxy theatre management software (v3.4, iSOFT Banbury, UK) were used to calculate frequencies and rates of door opening during operations. Forty-six cases were analysed with 4273 door openings recorded. The median age of patients was 65 (range 43-75) with a median EuroSCORE of 5 (1-14). The mean frequency of door openings per case was 92.9 (45-205), with 19.2 (6.4-38.2) openings per hour. The theatre door was open for 10.7% of each hour of operating. Prolonged, acute and cases involving patients with higher EuroSCOREs demonstrated a trend towards increased opening. Door opening disturbs theatre airflow and results in increased air and wound contamination. It is also described as a contributor to surgical mistakes. Current levels of traffic are unacceptably high and represent a modifiable risk factor for SSI and error. PMID:20100706

Young, Richard S; O'Regan, David J

2010-04-01

373

Anatomical basis for surgical approaches to the hip.  

PubMed

The hip joint is one of the most surgically exposed joints in the body. The indications for surgical exposure are numerous ranging from simple procedures such as arthrotomy for joint drainage in infection to complex procedures like revised total hip replacement. Tissue dissections based on sound knowledge of anatomic orientations is essential for best surgical outcomes. In this review, the anatomical basis for the various approaches to the hip is presented. Systematic review of the literature was done by using PubMed, Cochrane, Embase, OVID, and Google databases. Out of the initial 150 articles selected from the the review and selection criteria, only 37 that suited the study were eventually used. Selected articles included case reports, clinical trials, review and research reports. Each of these approaches has various modifications that seek to correct certain difficulties or problems encountered with previous descriptions. An ideal approach for a procedure should be safe and provide satisfactory exposure of the joint. It should avoid bone and soft tissue damage as well as avoid unnecessary devascularization. Among the factors that determine the choice of surgical approach to the hip are the indication for the procedure; the influence of previous surgical incisions as well as the personal preferences and training of the operating surgeon. PMID:25221692

Onyemaechi, Noc; Anyanwu, Eg; Obikili, En; Ekezie, J

2014-07-01

374

HUMAN RIGHTS POLICIES AND PROCEDURES Approved by  

E-print Network

Rights Conflict Resolution and Complaints Procedures . . . . . . . . . . . 39 Part VI Systemic Issues by understanding, respect, peace, trust, openness and fairness. 3. We believe that universities have a mandate

375

10 CFR 452.5 - Bidding procedures.  

... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

2014-01-01

376

10 CFR 452.5 - Bidding procedures.  

Code of Federal Regulations, 2011 CFR

... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

2011-01-01

377

10 CFR 452.5 - Bidding procedures.  

Code of Federal Regulations, 2012 CFR

... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

2012-01-01

378

10 CFR 452.5 - Bidding procedures.  

Code of Federal Regulations, 2010 CFR

... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

2010-01-01

379

10 CFR 452.5 - Bidding procedures.  

Code of Federal Regulations, 2013 CFR

... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

2013-01-01

380

[Orthognathic surgery: specific aspects of surgical-orthodontic preparations].  

PubMed

Orthodontic preparation, mandatory before surgery, has benefited from great innovations in periodontics and implantology. The objectives of current orthodontics are short procedures and compliance with dental capital. Using bone anchorage changes treatment modalities for dental compensation. Piezo-electric surgery has become the first line procedure for osteotomies by improving surgical precision and downgrading nerve complications. Alveolar corticotomy has allowed decreasing orthodontic preparation time by causing an acceleration of tooth displacement. Primary transverse and sagittal surgery allow improving or protecting periodontal and muscular systems during orthodontic preparation. Normalization of oro-facial functions is an essential factor of surgical stability. The initial dysfunction justifies an appropriate and rapid management. PMID:25081489

Raberin, M; Mauhourat, S

2014-09-01

381

Stimulation of antibody synthesis induced by surgical trauma in rats.  

PubMed Central

The effect of a standard laparatomy on antibody synthesis was studied in Wistar R/A rats recieving an intravenous injection of 10(9) sheep red blood cells (SRBC) during the surgical procedure. Anti-SRBC antibody titres were significantly higher in operated animals than in controls. When SRBC were given 2 hr after the surgical procedure, stimulation of antibody synthesis still persisted, but when the antigen was administered 24 hr after laparotomy, no significant difference could be detected between the operated animals and controls. Surgery also enhances the secondary humoral response. PMID:668200

Kinnaert, P; Mahieu, A; Van Geertruyden, N

1978-01-01

382

Surgical Treatment of Anorectal Crohn Disease  

PubMed Central

Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario. PMID:24436656

Lewis, Robert T.; Bleier, Joshua I. S.

2013-01-01

383

Surgical sterilization of free-ranging wolves.  

PubMed Central

The objective of the study was to determine whether surgical sterilization of both males and females in wolf pairs alters basic wolf social and territorial behaviors. Wolves were located from the air by snow-tracking methods and were tranquilizer-darted from a helicopter. Surgeries were performed either in a tent at the capture site or in a heated building in a nearby village. Six vasectomies and seven uterine horn ligations were performed in January and February of 1996 and 1997. Two females died: one likely related to the capture procedure, the other of a peritonitis unrelated to the surgery. One wolf had a litter. None of the wolves have shown changes in behavioral patterns. Surgical sterilization can be effective, but other, less invasive, fertility control techniques should be investigated. PMID:10065320

Spence, C E; Kenyon, J E; Smith, D R; Hayes, R D; Baer, A M

1999-01-01

384

Surgical experts: born or made?  

PubMed

The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. PMID:23838344

Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

2013-01-01

385

Traumatic shoulder instability. Nonsurgical management versus surgical intervention.  

PubMed

Shoulder instability is classified as either traumatic or atraumatic based on the mechanism of injury. Traditional treatment for both forms of instability involves a nonsurgical approach, consisting of immobilization, rehabilitation, and a delay in the return to vigorous activities. This treatment is often quite successful in preventing recurrent dislocations in the patient with atraumatic instability. However, those patients with traumatic instability often experience further dislocations or subluxations, with recurrence rates as high as 94% in patients younger than 20 years. These recurrent episodes of instability can result in injuries to the capsulolabral structures (Bankart lesions), humeral head (Hill Sachs defect), and neurologic structures. Open surgical reconstructions for anterior instability have been reported to be 94-100% successful in preventing recurrence. Arthroscopic stabilization procedures are successful in preventing recurrence in 80-90% of patients and result in low morbidity. However, the most common form of initial treatment for traumatic anterior shoulder instability remains immobilization, supervised rehabilitation, and gradual return to full activity, despite significantly inferior results when compared to operative intervention. This article addresses the treatment options available to the nurse practitioner when managing the patient with traumatic anterior instability. PMID:14595995

Burgess, Bobbiann; Sennett, Brian J

2003-01-01

386

Influences of Item Content and Format on the Dimensionality of Tests Combining Multiple-Choice and Open-Response Items: An Application of the Poly-DIMTEST Procedure.  

ERIC Educational Resources Information Center

The DIMTEST statistical procedure was used in a confirmatory manner to explore the dimensionality structures of three kinds of achievement tests: multiple-choice tests, constructed-response tests, and tests combining both formats. The DIMTEST procedure is based on estimating conditional covariances of the responses to the item pairs. The analysis…

Perkhounkova, Yelena; Dunbar, Stephen B.

387

Surgical treatment of femoroacetabular impingement: what are the limits of hip arthroscopy?  

PubMed

The variety of hip pathology that can be addressed in a minimally invasive fashion in the young, pre-arthritic patient has rapidly grown in parallel with technical advances in hip arthroscopy. However, the indications and limits of arthroscopy must be carefully defined and indications must evolve correspondingly to avoid an increase in failure rates and unsatisfactory clinical outcomes. Some diagnoses may be better and more comprehensively addressed with open procedures or combined surgical approaches. The purpose of this article is to provide an unbiased and evidence-based review of conditions of the pre-arthritic hip to define our current understanding of the advantages, disadvantages, and limitations of an arthroscopic approach. PMID:24384276

Zaltz, Ira; Kelly, Bryan T; Larson, Christopher M; Leunig, Michael; Bedi, Asheesh

2014-01-01

388

Orthopedic surgical analyzer for percutaneous vertebroplasty  

NASA Astrophysics Data System (ADS)

Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically relevant finite element models. In conclusion, we were able to demonstrate the feasibility of our orthopedic surgical analyzer in a case for percutaneous vertebroplasty.

Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

2001-05-01

389

Surgical treatment of thymoma  

PubMed Central

Objective To describe experience with the surgical treatment of thymoma. Design A retrospective study. Setting A teaching hospital at the University of Ottawa. Patients Over 25 years, 42 consecutive patients (22 men, 20 women) who had a thymoma requiring operation. Interventions Thymectomy. Outcome measures Age, sex, association with myasthenia gravis, presence of a paraneoplastic syndrome, extent of surgical resection, tumour size, histologic features of the tumour, clinical staging of the thymoma and short- and long-term outcome after surgery. Results The mean (and standard deviation) age of the patients was 52.8 (12.5) years. Thirteen patients had myasthenia gravis. With respect to tumour staging, 24 patients had stage I, 7 had stage II and 11 had stage III disease. Three patients were lost to follow-up. Radiotherapy was used as an adjunct to surgical treatment in 83% of patients with stages II and III disease. Fifty-one percent of patients available for follow-up survived 175.1 months, and the cumulative 5- and 10-year overall survival rates were 87.3% and 81.4% respectively. Only 1 patient died of metastatic thymoma. Complete or partial remission of myasthenia gravis was seen in 10 (77%) affected patients. Mixed cellular histologic features and a tumour size of less than 115 cm3 were more commonly seen with stage I disease. Conclusions Thymomas are characterized by slow growth and prolonged survival even in patients with invasive disease as long as the tumour is resected completely and treatment is accompanied by radiotherapy. PMID:11837917

Mehran, Reza; Ghosh, Rishi; Maziak, Donna; O'Rourke, Keith; Shamji, Farid

2002-01-01

390

The effect of alcohol on surgical skills  

PubMed Central

INTRODUCTION The General Medical Council states ‘a surgeon must not work when their health state is adversely influenced by fatigue, disease, drugs or alcohol’. However, there are no defined criteria for acceptable blood alcohol levels when operating. The aim of this study was to measure the effect of varying amounts of alcohol on surgical dexterity, cognitive abilities and the social interactions required to ensure patient safety during a routine ear, nose and throat (ENT) operation. METHODS ENT surgeons were asked to perform a microlaryngoscopy with excision of a predetermined glottic lesion on a validated laryngeal model. The procedure was repeated four times over a period of four hours with varying doses of alcohol (no alcohol control, one glass, three glasses and six glasses of wine). The parameters recorded included theatre etiquette, surgical time, operative skills and patient safety. Scores were adjudicated by two independent observers. RESULTS The more glasses of wine consumed, the more detrimental the effect was on the surgical performance of all participants. There was a global reduction in ability of 7.25% after three glasses and 19.25% after six glasses of alcohol. No domain showed an improvement following sequential increase in blood alcohol concentration. CONCLUSIONS This study suggests that there are no deleterious effects on surgical performance following the consumption of one glass of wine 45 minutes prior to microlaryngoscopy among ENT surgeons of varying experience. However, there is clear evidence that with three or more glasses of wine there is an adverse effect on performance, with decreased surgical dexterity, cognition functions and professionalism. PMID:22391368

Kirby, G; Kapoor, K; Das-Purkayastha, P; Harries, M

2012-01-01

391

Institution of the Steiros Algorithm® Outpatient Surgical Protocol Reduced Orthopedic Surgical Site Infections (SSI) Rates  

PubMed Central

Background Control of surgical site infections (SSI) is imperative for the safety of our patients. As orthopedic surgeons we strive to have the lowest infection rate possible for all our surgical procedures. this study evaluates the effects of a simple outpatient peri-operative patient cleaning protocol (The Steiros Algorithm® Outpatient Surgery Protocol) on SSI rates. Methods We retrospectively reviewed the hospital's infection rate database for all procedures from July 2005 until February 2011 performed by one general orthopedic surgeon (PAW) within one hospital system. The Steiros Algorithm® Outpatient Surgery Protocol was instituted on January 1st, 2009. We calculated and compared the deep and superficial SSI rate for orthopedic surgeries performed before and after the Outpatient Protocol was instituted. All patients had a minimum of one-year follow-up data. Lowest previously published estimated costs for SSI were used for a cost analysis ($17,708). Results The July 1st, 2005 through December 31st, 2008 SSI rate was 1.0% (13/1292). From January 1st, 2009 through February 28th, 2011 the SSI rate was zero (0/875). the SSI rates decreased 100%. Due to the reduction in SSI, the hospital saved a minimum of $154,059 over a two year period. Conclusions In this retrospective review, the Steiros Algorithm® Outpatient Surgery Protocol dramatically reduced the overall SSI rate to zero and saved money. We believe this is a simple, effective protocol that can be used for all orthopedic surgical procedures. PMID:23576931

Watson, Paul A.; Watson, Luke; Torress-Cook, Alfonso

2012-01-01

392

Surgical treatments for Parkinson's disease.  

PubMed Central

OBJECTIVE: This article reviews surgical treatments for Parkinson's disease, emphasizing aspects pertinent to family physicians: rationale for and description of surgeries, patient selection issues, and outcome expectations. QUALITY OF EVIDENCE: No published series describes long-term follow up of a randomized controlled study of any surgery for Parkinson's disease. Some reports, however, describe thorough but brief follow up of functioning in small numbers of patients following surgery. MEDLINE articles were identified using Parkinson's disease, surgery, pallidotomy, thalamotomy, stimulation, grafting, and transplantation as search words. Articles chosen for this paper described patients with systematic follow up using accepted validated rating scales. MAIN MESSAGE: Reported series show impressive improvements to patients undergoing lesioning, stimulation, and grafting surgery for Parkinson's disease. These patients are typically severely disabled but highly selected, and follow up is brief. Stereotactic lesioning (pallidotomy and thalamotomy), deep brain stimulation (thalamic, and elsewhere) and grafting (striatal) can be performed safely, but results vary greatly among centres. CONCLUSIONS: Certain Parkinson's disease patients might benefit from surgery. Ideal candidates for pallidotomy experience motor fluctuations with disabling levodopa-induced dyskinesias. Tremors resistant to antiparkinsonian medications sometimes respond to thalamotomy or thalamic stimulation. Other parkinsonian syndromes, dementias, and difficulties with gait and balance respond poorly to unilateral pallidotomy. Bilateral deep brain stimulation procedures could benefit "midline" dysfunction. Images Figure 1 PMID:10690493

Uitti, R. J.

2000-01-01

393

Invisible barriers to clinical trials: the impact of structural, infrastructural, and procedural barriers to opening oncology clinical trials. | accrualnet.cancer.gov  

Cancer.gov

Analysis of clinical trial processes at a cancer center and three related community practices found steps that do not add value to the final protocol. Administrative barriers increase the length of time required to open a clinical trial.

394

[Current surgical treatment for gallbladder cancer].  

PubMed

Surgical resection offers the best chance for cure in patients with gallbladder cancer. An aggressive surgical approach to gallbladder cancer has been advocated to minimize morbidity and improve long-term survival. The theoretical mechanism of hepatic spread from gallbladder cancer includes direct extension, hematogenous metastasis, and lymphatic spread. Direct liver invasion and portal tract invasion are the main modes of hepatic spread from resectable gallbladder cancer. Portal tract invasion mainly results from lymphatic spread within the portal tracts. Partial hepatectomy involving the gallbladder bed is a critical part of gallbladder cancer resection and is a safe procedure. The performance of major hepatectomy is justified only if potentially curative resection is feasible. The presence of peripancreatic nodal disease is not a contraindication for radical resection. Combined major hepatectomy and pancreaticoduodenectomy provide survival benefit for some patients with locally advanced gallbladder cancer. Patients with gallbladder cancer with no bile duct involvement are potential candidates for this aggressive procedure, but the mortality rate after this procedure is higher. Patients with advanced gallbladder cancer should be managed at high-volume centers. The combination of surgery with chemotherapy should be established in the management of patients with locally advanced gallbladder cancer. PMID:25154236

Sakata, Jun; Takizawa, Kazuyasu; Takano, Kabuto; Kobayashi, Takashi; Minagawa, Masahiro; Wakai, Toshifumi

2014-07-01

395

Product of Tracking Experts for Visual Tracking of Surgical Tools Suren Kumar, Madusudanan Sathia Narayanan, Pankaj Singhal, Jason J. Corso and Venkat Krovi  

E-print Network

The field of surgical robotics had witnessed tremendous advancements over the last decade, transforming both) procedures result in minimal pre- and post- surgical trauma and faster recovery for the patients. However

Krovi, Venkat

396

Improving surgical training : maximising the benefits of surgical simulation  

Microsoft Academic Search

Background\\u000aSurgical training is undergoing a period of great change, partly due to the increasingly complex and specialised nature of modern surgical practice. Other factors include working hour restrictions and the need for efficient turnover which restrict trainingtime, and the growing awareness of ethical issues surrounding training on patients. Traditional apprenticeship models of surgical training are increasingly unfeasible and are

Emily Boyle

2009-01-01

397

[Rhabdomyolysis after prolonged surgical procedure in the lithotomy posture].  

PubMed

Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal surgery under general anaesthesia combined with thoracic epidural analgesia. The patient was in the lithotomy position during the ten hours time period of the surgery. As the patient was sedated in the intensive care unit, the diagnosis was made more difficult. Clinical signs consisted of pain, oedema and neurosensitive deficit in both legs. Creatinine kinase plasma concentration was increased. Treatment included fluid infusions and fasciotomy. The sequelae were major and consisted mainly in muscular deficiency of both legs. This complication is favoured by prolonged surgery and muscular compression elicited by non physiological positions. PMID:7818213

Muret, J; Farhat, F; Jayr, C

1994-01-01

398

[Two cases of penoscrotal elephantiasis treated by Ouzilleau's surgical procedure].  

PubMed

Two cases of penoscrotal elephantiasis treated following Ouzilleau's technique. The authors present two cases of penoscrotal elephantiasis operated following Ouzilleau's technique. This pathology is characterized by his painless, that the reason of a long time evolution and hence in consultation. Filariosis is the common etiology in tropical area. In our cases, the aetiology is unknown. Scrotal and penis elephantiasis is responsible of aesthetic and functional embarrassment. Resection of a considerable cutaneous mass associated with a reconstruction of the scrotal purse and the cutaneous sleeve of the penis using local flaps remain the suitable means to give a comfort of life. PMID:19939543

Kossoko, H; Allah, C K; Kadio, M Richard; Yéo, S; Djè, V Assi-Djè Bi

2011-06-01

399

[Procedural organisation: surgical and anaesthesiological management in hip fractures].  

PubMed

In patients with hip fractures, in order to reduce the high number of general complications and those associated with the specific treatment, the functional loss and cognitive impairment, implementation of co-ordinated, multidisciplinary treatment pathways, and rehabilitation, is mandatory. The imminent treatment of proximal femoral fracture consists of major orthopaedic surgery in most cases (total or partial hip arthroplasty, osteosynthesis). After the diagnosis of a hip fracture, an adequate pain medication should be initiated. The decision making for the fracture treatment includes fracture type, patient's age, cognitive function, mobility before the fall and functional demands of the patient in the context of patients life expectancy and goals of care. The anaesthesiological evaluation focuses on risk assessment. Medical abnormalities should be optimized within 24 to 48 h, or an increased perioperative risk due to comorbidities has to be accepted. The timing and the course of further preoperative diagnostic examinations and therapeutic interventions should be co-ordinated between the involved medical disciplines. After the operation a structured screening for delirium should be initiated and further evaluation of patient's nutrition, fall-associated medication, living conditions and osteoporosis treatment has to be performed. PMID:24201598

Müller, Ernst J; Gerstorfer, Ingeborg; Dovjak, Peter; Iglseder, Bernhard; Pinter, Georg; Müller, Walter; Pils, Katharina; Mikosch, Peter; Zmaritz, Michaela; Weissenberger-Leduc, Monique; Gosch, Markus; Thaler, Heinrich W

2013-10-01

400

Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft - surgical technique.  

PubMed

The standard approach to reconstruct the medial patellofemoral ligament (MPFL) is by mini-open incision at its patellar insertion and femoral origin. At the medial patella rim, the MPFL insertion may be visualized in most cases by dissection during surgery. On the femur, it is more difficult to localize the MPFL remnants by a mini-open incision due to soft tissue covering the anatomical origin. Therefore, the femoral MPFL origin is usually identified by intraoperative lateral fluoroscopy. However, the insertion and origin of the MPFL at the patella and femur might be directly visualized using an arthroscopic extraarticular approach from the knee joint through a window of the synovial layer. This is especially helpful on the femoral side but also at the patella to find the individual anatomical MPFL footprints. Arthroscopic extraarticular reconstruction may then be performed using one additional medial mid-parapatellar portal. The major advantages of this technique are an individualized anatomical procedure, which is minimal invasive and cosmetically appealing. The aim of this study was to describe the arthroscopic extraarticular approach to the MPFL insertion at the patella and origin at the femur through synovial windows and to explain the procedure of arthroscopic MPFL reconstruction with a gracilis tendon autograft. Level of evidence Expert opinion, surgical technique, Level V. PMID:22484369

Siebold, Rainer; Borbon, Carlo Angelo V

2012-07-01

401

A surgical support system for Space Station Freedom  

NASA Technical Reports Server (NTRS)

Surgical techniques in microgravity are being developed for the Health Maintenance Facility (HMF) on Space Station Freedom (SSF). This will be a presentation of the proposed surgical capabilities and ongoing hardware and procedural investigations. Methods: Procedures and prototype hardware, which include a medical restraint system, a surgical overhead isolation canopy, a suction device, and a regional laminar flow device were evaluated. This was accomplished by realistic sterile surgical simulations involving both mannequins and animals during KC-135 parabolic flight and in a high fidelity ground based HMF mockup. Results: Animal surgery in the environment of microgravity allowed the observation of unique arterial and venous bleeding characteristics for the first time. The ability to control bleeding and to prevent cabin atmosphere contamination was also demonstrated. Conclusions: The procedures and prototype hardware tested provided valuable information and should be investigated and developed further. The use of standard surgical techniques are possible in microgravity if the principles of personnel and supply restraint and operative field containment are adhered to.

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

1992-01-01

402

Ortho-surgical management of condylar hyperplasia: Rare case reports  

PubMed Central

Condylar hyperplasia of the mandible is a clinical condition of over-development and growth because of excessive cellular growth of one condylar part of the mandible leading to facial asymmetry, mandibular deviation and enlargement of condyle. The elongation of the condylar neck in turn leads to malocclusion and articular dysfunction. In the past the interceptive and corrective procedures of growth and deformity in condylar hyperplasia were either condylectomy or high condylotomy. However, the deformity ceases after growth is completed. Therefore, other surgical procedures have to be undertaken to correct the manifested deformity of condylar hyperplasia. Further it has to be stressed that no single procedure can completely correct the deformity. So in addition to condylectomy, other orthognathic surgical procedures both on body and ramus and also on maxilla can be undertaken to correct the canting of occlusion. Two rare cases of unilateral hyperplasia encountered in our hospital are presented which required different lines of treatment. PMID:25298720

Singh, Virendra; Verma, Ajay; Attresh, Gyanander; Batra, Jitender

2014-01-01

403

[Surgical treatment of ocular surface diseases].  

PubMed

Pathomechanisms leading to ocular surface diseases are difficult to influence, and conservative treatment efforts are inefficient in most cases. However, the development of microsurgical techniques, the clinical application of molecular biologic methods and the localisation and identification of the function of limbal stem cells made it possible to achieve visual improvement and quality of life in these cases. The authors review the methods of tissue harvesting, cell culturing, transplantation techniques and indications. They provide a detailed survey on the most recommended modern surgical procedures, especially focusing on amniotic membrane and limbal stem cell transplantation. PMID:19648078

Módis, László; Tóth, Eniko; Berta, András

2009-08-23

404

Combined endovascular and open revascularization.  

PubMed

The last decade has borne witness to a transformation in the care of patients with vascular disease. There has been a rapid transition towards minimally invasive techniques as interventionalists obtain increasingly advanced catheter-based skills and access to newer and more sophisticated devices. Patients who are not candidates for completely percutaneous revascularization, or those felt to be at prohibitive risk for traditional surgical reconstruction, may benefit from hybrid therapy, a combination of open surgery and endovascular repair that offers patients the opportunity for complete revascularization with decreased morbidity and mortality. This review examines applications of hybrid procedures for treating patients with disabling claudication and limb-threatening ischemia, aortic arch disease, thoracoabdominal aneurysms, extra-cranial carotid disease, and coronary artery disease. PMID:19359136

Slovut, David Paul; Sullivan, Timothy M

2009-01-01

405

Valgiza?ní vysoká osteotomie tibie u genu varum arthroticum rozev?ením klínu z vnit?ní strany stabilizovaná úhlov? stabilní dlahou TomoFix: Opera?ní technika Medial Opening-Wedge High Tibial Valgus Osteotomy, Using a Stable TomoFix Plate, in Genu Varum Arthritis: Surgical Technique  

Microsoft Academic Search

The authors present the technique of high tibial correction osteotomy by the medial opening procedure, with the use of an angle-stable TomoFix plate. The prerequisite for a long-term good outcome of corrective osteotomy in genu varum is to achieve limb alignment permitting transfer of weight-bearing from the affected medial compartment to the healthy lateral compartment of the knee. The development

D. HORÁ?EK; O. ?ECH; M. WEISSINGER; Mladá Boleslav

2006-01-01

406

Surgical Management of Patients with Chiari I Malformation  

PubMed Central

Chiari malformations (CMs) constitute a variety of four mainly syndromes (I, II, III, and IV), which describe the protrusion of brain tissue into the spinal canal through the foramen magnum. These malformations frequently occur in combination with other pathological entities such as myelomeningocele, hydrocephalus, and/or hydrosyringomyelia. The recent improvement of imaging techniques has increased not only the rate of CM diagnosis but also the necessity for its early treatment. Several different surgical techniques have been employed in the treatment of patients with symptomatic CM-I. In our current study, a systematic and critical review of the pertinent literature was made for identifying the most commonly employed surgical procedures in the management of these patients. Emphasis was given in outlining the advantages and disadvantages of each surgical approach. Moreover, an attempt was made for defining those parameters that may be prognostic factors for their surgical outcome. There is a consensus that surgical treatment is reserved only for symptomatic patients with CM-I. It has also been postulated that early surgically intervention is usually associated with better outcome. Despite the large number of previously published clinical series, further clinical research with large-scale studies is necessary for defining surgical treatment guidelines in these patients. PMID:22811732

Siasios, John; Kapsalaki, Eftychia Z.; Fountas, Kostas N.

2012-01-01

407

Analysis of exfoliated gastric carcinoma cells attached on surgical supplies  

PubMed Central

Surgery is considered to have a leading role in the treatment of gastric carcinoma. Surgical supplies are used to cut, divide, and ligate during surgery, and are not only in close contact with normal tissues, but may also be contaminated by pathological tissues and cells. This study sought to determine the presence of exfoliated tumor cells on surgical supplies at different stages during the surgical procedure. We collected five types of surgical supplies from 90 patients who underwent D2 radical gastrectomy to find out if there was any cancer cells attached to them. Highest numbers of cancer cells were found on gauze used to clean the surgical instruments and on the gloves of scrub nurses. The likelihood of finding cancer cells increased with advancing clinical stage of disease, lower differentiation of cancer cells, increasing frequency of use of supplies and extent of contact, and was also associated with the characteristic of surgical supplies. Dissemination of tumor cells could be prevented by using a number of methods, depending on the type of surgical supply items. PMID:25336978

Yu, Xiao-Fen; Ma, Ying-Yu; Hu, Xian-Qin; Zhang, Qin-Fang; Ye, Zai-Yuan

2014-01-01

408

[Surgical tactics in acute paraproctitis].  

PubMed

Individualized tactics of radical surgical treatment, applied in 100 patients, suffering an acute paraproctitis, was presented. Performing comparative estimation of the treatment results in 110 patients, in whom the conventional surgical approaches were applied, there was established, that an active surgical tactics secures essential reduction of the patients stationary treatment duration, the rate of the disease recurrence occurrence and transformation into the chronic illness. PMID:21698928

Bo?ko, V V; Babich, V A; Ivanova, Iu V; Lykhman, V N

2011-04-01

409

Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology  

Microsoft Academic Search

Objective: Computer (robotic) enhancement has been used to facilitate simple thoracoscopic procedures such as internal mammary artery (IMA) mobilization. This report describes the use of robotic technology in advanced thoracoscopic procedures. Methods: Ten patients underwent advanced thoracoscopic procedures utilizing the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) at our institution. Results: Patients 1–6 underwent endoscopic phrenic nerve

Jeffrey A. Morgan; Mark E. Ginsburg; Joshua R. Sonett; David L. S. Morales; Takushi Kohmoto; Lyall A. Gorenstein; Craig R. Smith; Michael Argenziano

2003-01-01

410

Results of open thoracoabdominal aortic aneurysm repair  

PubMed Central

Background Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) enables the effective replacement of the diseased aortic segment and reliably prevents aneurysm rupture. However, these operations also carry substantial risk of perioperative morbidity and mortality, principally caused by the associated ischemic insult involving the spinal cord, kidneys, and other abdominal viscera. Here, we describe the early outcomes of a contemporary series of open TAAA repairs. Methods We reviewed the outcomes of 823 open TAAA repairs performed between January 2005 and May 2012. Of these, 209 (25.4%) were Crawford extent I repairs, 264 (32.1%) were extent II, 157 (19.1%) were extent III, and 193 (23.5%