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Sample records for perioperative frozen section

  1. Perioperative coagulation management--fresh frozen plasma.

    PubMed

    Kor, Daryl J; Stubbs, James R; Gajic, Ognjen

    2010-03-01

    Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patients with liver disease, this practice needs broad reconsideration. Adverse effects of FFP include febrile and allergic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury. The latter is the most serious complication, being less common with the preferential use of non-alloimmunised, male-donor predominant plasma. FP24 and thawed plasma are alternatives to FFP with similar indications for administration. Both provide an opportunity for increasing the safe plasma donor pool. Although prothrombin complex concentrates and factor VIIa may be used as alternatives to FFP in a variety of specific clinical contexts, additional study is needed. PMID:20402170

  2. Grading of cervical dysplasias by frozen section.

    PubMed

    Fletcher, S; Smart, G E; Livingstone, J R

    1985-09-14

    Grading of cervical dysplasias at colposcopy by means of rapid frozen section avoids the delay inevitable with paraffin sections. The immediacy of the diagnosis benefits the patient, who can be treated at her first visit. A comparison of grading by frozen sections with paraffin sections has confirmed the safety of the frozen method. Additional advantages are opportunities for optimum orientation and "rescue" of specimens, improved colposcopic training, and the facilitation of special investigations on fresh cervical tissue. PMID:2863606

  3. Protocol for ultrarapid immunostaining of frozen sections.

    PubMed Central

    Richter, T; Nährig, J; Komminoth, P; Kowolik, J; Werner, M

    1999-01-01

    Rapid immunostaining of frozen sections within a tolerable time span would be very helpful for intraoperative diagnosis. A protocol was therefore established using the enhanced polymer one-step staining (EPOS) system (Dako) with antibodies against leucocyte common antigen (LCA), cytokeratin (CK), and anti-melanoma (MEL). Best results with reliable and specific immunostaining and a labelling intensity comparable to standard immunostaining protocols were achieved with fixation of samples in 100% acetone for 20 seconds (CK, LCA) or two minutes (MEL), followed by incubation of the primary antibody and development of the chromogen reaction with 3,3'diaminobenzidine (DAB) for three and five minutes at 37 degrees C, respectively. The total procedure takes only 12 minutes, thus enabling rapid immunostaining on intraoperative frozen sections. Apart from its use in tumour classification, this method is especially useful in detecting tumour cells in sentinel lymph nodes. Images PMID:10562816

  4. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    PubMed

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting. PMID:26596028

  5. The diagnostic value of frozen section for borderline ovarian tumours.

    PubMed

    Bozdag, Halenur; Guzin, Kadir; Gocmen, Ahmet; Kabaca, Sedef; Usta, Akın; Akdeniz Duran, Esra

    2016-07-01

    Borderline ovarian tumours (BOTs) are characterised histologically by a low degree of cellular proliferation and nuclear atypia in the absence of infiltrative growth or stromal invasion. Surgical treatment has been a crucial component of BOT therapy. Surgical decisions are established intraoperatively via the frozen section. We evaluated the accuracy of frozen section diagnosis. The rate of correct diagnosis, underdiagnosis and overdiagnosis of BOTs with frozen sections was 78%, 17% and 5%, respectively. The sensitivity and positive predictive values for the diagnosis of BOTs with frozen sections were 82.3% and 93.3%, respectively. The positive likelihood ratio was 0.82 (95% CI: 0.85-0.96). The histological classification of BOTs had a significant effect on the accuracy of diagnosis (p = 0.001). Frozen section diagnosis is not suitable to be considered as the gold standard for a definitive diagnosis. Clinicians should be aware that using frozen sections is insufficient for the accurate staging of BOTs. PMID:26790979

  6. Quantitative digital X-ray imaging using frozen hydrated and frozen dried tissue sections.

    PubMed

    Saubermann, A J; Heyman, R V

    1987-05-01

    Application of quantitative X-ray imaging to frozen hydrated tissue sections has presented a number of major problems including lack of a suitable algorithm which could deal effectively with mass loss due to radiation damage, problems of low characteristic X-ray signal to background ratios, and provide a means of analysis of the same location in both hydrated and dried states. This paper presents details of the application of our algorithm for analysis of frozen hydrated, then dried cryosections applied to quantitative X-ray imaging, which provides relatively high precision quantitative measurement of elemental content (related to both wet and dry weight) and water content of each pixel. This algorithm largely circumvents many of the problems of analysis of frozen hydrated tissue sections. Our algorithm for X-ray imaging obtains reasonably precise quantitative measurements coupled with morphological information by trading speed and image resolution. PMID:3612771

  7. [Perioperative metronidazole-prophylaxis for cesarian section (author's transl].

    PubMed

    Gerstner, G; Kofler, E; Huber, J

    1980-12-01

    A prospective, randomized clinical trial was conducted in 103 patients undergoing cesarian section to assess the efficacy of prophylactic, intravenously administered Metronidazole on the infectious morbidity. A group of 53 patients with perioperative Metronidazol-prophylaxis was compared to a similar controll-group without prophylaxis. Bacteriologic swabs were taken from the cervix pre- and postoperatively, using anaerobic transport media. Prophylactic Metronidazole reduced postoperative fever of more than 38 degrees C on two subsequent days from 60% in the controll-group to 30,2% in the Metronidazole-group (p less than 0,01) wound infections were reduced from 18% without to 5,7% with prophylaxis (p less than 0,05) and Endometritis from 30% without to 13,2% with prophylaxis (p less than 0,05). An additional antibiotic therapy was necessary in 44% of the cases in the controllgroup, compared to 24,5% of the cases in the Metronidazolegroup (p less than 0,05). The mean duration of hospitalisation was reduced from 12,1 +/- 3,2 days in the controll-group to 11,2 +/- 2,1 in the Metronidazole-group (p less than 0,01). Anaerobic bacteria were isolated from the servical swabs in 60% preoperatively, with a still increasing incidence to 72% postoperatively, compared to 7% in the Metronidazole-group. Our results suggest, that prophylactic, intravenously administered Metronidazol reduces the infectious morbidity following cesarian section due to the reduction of the anaerobic flora at the female genital-tract. PMID:7222872

  8. Laser Capture and Single Cell Genotyping from Frozen Tissue Sections.

    PubMed

    Kroneis, Thomas; Ye, Jody; Gillespie, Kathleen

    2016-01-01

    There is an increasing requirement for genetic analysis of individual cells from tissue sections. This is particularly the case for analysis of tumor cells but is also a requirement for analysis of cells in pancreas from individuals with type 1 diabetes where there is evidence of viral infection or in the analysis of chimerism in pancreas; either post-transplant or as a result of feto-maternal cell transfer.This protocol describes a strategy to isolate cells using laser microdissection and to run a 17plex PCR to discriminate between cells of haplo-identical origin (i.e., fetal and maternal cells) in pancreas tissue but other robust DNA tests could be used. In short, snap-frozen tissues are cryo-sectioned and mounted onto membrane-coated slides. Target cells are harvested from the tissue sections by laser microdissection and pressure catapulting (LMPC) prior to DNA profiling. This is based on amplification of highly repetitive yet stably inherited loci (short tandem repeats, STR) as well as the amelogenin locus for sex determination and separation of PCR products by capillary electrophoresis. PMID:26659805

  9. Raman molecular imaging of brain frozen tissue sections.

    PubMed

    Kast, Rachel E; Auner, Gregory W; Rosenblum, Mark L; Mikkelsen, Tom; Yurgelevic, Sally M; Raghunathan, Aditya; Poisson, Laila M; Kalkanis, Steven N

    2014-10-01

    Raman spectroscopy provides a molecular signature of the region being studied. It is ideal for neurosurgical applications because it is non-destructive, label-free, not impacted by water concentration, and can map an entire region of tissue. The objective of this paper is to demonstrate the meaningful spatial molecular information provided by Raman spectroscopy for identification of regions of normal brain, necrosis, diffusely infiltrating glioma and solid glioblastoma (GBM). Five frozen section tissues (1 normal, 1 necrotic, 1 GBM, and 2 infiltrating glioma) were mapped in their entirety using a 300-µm-square step size. Smaller regions of interest were also mapped using a 25-µm step size. The relative concentrations of relevant biomolecules were mapped across all tissues and compared with adjacent hematoxylin and eosin-stained sections, allowing identification of normal, GBM, and necrotic regions. Raman peaks and peak ratios mapped included 1003, 1313, 1431, 1585, and 1659 cm(-1). Tissue maps identified boundaries of grey and white matter, necrosis, GBM, and infiltrating tumor. Complementary information, including relative concentration of lipids, protein, nucleic acid, and hemoglobin, was presented in a manner which can be easily adapted for in vivo tissue mapping. Raman spectroscopy can successfully provide label-free imaging of tissue characteristics with high accuracy. It can be translated to a surgical or laboratory tool for rapid, non-destructive imaging of tumor margins. PMID:25038847

  10. Assessing Residents' Frozen Section Skills for Endometrial Cancer.

    PubMed

    Selove, William; Bradford, Leslie S; Liu, Yuxin

    2016-09-01

    Intraoperative frozen section (IFS) on endometrial cancer is an invaluable skill for pathologists-in-training to master. Within limited time constraints, pathologists are expected to determine tumor type, grade, and depth of myometrial invasion. During their training, pathology residents gradually gain experience in handling the majority of cases. However, significant errors can still be seen among senior level trainees. We aimed to improve training effectiveness by evaluating our trainees' performance, identifying common errors, and recommending focused curriculum. Twenty-two residents [postgraduate year (PGY)-1-PGY-4] performed 260 IFS during a 4-yr period. We compared their independent IFS diagnoses with final diagnoses. Overall resident IFS accuracy was 73%. Accuracy for tumor type and depth of myometrial invasion was 80% and 93%, respectively. Two thirds of errors were due to sampling with the rest because of interpretation. Major deficiencies lay in recognizing high-risk histologic types (serous, clear cell, sarcoma) and unconventional myometrial invasion patterns (MELF, adenoma malignum, and adenomyosis-like). Resident IFS errors would theoretically result in suboptimal staging for 32 (12%) patients and unnecessary staging for 1 (0.4%). Overall IFS performance improved as training level increased (76% accuracy for PGY-1 accompanied by PGY-5; 59% for PGY-2; 74% for PGY-3; and 86% for PGY-4). We recommend a dedicated curriculum targeting these difficult yet clinically important entities through review literature and a collection of classic cases demonstrating the diverse morphology variations. Implementing such focused training would greatly improve our trainees' competence on IFS, preparing them to handle a wide variety of cases and situations in future practice. PMID:26598984

  11. Contraction-free, fume-fixed longitudinal sections of fresh frozen muscle

    NASA Technical Reports Server (NTRS)

    Riley, Danny A.; Slocum, Glenn R.

    1988-01-01

    Contraction damage occurring when longitudinal frozen sections of fresh unfixed muscles are thawed on microscope slides has limited histological examination of this tissue mainly to cross sections. Longitudinally oriented sections are advantageous for investigating properties that vary along the length of the muscle fibers. A fume fixation technique has been developed for preventing contraction of thick longitudinal frozen sections. The technique is compatible with histochemical staining of enzymes.

  12. The Bethesda System for Reporting Thyroid Cytopathology is applicable to frozen section diagnosis in children.

    PubMed

    Arnold, Michael A; Nicol, Kathleen K

    2015-01-01

    The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) offers standardized and widely understood diagnostic categories for reporting thyroid cytology diagnoses. We compared the utility of TBSRTC categories in pediatric cytology diagnoses and pediatric intraoperative frozen section diagnoses. We examined the experience of our primary and referral care center over a 20-year period. This included 182 thyroidectomy patients who underwent 64 preoperative fine-needle aspirations and 91 intraoperative frozen section evaluations, including 38 patients evaluated sequentially by each method. All diagnoses were retrospectively reclassified into TBSRTC categories and correlated with the final thyroidectomy diagnoses. For each sampling method, malignant final diagnoses were observed at similar frequencies to rates predicted by TBSRTC. Malignant final diagnoses following fine-needle aspiration or frozen section diagnoses in TBSRTC categories other than malignant or suspicious for malignancy most often resulted from difficulty in detecting papillary carcinoma, including difficulty detecting the nuclear characteristics of papillary carcinoma in frozen sections. The limitations of needle biopsy and frozen section evaluations differ, yet serial utilization of these procedures was rarely informative. Based on the experience of our institution, classification of cytology and frozen section diagnosis by TBSRTC predicts a risk of malignancy similar to the guidance offered by TBSRTC. We recommend including a TBSRTC category when reporting either thyroid cytology or frozen section diagnoses in children. PMID:25625563

  13. Freezing in Sealed Capillaries for Preparation of Frozen Hydrated Sections

    PubMed Central

    Yakovlev, Sergey; Downing, Kenneth H.

    2014-01-01

    We have investigated the freezing of specimens in a confined volume for preparation of vitreous samples for cryosectioning. With 15% dextran as a cryoprotectant, a sample sealed in a copper tube begins to freeze into crystalline ice when plunged into liquid ethane. Crystallization rapidly causes an increase in the pressure to the point that much of the sample freezes in a vitreous state. We used synchrotron X-ray diffraction of samples frozen with various amounts of dextran to characterize the ice phases and crystal orientation, providing insights on the freezing process. We have characterized cryosections obtained from these samples to explore the optimum amount of cryoprotectant. Images of cryosectioned bacteria frozen with various levels of cryoprotectant illustrate effects of cryoprotectant concentration. PMID:22077543

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

    PubMed

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

    1995-12-01

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

  15. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

    PubMed Central

    Klett, Dane E.; Abdollah, Firas; Sammon, Jesse D.; Pucheril, Dan; Menon, Mani; Jeong, Wooju; Peabody, James O.

    2016-01-01

    Purpose To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy. PMID:27195322

  16. Excision of periocular basal cell carcinoma guided by en face frozen section.

    PubMed

    Tullett, Mark; Sagili, Suresh; Barrett, Andrew; Malhotra, Raman

    2013-09-01

    We describe a technique for monitoring excision margins in periocular basal cell carcinoma (BCC) using en face frozen sections and report outcomes. We excised periocular BCC with 3mm margins. An outer 1mm sliver of the perimeter of the specimen was mapped and sent for evaluation by en face frozen section. The central tumour mass was processed using routine paraffin sections. A further 3mm level was excised at the site of any affected margin and the outer 1mm sliver was again evaluated by frozen section. We identified 78 patients from November 2003 to July 2009; 67 had primary tumours and 11 (14%) had recurrent BCC of which 52 (66%) were located on the lower eyelid. Growth patterns were nodular (n=34, 43%), infiltrative (n=25, 32%), micronodular (n=12, 16%), and superficial (n=7, 9%). A third of BCC with a clinically nodular appearance showed additional histological patterns including infiltrative and micronodular growth patterns. Of 30 clinically nodular carcinomas, 29 were excised completely with one level, and one required 2 levels of excision for clearance after evaluation by frozen section. Mean follow-up was 23 months (range 2-60). There was one recurrence (1%). Excision of margins guided by en face frozen section is justified by the low rates of recurrence, and it can easily be taught or imported into hospital practice. Clinically nodular BCC have subclinical extensions that can be missed on bread loaf sectioning, which makes the sampling of margins a standard for periocular BCC. PMID:23219018

  17. FNAC and frozen section correlations with definitive histology in thyroid diseases.

    PubMed

    Mayooran, Nithiananthan; Waters, Peadar S; Kaim Khani, Tahir Y; Kerin, Michael J; Quill, Denis

    2016-08-01

    The ability to diagnose thyroid cancers pre-op or intra-operatively by fine needle aspiration cytology (FNAC) or frozen section (FS) leads to the delivery of appropriate one-stage surgical management. We aim to study the concordance and discordance of FNAC and FS with final histology in thyroid pathologies. All thyroid procedures from 2007 to 2011(n = 423), involving FNAC and or frozen section in their management pathway were included. FNAC (n = 159) were classified in a five-tier system (Nondiagnostic, Benign, Atypical, Suspicious or Malignant). FS (n = 128) were classified as inconclusive, benign, suspicious or malignant. FNAC and FS were correlated with final histopathology. 159 out of 423 patients had FNAC (PPV 85.1 %), 26 inadequate specimens noted, benign cytology 57, atypical (n = 23), follicular neoplasm (n = 27), suspicious for malignancy (n = 16) and malignant 11. 13 out of 27 follicular neoplasm and 6 of atypical FNAC cases showed malignancy in their final histopathology. Frozen sections; total of 126 patients had intra-operative frozen section biopsies performed. Overall 105 out of 126 FS biopsies were benign; 21 malignancies detected intraoperatively. Three FS were inconclusive and reported benign in final histopathology. Overall, FNAC demonstrated a PPV of 66.6 % and NPV of 84.6 %. FS demonstrated PPV and NPV of 76.1 and 85.7%, respectively. In conclusion, FNAC is considered as the best modality to triage the thyroid nodule pre-operatively. Atypical and follicular neoplasm cytology categories warrant further clinical assessment and close follow-ups when appear benign. The intra-operative frozen sections are helpful to perform a one-stage operation for suspicious thyroid lesion. This study also highlights the recognised limitation of intra-operative frozen section analysis of thyroid neoplasia. PMID:26242254

  18. Quantification of sarcomere length distribution in whole muscle frozen sections.

    PubMed

    O'Connor, Shawn M; Cheng, Elton J; Young, Kevin W; Ward, Samuel R; Lieber, Richard L

    2016-05-15

    Laser diffraction (LD) is a valuable tool for measuring sarcomere length (Ls), a major determinant of muscle function. However, this method relies on few measurements per sample that are often extrapolated to whole muscle properties. Currently it is not possible to measure Ls throughout an entire muscle and determine how Ls varies at this scale. To address this issue, we developed an actuated LD scanner for sampling large numbers of sarcomeres in thick whole muscle longitudinal sections. Sections of high optical quality and fixation were produced from tibialis anterior and extensor digitorum longus muscles of Sprague-Dawley rats (N=6). Scans produced two-dimensional Ls maps, capturing >85% of the muscle area per section. Individual Ls measures generated by automatic LD and bright-field microscopy showed excellent agreement over a large Ls range (ICC>0.93). Two-dimensional maps also revealed prominent regional Ls variations across muscles. PMID:26994184

  19. Electron microscopy of frozen hydrated sections of vitreous ice and vitrified biological samples.

    PubMed

    McDowall, A W; Chang, J J; Freeman, R; Lepault, J; Walter, C A; Dubochet, J

    1983-07-01

    The preparation and high resolution observation of frozen hydrated thin sections has been studied by transmission electron microscopy (TEM and STEM) on model systems, including pure water, protein solutions, catalase crystals, myelin sheath and various tissues. The state of the ice is determined by electron diffraction. Mass measurement in the electron microscope is used to determine section thickness and control hydration. An adequate depth of vitrified material for sectioning can be obtained from many biological suspensions or untreated tissues. Frozen hydrated sections around 100 nm thick can be produced under optimal conditions from vitreous ice or from vitrified biological samples. Sectioning, transfer and observation in the electron microscope is feasible without alteration of the sample hydration or its initial vitrification. Biological structures can be preserved and observed down to 10 nm. Under favourable working conditions, specimen compression during sectioning and electron beam damage are the factors limiting high resolution observations. PMID:6350598

  20. FROZEN THIN SECTIONS OF FRESH TISSUE FOR ELECTRON MICROSCOPY, WITH A DESCRIPTION OF PANCREAS AND LIVER

    PubMed Central

    Christensen, A. Kent

    1971-01-01

    A simple method has been developed that allows frozen thin sections of fresh-frozen tissue to be cut on a virtually unmodified ultramicrotome kept at room temperature. A bowl-shaped Dewar flask with a knifeholder in its depths replaces the stage of the microtome; a bar extends down into the bowl from the microtome's cutting arm and bears the frozen tissue near its lower end. When the microtome is operated, the tissue passes a glass or diamond knife in the depths of the bowl as in normal cutting. The cutting temperature is maintained by flushing the bowl with cold nitrogen gas, and can be set anywhere from about -160°C up to about -30°C. The microtome is set for a cutting thickness of 540–1000 A. Sections are picked up from the dry knife edge, and are placed on membrane-coated grids, flattened with the polished end of a copper rod, and either dried in nitrogen gas or freeze-dried. Throughout the entire process the tissue is kept cold and does not come in contact with any solvent. The morphology seen in frozen thin sections of rat pancreas and liver generally resembles that in conventional preparations, although freezing damage and low contrast limit the detail that can be discerned. Among unusual findings is a frequent abundance of mitochondrial granules in material prepared by this method. PMID:4942776

  1. Micro-PIXE analyses of frozen-hydrated semi-thick biological sections

    NASA Astrophysics Data System (ADS)

    Wang, Y. D.; Mesjasz-Przybylowicz, J.; Tylko, G.; Barnabas, A. D.; Przybylowicz, W. J.

    2013-07-01

    Cryo-micro-PIXE system and methodology of microanalysis of frozen-hydrated semi-thick biological sections is described. A commercially available cryotransfer system used in electron microscopy has been adapted for this purpose. The analyzed material was frozen by metal-mirror method and sections of 20-50 micron thickness were prepared. Micro-PIXE and simultaneous proton backscattering was performed using 3 MeV proton beam. Monitoring of water vapour composition during the proton bombardment showed good stability of the analyzed material. The results of repetitive analyses of standards prepared from gelatin-glycerol solution with added known concentrations of K, Ni, Cu, Zn were in good agreement with expected, calculated values. Mass losses and changes of elemental composition were monitored. Elemental maps obtained for frozen-hydrated semi-thick section of Ni hyperaccumulator Senecio coronatus showed excellent preservation of leaf morphology and the distribution of elements. Quantitative elemental mapping of frozen-hydrated specimens compared with subsequent analysis of the same areas after freeze-drying revealed similar distribution pattern in both cases. It is clear, however, that freeze-drying induces some distortion of cell morphology and specimen shrinkage.

  2. Diagnostic accuracy of remote frozen sections compared with paraffin-embedded sections: a telepathology project in Austria

    NASA Astrophysics Data System (ADS)

    Moser, Patrizia; Soegner, Peter I.; Stadlmann, Sonja; Jacobs, Jan; Mikuz, Gregor

    2000-04-01

    The purpose of the present study was to evaluate the diagnostic accuracy of remote frozen sections examined by telepathology. The gold standard was the diagnosis made using direct examination of paraffin-embedded sections. A consecutive series of 134 frozen-section cases were examined by six qualified pathologists. We used the Zeiss telepathology system with robot microscopy, which allowed different magnifications and fields of view to be chosen. The wide-area network used the TCP/IP protocol. The diagnosis made on the frozen sections was compared with the final diagnosis in the paraffin-embedded sections. Times were recorded for each telepathology session, as well as the users comments on usability and software, and on any communication problems which occurred. In addition, we evaluated the importance of the macroscopic sampling of the surgical specimen, applied to each type of tissue. The diagnostic evaluation showed complete agreement in approximately 80% of cases, in 20% diagnosis was not possible due to insufficient quality of the slides. The median time for the telemedicine diagnosis was 14 min 30 sec.

  3. Extraction of DNA from small sections of frozen tissue with simultaneous histological examination.

    PubMed Central

    Cotter, F E; Hall, P A; Young, B D

    1988-01-01

    Though analysis of small sections of biopsy material by molecular techniques permits increased sensitivity, it also requires accurate histological examination of the tissue in order to reduce sampling error. A technique for the extraction of DNA from small sections of frozen biopsy material with simultaneous histological examination from adjacent sections is described that may enhance the accuracy of characterisation of the tissue, particularly where there is focal variation. The quality of the DNA obtained enables a full range of molecular studies to be carried out. Images Fig 1 Fig 2 PMID:3192737

  4. A reliable frozen section technique for basal cell carcinomas of the head and neck

    PubMed Central

    Menesi, Wisam; Buchel, Edward W; Hayakawa, Thomas JE

    2014-01-01

    Basal cell carcinomas (BCCs) of the head and neck treated by conventional techniques of surgical excision, curettage, cryotherapy and radiation therapy have recurrence rates of up to 42%. Mohs micrographic surgery (MMS) decreases the recurrence rate but can be expensive, delay definitive reconstruction and is limited in its availability. The authors report a series of 50 patients with head and neck BCCs treated by a surgeon-directed ‘en face’ frozen section technique that immediately evaluates the entire peripheral and deep margins during BCC resection, and potentially offers a more efficient and equally effective alternative to MMS. Patient demographics, pathology results, operative time, technique and outcomes are all reported. With a mean follow-up of three years, there was only one recurrence (1.7%). Mean total operative time was 1 h 47 min. The authors conclude that this surgeon-directed ‘en face’ frozen section technique does not require any specialized training, enables more rapid and reliable results than standard frozen section techniques that are currently used, and provides outcomes equivalent to MMS in the surgical treatment of head and neck BCCs. PMID:25332646

  5. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis.

    PubMed

    Basaran, D; Salman, M C; Calis, P; Ozek, A; Ozgul, N; Usubütün, A; Yuce, K

    2014-07-01

    The objective of our study was to evaluate the accuracy of frozen section (FS) in borderline ovarian tumours (BOT) and to define the factors associated with misdiagnosis during FS evaluation. We performed a retrospective review of patients who underwent exploratory laparotomy for an adnexal mass, from January 2007 to July 2012, at a tertiary oncology centre in Turkey. Patients with a diagnosis of BOT either in FS or in permanent pathology were identified. Agreement between FS diagnosis and permanent histology was observed in 37/59 patients (62.7%), which gave a sensitivity and a positive predictive value of 71.2% and 84.1%, respectively. In patients with a diagnosis of BOT by frozen section only (n = 44), the diagnosis was consistent with permanent histopathology in 37/44 patients (84.1%). Frozen section interpreted a malignant tumour as BOT (under-diagnosis) in 6/44 (13.6%) of cases and interpreted a benign lesion as BOT (over-diagnosis) in 1/44 (2.3%) of cases. Slide review of discrepant cases revealed that major pathological causes of under-diagnosis were misinterpretation and sampling errors. Univariate analysis showed that presence of bilateral tumour and positive peritoneal cytology were associated with under-diagnosis. We concluded that, despite significant risk of under-diagnosis, FS analysis is an accurate method for intraoperative diagnosis of BOTs. PMID:24734941

  6. Frozen section evaluation of breast carcinoma sentinel lymph nodes: a retrospective review of 1,940 cases.

    PubMed

    Poling, Justin S; Tsangaris, Theodore N; Argani, Pedram; Cimino-Mathews, Ashley

    2014-11-01

    Many sentinel lymph node biopsies (SLNBs) are evaluated intraoperatively by frozen section, which may impact the need for further axillary dissection (AD). However, the need for AD in patients with small metastases has been recently called into question, meaning that frozen SLNB may be unnecessary. Furthermore, frozen section can compromise tissue for further study. At our institution, we grossly evaluate all SLNB and freeze half of the node. Here, we evaluate the frozen SLNB discrepancy rate using this method, focusing on cause of discrepancy and need for further surgery. We reviewed surgical pathology records for all breast cancer resections with frozen section of SLNB examined from 2003 to 2012. For cases with a frozen section discrepancy, we compiled clinicopathologic data. In total, 1,940 cases involved frozen section evaluation of SLNB. In 95 cases (4.9% of total cases, 23.8% of positive node cases), the SLNB was called negative on frozen but positive on final examination (false negatives). The majority of missed metastases are isolated tumor cells or micrometastases. A trend was observed toward fewer patients receiving completion AD after a discrepant frozen SLNB in the later years of the study. The protocol of freezing half of a SLNB is a reasonable method, with results similar to or better than other studies. The main adverse outcome is the need for separate AD; however, additional positive nodes are uncommon. The trend of fewer patients getting additional AD after a discrepant frozen SLNB suggests that clinicians may be using this information differently recently. PMID:25318925

  7. Errors, limitations, and pitfalls in the diagnosis of central and peripheral nervous system lesions in intraoperative cytology and frozen sections

    PubMed Central

    Chand, Priyanka; Amit, Sonal; Gupta, Raghvendra; Agarwal, Asha

    2016-01-01

    Context: Intraoperative cytology and frozen section play an important role in the diagnosis of neurosurgical specimens. There are limitations in both these procedures but understanding the errors and pitfalls may help in increasing the diagnostic yield. Aims: To find the diagnostic accuracy of intraoperative cytology and frozen section for central and peripheral nervous system (PNS) lesions and analyze the errors, pitfalls, and limitations in these procedures. Settings and Design: Eighty cases were included in this prospective study in a span of 1.5 years. Materials and Methods: The crush preparations and the frozen sections were stained with hematoxylin and eosin method. The diagnosis of crush smears and the frozen sections were compared with the diagnosis in the paraffin section, which was considered as the gold standard. Statistical Analyses Used: Diagnostic accuracy, sensitivity, and specificity. Results: The diagnostic accuracy of crush smears was 91.25% with a sensitivity of 95.5% and specificity of 100%. In the frozen sections, the overall diagnostic accuracy was 95%, sensitivity was 96.8%, and specificity was 100%. The categories of pitfalls noted in this study were categorization of spindle cell lesions, differentiation of oligodendroglioma from astrocytoma in frozen sections, differentiation of coagulative tumor necrosis of glioblastoma multiforme (GBM) from the caseous necrosis of tuberculosis, grading of gliomas in frozen section, and differentiation of the normal granular cells of the cerebellum from the lymphocytes in cytological smears. Conclusions: Crush smear and frozen section are complimentary procedures. When both are used together, the diagnostic yield is substantially increased. PMID:27279685

  8. Omental sclerosing extramedullary hematopoietic tumors in Janus kinase-2 negative myelofibrosis: caveat at frozen section.

    PubMed

    Shinde, Sweety V; Shenoy, Asha S; Balsarkar, Dharmesh J; Shah, Vinaya B

    2014-01-01

    Sclerosing extramedullary hematopoietic tumors (SEMHTs) are associated with chronic myeloproliferative neoplasms. These extremely rare mass lesions were first described in kidney and peritoneum. On histopathology, they are characterized by sclerosis, entrapped fat, atypical megakaryocytes with myeloid and erythroid elements. Only approximately ten cases have been subsequently reported in orbit, lacrimal system, liver, omentum, and skin. The authors present a case of SEMHTs as incidentally detected omental nodules, while the patient was undergoing splenectomy for Janus kinase-2 negative myelofibrosis. The authors postulate their origin in omentum-associated lymphoid tissue; and highlight the diagnostic dilemma presented by SEMHTs at frozen section. PMID:25118752

  9. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section

    PubMed Central

    Hassan, Hossam Ibrahim Eldesuky Ali

    2014-01-01

    Background: Cesarean section (CS) is the one of the most common surgical procedure in women. There is preoperative stress effect before the delivery of the baby as (intubation and skin incision). There is acute postoperative pain, which may be progressed to chronic pain. All these perioperative stress effects need for various approach of treatment, which including systemic and neuraxial analgesia. The different analgesia modalities may affect and impair early interaction between mother and infant. Preemptive intravenous (I.V.) paracetamol (before induction) may reduce stress response before the delivery of the baby, intraoperative opioids and postoperative pain. Objectives: The aim of this study to compare between the administration of I.V. paracetamol as: Preemptive analgesia (preoperative) and preventive analgesia (at the end of surgery) as regards of hemodynamic, pain control, duration of analgesia, cumulative doses of intraoperative opioids and their related side-effects and to compare between two different protocols of postoperative analgesia and their cumulative doses. Patients and Methods: Sixty patients undergoing elective CS were randomly enrolled in this study and divided into two groups of 30 patients each. Group I: i.V. paracetamol 1 g (100 ml) was given 30 min before induction of anesthesia. Group II: i.V. paracetamol 1 g (100 ml) was given 30 min before the end of surgery. Heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation were recorded. Postoperative pain was assessed by visual analog score. Postoperative pethidine was given by two different protocols: group I: 0.5 mg/kg was divided into 0.25 mg/kg intramuscular and 0.25 mg/kg I.V. Group II was given pethidine 0.5 mg/kg I.V. Doses of intraoperative fentanyl, postoperative pethidine, duration of paracetamol analgesic time, time to next analgesia, and side-effects of opioid were noted and compared. Result: Preemptive group had hemodynamic stability

  10. Utility of Fresh Frozen Section Analysis in Foot and Ankle Surgery: A Pilot Study.

    PubMed

    Monaco, Spencer J; Manway, Jeffery M; Burns, Patrick R

    2016-01-01

    The use of intraoperative fresh frozen section (FFS) analysis to determine the presence of infection has been well reported in orthopedic studies. Specifically, the number of polymorphonuclear leukocytes per high-power field has been used to diagnose total joint arthroplasty-related infection. Less commonly, reconstructive surgeons have extended the use of FFS analysis for intraoperative evaluation when suspicion of deep infection with or without hardware is high. The purpose of the present study was to retrospectively review the data from 11 patients undergoing foot and ankle reconstruction in the setting of possible deep infection and determine the usefulness of FFS analysis. A retrospective review of the medical records of patients who had undergone reconstructive foot and ankle revision surgery with intraoperative FFS analysis and tissue/swab cultures available was performed. A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field. A positive frozen section was associated with a positive tissue culture 4 of 7 times (57%). The sensitivity and specificity of FFS analysis for infection was 80% and 50%, respectively. The positive and negative predictive value of the FFS result was 57.1% and 75%, respectively. In conclusion, FFS analysis and intraoperative cultures correlated only 57% of the time in the present series. This test had moderate sensitivity for detecting infection at 80%, but the specificity was poor (50%). More research is needed to further evaluate the role of FFS analysis in foot and ankle surgery. PMID:27068638

  11. Evaluation of panoramic digital images using Panoptiq for frozen section diagnosis

    PubMed Central

    Pradhan, Dinesh; Monaco, Sara E.; Parwani, Anil V.; Ahmed, Ishtiaque; Duboy, Jon; Pantanowitz, Liron

    2016-01-01

    Introduction: Whole slide imaging (WSI) permits intraoperative consultations (frozen sections) to be performed remotely. However, WSI files are large and can be problematic if there are tissue artifacts (e.g., tissue folds) or when slides are scanned without multiplanes (Z-stacks) to permit focusing. The Panoptiq dynamic imaging system allows users to create their own digital files that combine low power panoramic digital images with regions of interest that can be imaged using high power Z-stacks. The aim of this study was to determine the utility of the Panoptiq dynamic imaging system for frozen section telepathology. Materials and Methods: Twenty archival randomly selected genitourinary surgical pathology frozen sectional cases were evaluated using conventional light microscopy (glass slides), panoramic images, and whole slide images. To create panoramic images glass slides were digitized using a Prosilica GT camera (model GT1920C, Allied Vision Technologies) attached to an Olympus B × 45 microscope and Dell Precision Tower 810 computer (Dell). Panoptiq 3 version 3.1.2 software was used for image acquisition and Panoptiq View version 3.1.2 to view images (ViewsIQ, Richmond, BC, Canada). Image acquisition using Panoptiq software involved a pathology resident, who manually created digital maps (×4 objective) and then selected representative regions of interest to generate Z-stacks at higher magnification (×40 objective). Whole slide images were generated using an Aperio XT Scanscope (Leica) and viewed using ImageScope Software (Aperio ePathology, Leica). Three pathologists were asked to render diagnoses and rate image quality (1–10) and their diagnostic confidence (1–10) for each modality. Results: The diagnostic concordance with glass slides was 98.3% for panoramic images and 100% for WSI. Panoptiq images were comparable to the glass slide viewing experience in terms of image quality and diagnostic confidence. Complaints regarding WSI included poor focus

  12. Frozen-section diagnosis by wireless telepathology and ultra portable computer: use in pathology resident/faculty consultation.

    PubMed

    Frierson, Henry F; Galgano, Mary T

    2007-09-01

    Residents in anatomic pathology are allowed increased diagnostic responsibility including the initial interpretation of intraoperative frozen-section consultations during their years of training. This frozen-section responsibility requires staff faculty backup for diagnostic confirmation and consultation. In this study, we tested a telepathology system using an ultra portable computer with a 4.5-in diagonal screen (scrolled image size of 2.5 x 1.75 in, width x height) and both wireless Local Area Network (LAN) final connection from a DSL and wireless Wide Area Network (WAN) telecommunications. The diagnostic agreement for a chief resident/faculty staff duo using telepathology for 100 consecutive frozen-section cases (50 with wireless LAN final connection and 50 with wireless WAN) with limited clinical information was compared with the original frozen-section diagnosis rendered by other staff pathologists. There was diagnostic agreement for 95 of the 100 cases. For the 5 that were discordant, 2 were deemed to be errors in the original frozen-section diagnosis; 1 was not clinically important; and 2 were believed to have potential clinical implications. For the 2 having potential clinical importance, the absence of knowledge of the gross findings in each case and the preoperative biopsy results for one specimen contributed to the misinterpretation of the frozen sections. The median time between transmission of image(s) from the chief resident to the faculty consultant until diagnosis by the latter was 1 minute 42 seconds for wireless WAN and 51 seconds for the wireless LAN final connection to the display device. We conclude that a telepathology system using an ultra portable computer and wireless telecommunications is useful for frozen-section consultation between an experienced resident and a faculty member in pathology. PMID:17555793

  13. Forecast on the application of Japanese universal service fund to remote diagnosis for frozen section.

    PubMed

    Nakajima, Isao

    2010-12-01

    Due to the socioeconomic reason in Japan, some cancer patient is sometimes operated at a rural hospital where only several surgeons perform and no pathologist checks its malignancy. Therefore, the system of the remote diagnosis for frozen section has been standing up in this country for 7 years. In Japan, the USF has started from February 2007 to support only telecommunications operator's hardware (NTT's equipment such as digital switch board) in high cost areas, not for the reimbursement of the tariff of the public users, such as telepathology. To solve such social cormorant equality, when the USF and PAs were supported in the present quick frozen intraoperative telepathology diagnosis, the quality of the cancer treatment in rural area will be improved. Based on the past data of the Japanese telepathology with beta distribution function, it can be estimated that user terminals becomes five times more than present users with support of USF and PAs. Moreover, using VPN on the B'FLETS, the effect of other teleconsultations will spread to the nationwide. PMID:20703605

  14. A comparative study of frozen-section immunoperoxidase and flow cytometry for immunophenotypic analysis of lymph node biopsies.

    PubMed Central

    Biesemier, K W; Dent, G A; Pryzwansky, K B; Folds, J D

    1994-01-01

    Immunophenotyping by flow cytometry and frozen-section immunoperoxidase was compared on 21 consecutive lymph node biopsy specimens, of which a diagnosis of lymphoma was made for 11 specimens. Samples for flow cytometry were obtained by a fine-needle aspiration technique. Concordance between frozen-section immunoperoxidase and flow cytometry for all routine markers on all specimens ranged from 76 to 100%. In general, B-cell markers showed poorer concordance than T-cell markers, with kappa and lambda light chains having the poorest concordance, at 76% each. Flow cytometry was significantly more sensitive (90 versus 30%; P < 0.006) and had a significantly higher negative predictive value (100 versus 63%; P < 0.006) than frozen-section immunoperoxidase for demonstrating light-chain restriction. There was no significant difference in the specificities (100 versus 91%) or positive predictive values (100% each) between the two methods. Both methods demonstrated characteristic immunophenotypes for intermediate cell lymphomas, small lymphocytic lymphomas, and T-cell lymphoblastic lymphomas. Frozen-section immunoperoxidase and flow cytometry appear to be significantly concordant methods for immunophenotypic analysis of lymph node biopsies. Light-chain restriction is more readily demonstrated by flow cytometry than frozen-section immunoperoxidase. We believe that ex vivo fine-needle aspiration is a simple and reliable method of obtaining cell suspensions of lymph nodes for flow cytometry. PMID:7496966

  15. Palatal process movement in the rat as demonstrated in frozen sections.

    PubMed Central

    Diewert, V M; Tait, B

    1979-01-01

    During mammalian secondary palate development, movement of the lateral palatine processes from the vertical plane to the horizontal plane involves a complex interaction of the palatine processes and the tongue within a dynamic growing oronasal cavity environment. This study of pre-fixation facial profile photographs and frozen sections was undertaken to evaluate external and internal changes in the oronasal complex during secondary palate elevation without the shrinkage known to be present with routinhistological preparation of embryonic tissues. Frozen sections of Sprague-Dawley rat embryos between 15 and 17 days of (conceptual) age were prepared by hexane quenching and cryostat cutting. The results showed that, during the stages of palate development prior to shelf elevation, the tongue and mandible became positioned beneath the primary palate, and the vertical dimension of the oronasal cavity increased by the lifting of the nasomaxillary complex. The tongue and mandible maintained contact with the primary palate, whereas a space developed above the tongue in the middle and posterior palate regions. As the vertical dimension increased the volume of the palatomaxillary processes increased rapidly, the tongue became squeezed, and the palatine processes bulged medially above the level of the tongue. After shelf elevation extensive contact between the palatine processes was present, and the tongue became flattened. The results of this study support the observations of Lazzaro (1940) that rapid increase in shelf volume owing to increased intercellular volume contributes to movement of the processes above the tongue. But, rapid increase in shelf volume occurred contemporaneously with the time when the tongue and mandible outgrew the oronasal cavity and became positioned beneath the primary palate. Therefore, it would appear that the simultaneous occurrence of a lower and more forward tongue position, and an increased palatomaxillary process volume without change in

  16. The role of intraoperative frozen section in decision making in revision hip and knee arthroplasties in a local community hospital.

    PubMed

    Ko, Put Shui; Ip, David; Chow, Kai Pun; Cheung, Florence; Lee, On Bong; Lam, James Joseph

    2005-02-01

    There is little information in the literature regarding the reliability of intraoperative frozen section to predict infection in revision arthroplasties performed in community hospitals as most reports are from specialized centers or academic institutes. Between November 1997 and May 2001, we performed intraoperative frozen sections in 40 revision hip and knee arthroplasties. We used Mirra's criteria of more than 5 polymorphs per high power field to constitute a positive result. We found a sensitivity of 67% and a specificity of 97%. The positive and negative predictive values were 86% and 91%, respectively, with an accuracy of 90%. We conclude that intraoperative frozen section is a reasonably sensitive and specific adjunct investigation in the differentiation between septic and aseptic loosening. PMID:15902857

  17. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma.

    PubMed

    Fanning, J; Tsukada, Y; Piver, M S

    1990-04-01

    From January 1981 to December 1988, a prospective trial was conducted on 216 consecutive patients undergoing hysterectomy for FIGO stage I endometrial adenocarcinoma to determine the accuracy of intraoperative frozen section (IFS) diagnosis of depth of myometrial invasion. IFS and D&C diagnoses were compared to the permanent section diagnosis to determine their accuracy. Patients with an IFS or D&C diagnosis of grade 3 carcinoma, deep myometrial invasion, cervical invasion, or adnexal involvement were considered high risk for paraaortic nodal metastasis, and paraaortic lymphadenectomy was performed. IFS correctly diagnosed the depth of myometrial invasion in 194 of 204 cases (95%). The sensitivity of IFS diagnosis of deep invasion was 87%, the specificity was 99%, the positive predictive value was 98%, and the negative predictive value was 94%. Grade, subtype, cervical invasion, and adnexal involvement were also accurately diagnosed. Based on IFS and D&C diagnosis, paraaortic lymphadenectomy was performed in 32% of patients, while 68% were considered low risk and were spared paraaortic lymphadenectomy. Eight patients (5%) were incorrectly diagnosed as low risk and did not have paraaortic lymphadenectomy performed. Sixty-five of seventy-three (90%) patients considered high risk on permanent section had paraaortic lymphadenectomies performed on the basis of IFS and D&C diagnosis. Inaccurate IFS diagnosis of depth of myometrial invasion can occur when tumor involves the uterine isthmus or cornua and when tumor invades areas of adenomyosis. PMID:2323612

  18. [Uncorrected transposition of the great arteries and large ventricular septum defect perioperative management of a caesarean section].

    PubMed

    Schummer, W; Schummer, C; Schleussner, E; Fröber, R; Ferrari, M; Fuchs, J

    2005-04-01

    Patients with congenital cyanotic heart disease are a challenge to the anaesthetist due to the individual haemodynamic characteristics. Maintaining a balance between systemic and pulmonary-vascular resistance is crucial. Here we outline the successful perioperative management of a 24-year-old female with uncorrected transposition of the great arteries (D-TGA) and large septal defect of the ventricle (functionally single ventricle). She was transferred to our perinatologic centre in the 32nd week of pregnancy with symptoms of increasing cardial insufficiency. The peripartum management was agreed upon at an interdisciplinary conference and caesarean section was performed in the 35th week of pregnancy with epidural anaesthesia and no significant problems. Due to hypercoagulability and the risk of "paradoxical" embolism, low molecular weight heparin was given for 6 weeks post partum. The infant was underweight and was admitted to the neonatal intensive care unit, where she made a satisfactory progress. PMID:15614542

  19. Optimization of electron microscopy for human brains with long-term fixation and fixed-frozen sections

    PubMed Central

    2014-01-01

    Background Abnormal connectivity across brain regions underlies many neurological disorders including multiple sclerosis, schizophrenia and autism, possibly due to atypical axonal organization within white matter. Attempts at investigating axonal organization on post-mortem human brains have been hindered by the availability of high-quality, morphologically preserved tissue, particularly for neurodevelopmental disorders such as autism. Brains are generally stored in a fixative for long periods of time (often greater than 10 years) and in many cases, already frozen and sectioned on a microtome for histology and immunohistochemistry. Here we present a method to assess the quality and quantity of axons from long-term fixed and frozen-sectioned human brain samples to demonstrate their use for electron microscopy (EM) measures of axonal ultrastructure. Results Six samples were collected from white matter below the superior temporal cortex of three typically developing human brains and prepared for EM analyses. Five samples were stored in fixative for over 10 years, two of which were also flash frozen and sectioned on a freezing microtome, and one additional case was fixed for 3 years and sectioned on a freezing microtome. In all six samples, ultrastructural qualitative and quantitative analyses demonstrate that myelinated axons can be identified and counted on the EM images. Although axon density differed between brains, axonal ultrastructure and density was well preserved and did not differ within cases for fixed and frozen tissue. There was no significant difference between cases in axon myelin sheath thickness (g-ratio) or axon diameter; approximately 70% of axons were in the small (0.25 μm) to medium (0.75 μm) range. Axon diameter and g-ratio were positively correlated, indicating that larger axons may have thinner myelin sheaths. Conclusion The current study demonstrates that long term formalin fixed and frozen-sectioned human brain tissue can be used for

  20. Cryo-Transmission Electron Microscopy of Frozen-Hydrated Sections of Escherichia coli and Pseudomonas aeruginosa

    PubMed Central

    Matias, Valério R. F.; Al-Amoudi, Ashraf; Dubochet, Jacques; Beveridge, Terry J.

    2003-01-01

    High-pressure freezing of Escherichia coli K-12 and Pseudomonas aeruginosa PAO1 in the presence of cryoprotectants provided consistent vitrification of cells so that frozen-hydrated sections could be cut, providing ∼2-nm resolution of structure. The size and shape of the bacteria, as well as their surface and cytoplasmic constituents, were nicely preserved and compared well with other published high-resolution techniques. Cells possessed a rich cytoplasm containing a diffuse dispersion of ribosomes and genetic material. Close examination of cells revealed that the periplasmic space was compressed during cryosectioning, a finding which provided supporting evidence that this space is filled by a compressible gel. Since the outer membrane and peptidoglycan layer are bonded together via lipoproteins, the space between them (although still part of the periplasmic space) was not as compacted. Even when this cryosectioning compression was taken into account, there was still substantial variability in the width of the periplasmic space. It is possible that the protoplast has some capacity to float freely within the periplasm. PMID:14526023

  1. Application of scanning electron microscopy to x-ray analysis of frozen- hydrated sections. I. Specimen handling techniques

    PubMed Central

    1981-01-01

    X-ray microanalysis of frozen-hydrated tissue sections permits direct quantitative analysis of diffusible elements in defined cellular compartments. Because the sections are hydrated, elemental concentrations can be defined as wet-weight mass fractions. Use of these techniques should also permit determination of water fraction in cellular compartments. Reliable preparative techniques provide flat, smooth, 0.5 micrometers-thick sections with little elemental and morphological disruption. The specimen support and transfer system described permits hydrated sections to be transferred to the scanning electron microscope cold stage for examination and analysis without contamination or water loss and without introduction of extraneous x- ray radiation. PMID:7204491

  2. Frozen Section Interpretation of Pancreatic Margins: Subspecialized Gastrointestinal Pathologists Versus General Pathologists.

    PubMed

    Liu, Yong-Jun; Smith-Chakmakova, Faye; Rassaei, Negar; Han, Bing; Enomoto, Laura M; Crist, Henry; Hollenbeak, Christopher S; Karamchandani, Dipti M

    2016-04-01

    Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8% versus 87.5%, 61.1% versus 66.7%, 78.6% versus 41.4%, 95% versus 95.2%, and 93.5% versus 85.1%, respectively. The interobserver agreement between GI and general pathologists was fair (κ = .337, P < .001). The interobserver agreement between 2 GI pathologists was fair (κ = .373, P = .0005) and between 2 general pathologists was slight (κ = .195, P = .042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100%. Our study reaffirms the challenging nature of these FSs. PMID:26378055

  3. Validation of whole slide imaging for frozen section diagnosis in surgical pathology

    PubMed Central

    Bauer, Thomas W.; Slaw, Renee J.; McKenney, Jesse K.; Patil, Deepa T.

    2015-01-01

    Background: Whole slide imaging (WSI) using high-resolution scanners is gaining acceptance as a platform for consultation as well as for frozen section (FS) evaluation in surgical pathology. We report results of an intra-observer concordance study comparing evaluation of WSI of scanned FS microscope slides with the original interpretation of the same microscope slides after an average lag time of approximately 1-year. Methods: A total of 70 FS cases (148 microscope slides) originally interpreted by 2 pathologists were scanned at ×20 using Aperio CS2 scanner (Leica Biosystems, San Diego, CA, USA). Reports were redacted such that the study pathologists reviewed images using eSlide Manager Healthcare Network application (Leica Biosystems) accompanied by the same clinical information available at the time of original FS evaluation. Discrepancies between the original FS diagnosis and WSI diagnosis were categorized as major (impacted patient care) or minor (no impact on patient care). Results: Lymph nodes, margins for head and neck cancer resections, and arthroplasty specimens to exclude infection, were the most common FS specimens. The average wash-out interval was 380 days (range: 303–466 days). There was one major discrepancy (1.4% of 70 cases) where the original FS was interpreted as severe squamous dysplasia, and the WSI FS diagnosis was mild dysplasia. There were two minor discrepancies; one where the original FS was called focal moderate squamous dysplasia and WSI FS diagnosis was negative for dysplasia. The second case was an endometrial adenocarcinoma that was originally interpreted as Federation of Gynecology and Obstetrics (FIGO) Grade I, while the WSI FS diagnosis was FIGO Grade II. Conclusions: These findings validate and support the use of WSI to provide interpretation of FS in our network of affiliated hospitals and ambulatory surgery centers. PMID:26430537

  4. Snap-frozen brain tissue sections stored with desiccant at ambient laboratory conditions without chemical fixation are resistant to degradation for a minimum of 6 months.

    PubMed

    Sadler, Theodore R; Khodavirdi, Ani C; Hinton, David R; Holschneider, Daniel P

    2009-03-01

    Cryosectioned tissues from snap-frozen samples offer the advantage of preserving proteins at the cellular and subcellular levels and maintaining overall cell integrity in the tissue of interest without the use of chemical fixatives. To prevent specific or nonspecific degradation of proteins by autolytic and/or proteolytic processes, it is common practice to immediately store frozen tissue sections obtained from a cryostat under cryogenic conditions, for example -80 degrees C. Our laboratory recently challenged this widely held belief by extracting proteins from brain tissue samples that were archived for 1 day, 1 week, 1 month, and 6 months at various storage conditions (frozen, ambient, or desiccated) without the use of chemical fixatives. Our results from immunofluorescent stains, immunoperoxidase stains, silver stains, and Western blot analyses demonstrated that snap-frozen, heat-dried tissue sections stored and desiccated at ambient laboratory conditions are comparable to frozen samples stored up to 6 months. PMID:19521279

  5. A simple method for fixation and microdissection of frozen fresh tissue sections for molecular cytogenetic analysis of cancers.

    PubMed

    Huang, Q; Sacks, P G; Mo, J; McCormick, S A; Iacob, C E; Guo, L; Schaefer, S; Schantz, S P

    2005-01-01

    Microdissection has been widely used for procuring DNA from specific microscopic regions of formalin fixed, paraffin embedded tissue sections. We have developed a method for fixation and microdissection of frozen fresh biopsy tissue sections. Five micrometer frozen fresh tissue sections were fixed with ethanol and stored at room temperature. Well defined regions from hematoxylin and eosin (H & E) stained or unstained sections were briefly steamed and microdissected using a needle. The dissected tissue was digested with proteinase K and DNA was isolated. Whole genome amplifications were obtained by degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) from these samples. The reliability of this technique was demonstrated by comparing conventional comparative genomic hybridization (CGH) with DOP-PCR-CGH. The advantages of this method are that frozen fresh sections can be fixed easily and stored for more than 4 years, it is easy to microdissect and pick-up very minute regions (0.1 mm(2)), and it is rapid; microdissection and purification can be accomplished within 3 h. Using DNA from microdissected sections, DOP-PCR-CGH revealed genetic abnormalities more accurately than conventional CGH. Although this novel method was demonstrated using DOP-PCR-CGH, we believe that it will be useful for other genetic analyses of specific small regions and cell populations. We also observed whether storage time, H & E staining and crude DNA extracts affected the quality of amplified DNA. DNA integrity was maintained for at least 49 months in ethanol fixed sections that were stored at room temperature, but DNA was gradually degraded after one month if the ethanol fixed sections had been H & E stained and stored. When crude DNA extracts from H & E stained sections were used, the size of the DOP-PCR product was reduced. Our study suggests that ethanol fixed tissue sections may be stored at room temperature for at least 4 years without DNA degradation, the H & E stains may

  6. [Intraoperative frozen section diagnosis of head and neck tumors: possibilities, limitations, pitfalls and tips for the daily practice].

    PubMed

    Agaimy, A; Stelzle, F; Zenk, J; Iro, H

    2012-09-01

    Intraoperative consultation (synonym: frozen section diagnostics) has increasingly gained significance for the daily practice in head and neck surgery. The main aim of this investigation method which is usually associated with much stress and effort is to facilitate an optimal and timely oncological surgical treatment of neoplastic diseases with a minimum rate of postoperative functional disturbance. In order to achieve this purpose pathologists are expected to deliver as much correct information as possible to accurately influence intraoperative surgical decisions. At the same time this aim should be reached without significantly and unnecessarily increasing the workload for the pathology laboratory and without significantly inducing tissue artifacts. This would otherwise negatively influence the tissue quality for permanent section examination and consequently the overall quality of diagnosis and tumor staging. Thus, the quality and efficacy of frozen sections span a spectrum with the highest quality having the least possible false negative rate on the one hand and a false positive result of approximately zero on the other hand. Sticking to this approach would result in a high positive impact on the surgical treatment of a variety of neoplastic diseases and help to minimize or even eliminate the rate of medicolegal consequences. PMID:22907604

  7. Affinity imaging mass spectrometry (AIMS): high-throughput screening for specific small molecule interactions with frozen tissue sections.

    PubMed

    Yoshimi, T; Kawabata, S; Taira, S; Okuno, A; Mikawa, R; Murayama, S; Tanaka, K; Takikawa, O

    2015-11-01

    A novel screening system, using affinity imaging mass spectrometry (AIMS), has been developed to identify protein aggregates or organ structures in unfixed human tissue. Frozen tissue sections are positioned on small (millimetre-scale) stainless steel chips and incubated with an extensive library of small molecules. Candidate molecules showing specific affinity for the tissue section are identified by imaging mass spectrometry (IMS). As an example application, we screened over a thousand compounds against Alzheimer's disease (AD) brain tissue and identified several compounds with high affinity for AD brain sections containing tau deposits compared to age-matched controls. It should also be possible to use AIMS to isolate chemical compounds with affinity for tissue structures or components that have been extensively modified by events such as oxidation, phosphorylation, acetylation, aggregation, racemization or truncation, for example, due to aging. It may also be applicable to biomarker screening programs. PMID:26365298

  8. Two-photon excitation cross section in light and intermediate atoms in frozen-core LS-coupling approximation

    NASA Technical Reports Server (NTRS)

    Omidvar, K.

    1980-01-01

    Using the method of explicit summation over the intermediate states two-photon absorption cross sections in light and intermediate atoms based on the simplistic frozen-core approximation and LS coupling have been formulated. Formulas for the cross section in terms of integrals over radial wave functions are given. Two selection rules, one exact and one approximate, valid within the stated approximations are derived. The formulas are applied to two-photon absorptions in nitrogen, oxygen, and chlorine. In evaluating the radial integrals, for low-lying levels, the Hartree-Fock wave functions, and for high-lying levels, hydrogenic wave functions obtained by the quantum-defect method have been used. A relationship between the cross section and the oscillator strengths is derived.

  9. Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma.

    PubMed

    Duarte, Giuliano M; Tomazini, Maria Virginia; Oliveira, André; Moreira, Luciana; Tocchet, Fernando; Worschech, Adriana; Torresan, Renato Z

    2015-10-01

    The sub-nipple tissue (SNT) examination has been used by surgeons to preserve, or not, the nipple in nipple-sparing mastectomy. However, it is uncertain whether SNT evaluation can predict nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, PPV, and NPV of the intraoperative frozen section and imprint cytology, and permanent histology of SNT to predict the involvement of the nipple in breast carcinoma and to compare the three exams. A prospective study was performed with 68 consecutive breast carcinoma women who had undergone mastectomy or central segmentectomy (removing nipple-areolar complex). After surgery, the nipple-areolar complex was dissected simulating a nipple-sparing flap (ex vivo). The SNT was subsequently removed and submitted to frozen section, imprint cytology, and permanent histology. The nipple was examined separately by paraffin histopathology and was considered the gold standard. The occult nipple involvement rate was 11.7 %. The frozen section, cytology, and permanent histology of SNT presented accuracy 86.8, 76.5, and 86.8 %; sensitivity 50, 37.5, and 62.5 %; specificity 91.7, 81.7, and 90 %; PPV 44.4, 21.4, and 45.5 %; and NPV 93.2, 90.7, and 94.7 %, respectively. The accuracy of the frozen section was similar to that of permanent histology (p = 0.77) and both were better than cytology (p = 0.01). False negative rates were 6.8 % for frozen section, 9.3 % for cytology and 5.3 % for paraffin. SNT evaluation is a good method for predicting occult nipple involvement; the outcomes showed a good accuracy and low false negative rate for the frozen section, cytology, and permanent histology exams. When we compared the exams, the frozen section was similar to permanent histology and more accurate than imprint cytology. PMID:26358710

  10. Shape and fine structure of nucleoids observed on sections of ultrarapidly frozen and cryosubstituted bacteria.

    PubMed Central

    Hobot, J A; Villiger, W; Escaig, J; Maeder, M; Ryter, A; Kellenberger, E

    1985-01-01

    Very rapidly frozen cells of Escherichia coli and Bacillus subtilis were substituted at low temperature into acetone with 1% OsO4 and embedded in Epon. They showed ribosome-free spaces filled with globular and fibrillar material of up to 15 nm. The sizes of structures seen do not exclude DNA superstructures such as supercoils, aggregates, and nucleosomes. With the Feulgen analog osmium-ammines stain, DNA was localized within the ribosome-free space. The bulk of DNA, the nucleoid, is therefore a major part of, or identical to, the main ribosome-free space. The ribosome-free space would correspond directly to the light microscopy phase-contrast image of nucleoids in living bacteria. The shape of the ribosome-free space does not reflect intracellular salt concentrations, nor do the Feulgen-positive areas. The previously observed dependency on the salt concentration of the growth medium seems to be due to permeabilization induced by the chemical fixative at room temperature. The ribosome-free space is more cleft in appearance than the nucleoid obtained by fixation with OsO4 but more confined than its very dispersed form found after aldehyde fixation. Images PMID:3922958

  11. Localization of telomerase hTERT protein in frozen sections of basal cell carcinomas (BCC) and tumor margin tissues.

    PubMed

    Fabricius, Eva-Maria; Kruse-Boitschenko, Ute; Khoury, Reem; Wildner, Gustav-Paul; Raguse, Jan-Dirk; Klein, Martin; Hoffmeister, Bodo

    2009-12-01

    In previous studies we demonstrated telomerase activity in frozen tissues from BCC and their tumor-free margins by the PCR ELISA. In this study we examined in the same frozen sections immunohistochemical presence of hTERT in the nucleus. After fixation in acetone and methanol followed by steaming we used for visualization the antigen-antibody reactions by APAAP. This was the best method of preparation of the frozen sections in our preliminary hTERT-study with squamous cell carcinomas. This study was supplemented with antibodies against Ki-67, nucleolin, common leucocyte antigen CD45 and mutated p53. The immunoreactive scores were determined and included the comparison with telomerase activity. The investigation of hTERT expression was performed in the tissues of 41 patients with BCC and control tissues of 14 patients without tumor. Eleven commercial antibodies were used for a nuclear staining of hTERT expression. With the anti-hTERT antibodies we looked for both satisfactory distribution and intensity of immunohistochemical labeling in the carcinomas and in the squamous epithelia of the tumor centers, of the tumor-free margins and of the control tissues. The hTERT expression in the BCC was distributed heterogeneously. The score values established by the anti-hTERT antibodies used were variably or significantly increased. In the stroma they tended to be negative, so we disregarded stroma hTERT. Proof of hTERT did not differ uniformly from telomerase activity. We compared the high with the lower median hTERT values in the Kaplan-Meier curve. Patients with lower hTERT scores in the center or tumor margin as shown by some of the antibodies suffered relapse earlier. Finally, we compared the hTERT expression in BCC tissues with the hTERT scores in HNSCC tissues from our previous study. Only one anti-hTERT antibody (our Ab 7) yielded significantly higher scores in BCC than in HNSCC. PMID:19885561

  12. Is frozen section analysis of the urethra at the time of radical cystectomy and orthotopic neobladder urinary diversion mandatory?

    PubMed Central

    Sureka, Sanjoy Kumar; Yadav, Abhishek; Arora, Sohrab; Kapoor, Rakesh; Mandhani, Anil

    2015-01-01

    Introduction: This study was aimed at analyzing the need for routine use of frozen section analysis (FSA) before performing orthotopic neobladder (ONB) after radical cystectomy for carcinoma urinary bladder. Materials and Methods: A total of 233 patients underwent radical cystectomy from January 2000 to June 2013. Of these, 151 (65.6%) patients were planned for ONB. In the initial 109 (72%) patients, FSA of urethral margin was performed, but, in the subsequent 42 (28%) patients, frozen section of urethral margin was not sent. Impact of hydroureteronephrosis, tumor size and location of tumor in relation to the bladder neck on the status of the urethral margin was analyzed. Results: Only three of the 109 (2.7%) patients had a positive urethral margin. Two of them had ileal conduit and one, after negative re-resection, had ONB. Although none of the factors was found to be significant, all three patients with a positive urethral margin had growth at the bladder neck and died of cancer at a mean follow up of 29.33 ± 18.3 months, without urethral recurrence. Among the negative FSA (106), two patients had recurrence in the penile urethra. The mean follow-up was 46.3 ± 25.1 months. None of the patients without FSA (42) had urethral recurrence at the mean follow-up of 36 ± 9.3 months. Of the 28 patients who had their growth located at the bladder neck, three had positive FSA, while none with growth away from the bladder neck had positive FSA. Conclusion: Routine FSA of the urethra before performing ONB can be avoided in those patients where the tumor does not reach the bladder neck. PMID:26604448

  13. Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: Pathologic pitfalls and the application of an objective scoring system

    PubMed Central

    Park, Kay J.; Soslow, Robert A.; Sonoda, Yukio; Barakat, Richard R.; Abu-Rustum, Nadeem R.

    2016-01-01

    Objective To analyze the incidence of diagnostic discrepancy between frozen-section and final diagnosis of the endocervical margin at time of radical trachelectomy and to apply an objective scoring system to non-invasive endocervical glandular atypia to determine its utility in distinguishing benign from malignant lesions. Methods Histologic slides from 19 cases of radical trachelectomy performed for invasive endocervical adenocarcinoma were evaluated for correlation between the frozen and permanent sections of the endocervical margin. An objective scoring system for grading non-invasive endocervical glandular lesions proposed by Ioffe et al. was also applied to the frozen and permanent section slides and compared to the final diagnosis. Results There was 84% concordance between the frozen-section and final diagnosis using histology alone, vs. 95% concordance using the Ioffe scoring system. One trachelectomy was converted to completion hysterectomy for what was presumed to be adenocarcinoma in situ at the margin, which in retrospect, was a benign lesion and was correctly classified using the Ioffe system. Most of the discrepancies were due to misinterpretation of tubal metaplasia, tubo-endometrioid metaplasia, and atypical tubal metaplasia as adenocarcinoma in situ. Conclusion Benign mimics of endocervical adenocarcinoma in situ can be difficult to distinguish from malignant lesions, especially during frozen-section evaluation of the trachelectomy. Correctly diagnosing the margin status intraoperatively has great clinical impact and the application of an objective scoring system, like that proposed by Ioffe et al., can increase diagnostic accuracy when applied to frozen-section slides and better correlates with final diagnosis when compared to histology alone. PMID:18635252

  14. Effective Melanin Depigmentation of Human and Murine Ocular Tissues: An Improved Method for Paraffin and Frozen Sections

    PubMed Central

    Manicam, Caroline; Pitz, Susanne; Brochhausen, Christoph; Grus, Franz H.; Pfeiffer, Norbert; Gericke, Adrian

    2014-01-01

    Purpose The removal of excessive melanin pigments that obscure ocular tissue morphology is important to address scientific questions and for differential diagnosis of ocular tumours based on histology. Thus, the goal of the present study was to establish an effective and fast melanin bleaching method for paraffin and frozen mouse and human ocular tissues. Methods Paraffin-embedded and frozen ocular specimens from mice and human donors were subjected to bleaching employing two methods. The first employed potassium permanganate (KMnO4) with oxalic acid, and the second 10% hydrogen peroxide (H2O2). To determine optimal bleaching conditions, depigmentation was carried out at various incubation times. The effect of diluents used for 10% H2O2 was assessed using phosphate-buffered saline (PBS), and deionized water. Three different slide types and two fixatives, which were ice-cold acetone with 80% methanol, and 4% paraformaldehyde (PFA) were used to determine the optimal conditions for better tissue adherence during bleaching. All tissues were stained in hematoxylin and eosin for histological evaluation. Results Optimal bleaching was achieved using warm 10% H2O2 diluted in PBS at 65°C for 120 minutes. Chromium-gelatin-coated slides prevented tissue detachment. Adherence of cryosections was also improved with post-fixation using 4% PFA and overnight air-drying at RT after cryosectioning. Tissue morphology was preserved under these conditions. Conversely, tissues bleached in KMnO4/oxalic acid demonstrated poor depigmentation with extensive tissue damage. Conclusions Warm dilute H2O2 at 65°C for 120 minutes rapidly and effectively bleached both cryo- and paraffin sections of murine and human ocular tissues. PMID:25025426

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

    PubMed

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

    2008-03-01

    Different methods for snap freezing surgical human tissue specimens exist. At pathology institutes with higher work loads, solid carbon dioxide, freezing sprays, and cryostat freezing are commonly used as coolants for diagnosing frozen tissue sections, whereas for tissue banking, liquid nitrogen or isopentane cooled with liquid nitrogen is preferred. Freezing tissues for diagnostic and research purposes are therefore often time consuming, laborious, even hazardous, and not user friendly. In tissue banks, frozen tissue samples are stored in cryovials, capsules, cryomolds, or cryocassettes. Tissues are additionally embedded using freezing media or wrapped in plastic bags or aluminum foils to prevent desiccation. The latter method aggravates enormously further tissue handling and processing. Here, we describe an isopentane-based workflow which concurrently facilitates tissue freezing and processing for both routine intra-operative frozen section and tissue banking and satisfies the qualitative demands of pathologists, cancer researchers, laboratory technicians, and tissue bankers. PMID:18253747

  16. Fine structures and ion images on fresh frozen dried ultrathin sections by transmission electron and scanning ion microscopy

    NASA Astrophysics Data System (ADS)

    Takaya, K.; Okabe, M.; Sawataishi, M.; Takashima, H.; Yoshida, T.

    2003-01-01

    Ion microscopy (IM) of air-dried or freeze-dried cryostat and semi-thin cryosections has provided ion images of elements and organic substances in wide areas of the tissue. For reproducible ion images by a shorter time of exposure to the primary ion beam, fresh frozen dried ultrathin sections were prepared by freezing the tissue in propane chilled with liquid nitrogen, cryocut at 60 nm, mounted on grids and silicon wafer pieces, and freeze-dried. Rat Cowper gland and sciatic nerve, bone marrow of the rat administered of lithium carbonate, tree frog and African toad spleen and buffy coat of atopic dermatitis patients were examined. Fine structures and ion images of the corresponding areas in the same or neighboring sections were observed by transmission electron microscopy (TEM) followed by sector type and time-of-flight type IM. Cells in the buffy coat contained larger amounts of potassium and magnesium while plasma had larger amounts of sodium and calcium. However, in the tissues, lithium, sodium, magnesium, calcium and potassium were distributed in the cell and calcium showed a granular appearance. A granular cell of the tree frog spleen contained sodium and potassium over the cell and magnesium and calcium were confined to granules.

  17. Visualizing Oxazine 4 nerve-specific fluorescence ex vivo in frozen tissue sections

    NASA Astrophysics Data System (ADS)

    Barth, Connor W.; Gibbs, Summer L.

    2016-03-01

    Nerve damage plagues surgical outcomes and remains a major burden for patients, surgeons, and the healthcare system. Fluorescence image-guided surgery using nerve specific small molecule fluorophores offers a solution to diminish surgical nerve damage through improved intraoperative nerve identification and visualization. Oxazine 4 has shown superior nerve specificity in initial testing in vivo, while exhibiting a red shifted excitation and emission spectra compared to other nerve-specific fluorophores. However, Oxazine 4 does not exhibit near-infrared (NIR) excitation and emission, which would be ideal to improve penetration depth and nerve signal to background ratios for in vivo imaging. Successful development of a NIR nerve-specific fluorophore will require understanding of the molecular target of fluorophore nerve specificity. While previous small molecule nerve-specific fluorophores have demonstrated excellent ex vivo nerve specificity, Oxazine 4 ex vivo nerve specific fluorescence has been difficult to visualize. In the present study, we examined each step of the ex vivo fluorescence microscopy sample preparation procedure to discover how in vivo nerve-specific fluorescence is changed during ex vivo tissue sample preparation. Through step-by-step examination we found that Oxazine 4 fluorescence was significantly diminished by washing and mounting tissue sections for microscopy. A method to preserve Oxazine 4 nerve specific fluorescence ex vivo was determined, which can be utilized for visualization by fluorescence microscopy.

  18. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  19. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  20. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  1. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  2. 21 CFR 160.110 - Frozen eggs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen eggs. 160.110 Section 160.110 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.110 Frozen eggs. (a) Frozen eggs, frozen whole eggs, frozen mixed eggs is the food prepared by...

  3. Expression of blood group antigens in urinary tract tumours: prospective fluorescence study using cryostat sections of fresh frozen tissues.

    PubMed Central

    Thorpe, S J; Abel, P; Henderson, D; Jones, N; Feizi, T

    1986-01-01

    Cryostat sections of fresh frozen tissues were used in a prospective study of blood group H and A antigen fluorescence in 73 transitional cell carcinomas of the bladder. The aim was to evaluate antigen expression without subjecting the tumour tissues to organic solvents that extract blood group active glycolipids. Deletion of the genetically predicted antigen was twice as common in tumours of pT1 or greater stage than those of pTa stage and also twice as common in poorly differentiated than in moderately well differentiated tumours. The considerable heterogeneity and overlap, however, in patterns of reactivity in tumours of various histopathological stages and grades and the effect of secretor status on antigenicity meant that there was no obvious antigenic feature that correlated precisely with invasive stage or differentiation grade. It remains to be determined whether the antigen positive and antigen negative tumours represent different disease entities with differing clinical courses. Our results indicate, however, that studies of the blood group antigens in urinary tract tumours are more likely to be of value in research into biochemical disorders in the neoplastic process than in routine clinical assessment as a guide to treatment. Images Fig 1 Fig 2 Fig 3 PMID:3540013

  4. Mineralization process during acellular cementogenesis in rat molars: a histochemical and immunohistochemical study using fresh-frozen sections.

    PubMed

    Yamamoto, Tsuneyuki; Domon, Takanori; Takahashi, Shigeru; Anjuman, Khan Ara Yasmin; Fukushima, Chifumi; Wakita, Minoru

    2007-03-01

    This study was designed to detect tissue non-specific alkaline phosphatase (TNSALP) by Azo-dye staining, calcium by glyoxal bis (2-hydroxyanil) (GBHA) staining, bone sialoprotein (BSP) and osteopontin (OPN) by immunoperoxidase staining in developing rat molars, and also to discuss the mineralization process during acellular cementogenesis. To restrain a reduction in histochemical and immunohistochemical reactions, fresh-frozen undemineralized sections were prepared. Where the epithelial sheath was intact, TNSALP reaction was observed in the dental follicle, but not in the epithelial sheath. With the onset of dentin mineralization, the BSP- and OPN-immunoreactive, initial cementum layer appeared. At this point, cementoblasts had shown intense TNSALP reaction and GBHA reactive particles (=calcium-GBHA complex) appeared on the root surface. With further development, the reaction of TNSALP and GBHA became weak on the root surface. Previous studies have shown that the initial cementum is fibril-poor and that matrix vesicles and calciferous spherules appear on the root surface only during the initial cementogenesis. The findings mentioned above suggest that: during the initial cementogenesis, cementoblasts release matrix vesicles which result in calciferous spherules, corresponding to the GBHA reactive particles. The calciferous spherules trigger the mineralization of the initial cementum. After principal fiber attachment, mineralization advances along collagen fibrils without matrix vesicles. PMID:17043865

  5. Surgical biopsy with intra-operative frozen section. An accurate and cost-effective method for diagnosis of musculoskeletal sarcomas.

    PubMed

    Ashford, R U; McCarthy, S W; Scolyer, R A; Bonar, S F; Karim, R Z; Stalley, P D

    2006-09-01

    The most appropriate protocol for the biopsy of musculoskeletal tumours is controversial, with some authors advocating CT-guided core biopsy. At our hospital the initial biopsies of most musculoskeletal tumours has been by operative core biopsy with evaluation by frozen section which determines whether diagnostic tissue has been obtained and, if possible, gives the definitive diagnosis. In order to determine the accuracy and cost-effectiveness of this protocol we have undertaken a retrospective audit of biopsies of musculoskeletal tumours performed over a period of two years. A total of 104 patients had biopsies according to this regime. All gave the diagnosis apart from one minor error which did not alter the management of the patient. There was no requirement for re-biopsy. This protocol was more labour-intensive and 38% more costly than CT-guided core biopsy (AU$1804 vs AU$1308). However, the accuracy and avoidance of the anxiety associated with repeat biopsy outweighed these disadvantages. PMID:16943474

  6. A method for preparing 2- to 50-micron-thick fresh-frozen sections of large samples and undecalcified hard tissues.

    PubMed

    Kawamoto, T; Shimizu, M

    2000-05-01

    This article describes a method for preparing 2- to 50-micron-thick fresh-frozen sections from large samples and completely calcified tissue samples. In order to perform the more routine work involved, a tungsten carbide disposable blade was installed to a heavy-duty sledge cryomicrotome. An entire 10-day-old rat and bone and tooth samples from a 7-month-old rat were rapidly frozen. The frozen samples were attached to the cryomicrotome stage. The cutting surface of the samples was covered with a polyvinylidene chloride film coated with synthetic rubber cement and cut at -25 degrees C. The soft tissues and the hard tissues were satisfactorily preserved and all tissue cells were easily identifiable. Enzymatic activity in the fresh sections was much stronger than that in chemically fixed and/or decalcified sections. The sections permitted histological and histochemical studies without trouble. In addition, the sections can be used for multiple experiments such as immunohistochemistry, in situ hybridization, and electron microprobe X-ray micro-analysis. This method can be used with conventional cryomicrotome equipment. PMID:10883392

  7. Frozen Frozen CO2

    NASA Technical Reports Server (NTRS)

    2005-01-01

    2 October 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a view of frozen carbon dioxide in the south polar residual cap of Mars. Much of the south polar residual cap exhibits terrain that resembles stacks of sliced Swiss cheese, but this portion of the cap lacks the typical, circular depressions that characterize much of the region. Carbon dioxide on Mars freezes at a temperature of around 148 Kelvins, which is -125oC or about -193oF.

    Location near: 87.2oS, 28.4oW Image width: width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Spring

  8. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section.

    PubMed

    Howlett, D C; Skelton, E; Moody, A B

    2015-09-01

    The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic. PMID:25886878

  9. [CONTROVERSIES REGARDING THE ACCURACY AND LIMITATIONS OF FROZEN SECTION IN THYROID PATHOLOGY: AN EVIDENCE-BASED ASSESSMENT].

    PubMed

    Stanciu-Pop, C; Pop, F C; Thiry, A; Scagnol, I; Maweja, S; Hamoir, E; Beckers, A; Meurisse, M; Grosu, F; Delvenne, Ph

    2015-12-01

    Palpable thyroid nodules are present clinically in 4-7% of the population and their prevalence increases to 50%-67% when using high-resolution neck ultrasonography. By contrast, thyroid carcinoma (TC) represents only 5-20% of these nodules, which underlines the need for an appropriate approach to avoid unnecessary surgery. Frozen section (PS) has been used for more than 40 years in thyroid surgery to establish the diagnosis of malignancy. However, a controversy persists regarding the accuracy of FS and its place in thyroid pathology has changed with the emergence of fine-needle aspiration (FNA). A PubMed Medline and SpringerLink search was made covering the period from January 2000 to June 2012 to assess the accuracy of ES, its limitations and indications for the diagnosis of thyroid nodules. Twenty publications encompassing 8.567 subjects were included in our study. The average value of TC among thyroid nodules in analyzed studies was 15.5 %. ES ability to detect cancer expressed by its sensitivity (Ss) was 67.5 %. More than two thirds of the authors considered PS useful exclusively in the presence of doubtful ENA and for guiding the surgical extension in cases confirmed as malignant by FNA; however, only 33% accepted FS as a routine examination for the management of thyroid nodules. The influence of FS on surgical reintervention rate in nodular thyroid pathology was considered to be negligible by most studies, whereas 31 % of the authors thought that FS has a favorable benefit by decreasing the number of surgical re-interventions. In conclusion, the role of FS in thyroid pathology evolved from a mandatory component for thyroid surgery to an optional examination after a pre-operative FNA cytology. The accuracy of FS seems to provide no sufficient additional benefit and most experts support its use only in the presence of equivocal or suspicious cytological features, for guiding the surgical extension in cases confirmed as malignant by FNA and for the

  10. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen...

  11. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen peas. (a) Identity—(1) Product...

  12. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen...

  13. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen...

  14. 21 CFR 158.170 - Frozen peas.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen peas. 158.170 Section 158.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FROZEN VEGETABLES Requirements for Specific Standardized Frozen Vegetables § 158.170 Frozen...

  15. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen... frozen,” “fresh frozen,” “frozen fresh.” The terms defined in this section may be used on the label or in... state and has not been frozen or subjected to any form of thermal processing or any other form...

  16. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen... frozen,” “fresh frozen,” “frozen fresh.” The terms defined in this section may be used on the label or in... state and has not been frozen or subjected to any form of thermal processing or any other form...

  17. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen... frozen,” “fresh frozen,” “frozen fresh.” The terms defined in this section may be used on the label or in... state and has not been frozen or subjected to any form of thermal processing or any other form...

  18. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen... frozen,” “fresh frozen,” “frozen fresh.” The terms defined in this section may be used on the label or in... state and has not been frozen or subjected to any form of thermal processing or any other form...

  19. Tissue requirements in lung cancer diagnosis for tumor heterogeneity, mutational analysis and targeted therapies: initial experience with intra-operative Frozen Section Evaluation (FROSE) in bronchoscopic biopsies

    PubMed Central

    Iding, Jeffrey S.

    2016-01-01

    Background Recent advances in lung cancer treatment have changed the requirement for the amount and quality of biopsy specimens needed to characterize the tumor and select the best treatment. One adjunct to guide the bronchoscopist on the quality and quantity of specimens during bronchoscopic biopsies for the diagnosis of lung cancer is rapid on-site evaluation (ROSE) of cytological specimens. This technique has been shown to add to the diagnostic yield of bronchoscopy when obtaining adequate specimens for molecular profiling in lung cancer. ROSE is not available at all medical centers. We describe our initial experience using intra-procedural Frozen Section Evaluation (FROSE) of bronchoscopic biopsy specimens as an alternative to ROSE. Methods A retrospective analysis of all interventional pulmonology cases using FROSE between February and July 2015 was performed. Results analyzed to evaluate the success in obtaining adequate specimens for molecular profiling. Results A total of 88 interventional pulmonology cases employing a frozen section in at least one site were identified. In 94.3% of cases, a definitive diagnosis of benign or malignant was made. The concordance of frozen section diagnoses of benign or malignant was 100% with final diagnoses. Thirteen of the eighty-eight cases were ultimately sent for molecular analysis. Of these, twelve of thirteen (92.3%) cases were adequate to perform all ordered molecular testing. In all cases there was sufficient tissue to perform EGFR and ALK testing. Conclusions In medical centers where ROSE may not be available, the use of FROSE by the local pathologist can be an effective technique to obtain adequate tissue and cytological samples for the diagnosis and molecular profiling of lung cancers. Further prospective study in bronchoscopic tissue sampling techniques to obtain the optimum quantity and quality of samples for molecular profiling of lung cancers for targeted treatments is needed. PMID:27606077

  20. Cryo-electron tomography of plunge-frozen whole bacteria and vitreous sections to analyze the recently described bacterial cytoplasmic structure, the Stack.

    PubMed

    Delgado, Lidia; Martínez, Gema; López-Iglesias, Carmen; Mercadé, Elena

    2015-03-01

    Cryo-electron tomography (CET) of plunge-frozen whole bacteria and vitreous sections (CETOVIS) were used to revise and expand the structural knowledge of the "Stack", a recently described cytoplasmic structure in the Antarctic bacterium Pseudomonas deceptionensis M1(T). The advantages of both techniques can be complementarily combined to obtain more reliable insights into cells and their components with three-dimensional imaging at different resolutions. Cryo-electron microscopy (Cryo-EM) and CET of frozen-hydrated P. deceptionensis M1(T) cells confirmed that Stacks are found at different locations within the cell cytoplasm, in variable number, separately or grouped together, very close to the plasma membrane (PM) and oriented at different angles (from 35° to 90°) to the PM, thus establishing that they were not artifacts of the previous sample preparation methods. CET of plunge-frozen whole bacteria and vitreous sections verified that each Stack consisted of a pile of oval disc-like subunits, each disc being surrounded by a lipid bilayer membrane and separated from each other by a constant distance with a mean value of 5.2±1.3nm. FM4-64 staining and confocal microscopy corroborated the lipid nature of the membrane of the Stacked discs. Stacks did not appear to be invaginations of the PM because no continuity between both membranes was visible when whole bacteria were analyzed. We are still far from deciphering the function of these new structures, but a first experimental attempt links the Stacks with a given phase of the cell replication process. PMID:25617813

  1. Frozen shoulder

    MedlinePlus

    Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation. ... The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are ...

  2. Are frozen sections of mediastinoscopy samples as effective as formal paraffin assessment of mediastinoscopy samples for a decision on a combined mediastinoscopy plus lobectomy?

    PubMed

    Attaran, Saina; Jakaj, Gentjan; Acharya, Metesh; Anderson, Jon R

    2013-06-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Are frozen sections of mediastinoscopy samples as effective as formal paraffin assessment of mediastinoscopy samples for a decision on a same-day lobectomy?'. Five papers were found using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. These studies compared the efficacy and accuracy of frozen sections (FSs) from mediastinal lymph nodes for staging of patients with lung cancer to determine whether a combined procedure can be planned based on these results and to proceed to thoracotomy and lung resection in cases of negative mediastinal nodes diagnosed by FS. These studies unanimously showed that FS of mediastinal nodes are as accurate as permanent section results and definite histology diagnosis with a sensitivity of >94% and specificity of 100% with no false-positive results. They also confirmed that even in benign lung conditions and other malignancies of the mediastinum, the results of FS are compared with the histology of the node. Based on the current reports, a combined procedure (staging mediastinal nodes by FS and planning for thoracotomy or abandoning thoracotomy) is a safe approach to treat non-small-cell lung cancer (NSCLC). From the patients' point of view, this approach is superior to the staged procedure (mediastinoscopy followed by lung resection at a later date based on the histology of mediastinal nodes) due to single hospitalization and anaesthesia, however whether it is cost effective or not is debatable. It is also labour-intensive and operator-dependent. In conclusion, the current evidence in the literature suggests that a combined procedure of mediastinal node FS followed by lung resection can be a safe alternative to a staged

  3. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  4. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  5. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  6. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  7. 7 CFR 58.327 - Frozen cream.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Frozen cream. 58.327 Section 58.327 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Material § 58.327 Frozen cream. To produce frozen cream eligible for official certification, the quality...

  8. Analysis of differential shrinkage in frozen brain sections and its implications for the use of guard zones in stereology.

    PubMed

    Carlo, C N; Stevens, C F

    2011-10-01

    Increasing numbers of neuroanatomists are using stereological methods, and unbiased stereological estimation rules recommend the use of guard zones with the optical disector method to count objects of interest within a volume. Although these methods are statistically unbiased, we believe there is a need to explore sources of systematic bias (e.g., effects of tissue processing and sectioning) that may be affecting estimates of object number. Toward this end, we evaluated neuron distribution through, and tissue shrinkage in, non-embedded tissue cut on a freezing microtome. Our data show that in the x- and y-planes there are minimal changes in tissue area during tissue processing, sectioning, and staining. In the z-axis (perpendicular to the cutting surface), however, sections shrink to ∼25% of the cut thickness. This z-axis shrinkage was quite variable between sections (coefficient of variation about 10%) but stable within the same section (coefficient of variation about 3%). Lastly, individual particle densities are non-uniform through the thickness of the section when the densities should have been uniform. We advise experimenters to use a new protocol, a modified optical disector, for estimation when objects to be counted are marked such that the x-, y-, and z-coordinates are recorded through the full thickness of a section and guard zones are applied post data collection based on the characteristics of the object distribution along the z-axis. It is likely that individual experiments with different embedding materials and histological processing steps could require guard zones of varying sizes, or none at all, depending on object distribution in the z-axis. PMID:21491430

  9. Sensitivity of in situ detection with biotinylated probes of human papilloma virus type 16 DNA in frozen tissue sections of squamous cell carcinomas of the cervix.

    PubMed

    Walboomers, J M; Melchers, W J; Mullink, H; Meijer, C J; Struyk, A; Quint, W G; van der Noordaa, J; ter Schegget, J

    1988-06-01

    The sensitivity of human papilloma virus type 16 (HPV-16) DNA detection by DNA in situ hybridization using biotinylated probes (bio-DISH) was estimated by performing this technique on snap-frozen tissue sections of 10 cervical squamous cell carcinomas containing increasing amounts of HPV-16 as determined by Southern blot hybridization. A protocol using serial sections for bio-DISH and DNA extraction was used. The number of positively stained cells and the detection limit were strongly dependent on the treatment of the sections with proteinase K prior to hybridization. At low proteinase K concentration (0.1 micrograms/ml), the detection limit appeared to be 30-40 HPV-16 DNA copies per carcinoma cell, whereas morphology was preserved. A high proteinase K concentration (1-5 micrograms/ml) often resulted in an increase in the number of positively stained cells but also in a poor morphology. The detection limit was improved to at least 20 HPV-16 DNA copies per carcinoma cell. PMID:2837906

  10. Perioperative hypertension management

    PubMed Central

    Varon, Joseph; Marik, Paul E

    2008-01-01

    Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment difficult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension. PMID:18827911

  11. Unintended Perioperative Hypothermia

    PubMed Central

    Hart, Stuart R.; Bordes, Brianne; Hart, Jennifer; Corsino, Daniel; Harmon, Donald

    2011-01-01

    Background Hypothermia, defined as a core body temperature less than 36°C (96.8°F), is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. A threefold increase in the frequency of surgical site infections is reported in colorectal surgery patients who experience perioperative hypothermia. As part of the Surgical Care Improvement Project, guidelines aim to decrease the incidence of this complication. Methods We review the physiology of temperature regulation, mechanisms of hypothermia, effects of anesthetics on thermoregulation, and consequences of hypothermia and summarize recent recommendations for maintaining perioperative normothermia. Results Evidence suggests that prewarming for a minimum of 30 minutes may reduce the risk of subsequent hypothermia. Conclusions Monitoring of body temperature and avoidance of unintended perioperative hypothermia through active and passive warming measures are the keys to preventing its complications. PMID:21960760

  12. Using immunoglobulin Y as an alternative antibody for the detection of hepatitis A virus in frozen liver sections.

    PubMed

    Bentes, Gentil Arthur; Lanzarini, Natália Maria; Lima, Lyana Rodrigues Pinto; Manso, Pedro Paulo de Abreu; da Silva, Alexandre Dos Santos; Mouta Junior, Sergio da Silva E; Guimarães, Juliana Rodrigues; de Moraes, Marcia Terezinha Baroni; Pelajo-Machado, Marcelo; Pinto, Marcelo Alves

    2015-06-01

    An increasing amount of research has been conducted on immunoglobulin Y (IgY) because the use of IgY offers several advantages with respect to diagnostic testing, including its easy accessibility, low cost and translatability to large-scale production, in addition to the fact that it can be ethically produced. In a previous work, immunoglobulin was produced and purified from egg yolks (IgY) reactive to hepatitis A virus (HAV) antigens. In the present work, this anti-HAV-specific IgY was used in an indirect immunofluorescence assay to detect viral antigens in liver biopsies that were obtained from experimentally infected cynomolgus monkeys. Fields that were positive for HAV antigen were detected in liver sections using confocal microscopy. In conclusion, egg yolks from immunised hens may be a reliable source for antibody production, which can be employed for immunological studies. PMID:25993400

  13. Using immunoglobulin Y as an alternative antibody for the detection of hepatitis A virus in frozen liver sections

    PubMed Central

    Bentes, Gentil Arthur; Lanzarini, Natália Maria; Lima, Lyana Rodrigues Pinto; Manso, Pedro Paulo de Abreu; da Silva, Alexandre dos Santos; Mouta, Sergio da Silva e; Guimarães, Juliana Rodrigues; de Moraes, Marcia Terezinha Baroni; Pelajo-Machado, Marcelo; Pinto, Marcelo Alves

    2015-01-01

    An increasing amount of research has been conducted on immunoglobulin Y (IgY) because the use of IgY offers several advantages with respect to diagnostic testing, including its easy accessibility, low cost and translatability to large-scale production, in addition to the fact that it can be ethically produced. In a previous work, immunoglobulin was produced and purified from egg yolks (IgY) reactive to hepatitis A virus (HAV) antigens. In the present work, this anti-HAV-specific IgY was used in an indirect immunofluorescence assay to detect viral antigens in liver biopsies that were obtained from experimentally infected cynomolgus monkeys. Fields that were positive for HAV antigen were detected in liver sections using confocal microscopy. In conclusion, egg yolks from immunised hens may be a reliable source for antibody production, which can be employed for immunological studies. PMID:25993400

  14. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  15. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  16. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  17. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  18. 21 CFR 152.126 - Frozen cherry pie.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen cherry pie. 152.126 Section 152.126 Food... HUMAN CONSUMPTION FRUIT PIES Requirements for Specific Standardized Fruit Pies § 152.126 Frozen cherry pie. (a) Identity. (1) Frozen cherry pie (excluding baked and then frozen) is the food prepared...

  19. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  20. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  1. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  2. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  3. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  4. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  5. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  6. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  7. 21 CFR 160.190 - Frozen egg yolks.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen egg yolks. 160.190 Section 160.190 Food and... CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.190 Frozen egg yolks. (a) Frozen egg yolks, frozen yolks is the food prepared by freezing egg yolks...

  8. 21 CFR 160.150 - Frozen egg whites.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen egg whites. 160.150 Section 160.150 Food... HUMAN CONSUMPTION EGGS AND EGG PRODUCTS Requirements for Specific Standardized Eggs and Egg Products § 160.150 Frozen egg whites. (a) Frozen egg whites, frozen egg albumen is the food prepared by...

  9. Discordance of Intraoperative Frozen Section Analysis with Definitive Histology of Sentinel Lymph Nodes in Breast Cancer Surgery: Complementary Axillary Lymph Node Dissection is Irrelevant for Subsequent Systemic Therapy

    PubMed Central

    Geertsema, D.; Gobardhan, P. D.; Madsen, E. V. E.; Albregts, M.; van Gorp, J.; de Hooge, P.

    2010-01-01

    Background In breast cancer surgery, intraoperative frozen section (FS) analysis of sentinel lymph nodes (SLNs) enables axillary lymph node dissection (ALND) during the same operative procedure. In case of discordance between a “negative” FS analysis and definitive histology, an ALND as a second operation is advocated since additional lymph node metastases may be present. The clinical implications of the subsequent ALND in these patients were evaluated. Materials and Methods Between November 2000 and May 2008, 879 consecutive breast cancer patients underwent surgery including sentinel lymph node biopsy (SLNB) with intraoperative FS analysis of 2 central cuts from axillary SLNs. Following fixation and serial sectioning, SLNs were further examined postoperatively with hematoxylin and eosin (H&E) and immunohistochemical techniques. For patients with a discordant FS examination, the effect of the pathology findings of the subsequent ALND specimen on subsequent nonsurgical therapy were evaluated. Results FS analysis detected axillary metastases in the SLN(s) in 200 patients (23%), while the definitive pathology examination detected metastases in SLNs in another 151 patients (17%). A complementary ALND was performed in 108 of the 151 patients with discordant FS. Additional tumor positive axillary lymph nodes were found in 17 patients (16%), leading to “upstaging” in 7 (6%). Subsequent nonsurgical treatment was adjusted in 4 patients (4%): all 4 had more extensive locoregional radiotherapy; no patient received additional hormonal and/or chemotherapy. Conclusion Discordance between intraoperative FS analysis and definitive histology of SLNs is common. In this selection of patients, a substantial proportion had additional lymph node metastases, but postsurgical treatment was rarely adjusted based on the findings of the complementary ALND. PMID:20422461

  10. Identification of regions of normal grey matter and white matter from pathologic glioblastoma and necrosis in frozen sections using Raman imaging.

    PubMed

    Kast, Rachel; Auner, Gregory; Yurgelevic, Sally; Broadbent, Brandy; Raghunathan, Aditya; Poisson, Laila M; Mikkelsen, Tom; Rosenblum, Mark L; Kalkanis, Steven N

    2015-11-01

    In neurosurgical applications, a tool capable of distinguishing grey matter, white matter, and areas of tumor and/or necrosis in near-real time could greatly aid in tumor resection decision making. Raman spectroscopy is a non-destructive spectroscopic technique which provides molecular information about the tissue under examination based on the vibrational properties of the constituent molecules. With careful measurement and data processing, a spatial step and repeat acquisition of Raman spectra can be used to create Raman images. Forty frozen brain tissue sections were imaged in their entirety using a 300-µm-square measurement grid, and two or more regions of interest within each tissue were also imaged using a 25 µm-square step size. Molecular correlates for histologic features of interest were identified within the Raman spectra, and novel imaging algorithms were developed to compare molecular features across multiple tissues. In previous work, the relative concentration of individual biomolecules was imaged. Here, the relative concentrations of 1004, 1300:1344, and 1660 cm(-1), which correspond primarily to protein and lipid content, were simultaneously imaged across all tissues. This provided simple interpretation of boundaries between grey matter, white matter, and diseased tissue, and corresponded with findings from adjacent hematoxylin and eosin-stained sections. This novel, yet simple, multi-channel imaging technique allows clinically-relevant resolution with straightforward molecular interpretation of Raman images not possible by imaging any single peak. This method can be applied to either surgical or laboratory tools for rapid, non-destructive imaging of grey and white matter. PMID:26359131

  11. Perioperative allergy: risk factors.

    PubMed

    Caffarelli, C; Stringari, G; Pajno, G B; Peroni, D G; Franceschini, F; Dello Iacono, I; Bernardini, R

    2011-01-01

    Perioperative anaphylactic as well as anaphylactoid reactions can be elicited by drugs, diagnostic agents, antiseptics, disinfectants and latex. In some individuals, allergic reactions occur in the absence of any evident risk factor. Previous history of specific safe exposure to a product does not permit to exclude the risk of having a reaction. We have systematically reviewed characteristics in the patient's history or clinical parameters that affect the risk of developing reactions during anesthesia. Evidence shows that patients with previous unexplained reaction during anesthesia are at risk for perioperative allergic reactions. An allergic reaction to an agent is associated with previous reaction to a product that is related with the culprit agent. Multiple surgery procedures, professional exposure to latex and allergy to fruit are associated with an increased frequency of latex allergy. It has been shown that in some instances, allergic perioperative reactions may be more common in atopic patients and in females. PMID:22014923

  12. Perioperative lung injury.

    PubMed

    Slinger, Peter

    2008-03-01

    Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury and acute respiratory distress syndrome. Anesthetic management can cause, exacerbate or ameliorate most of these injuries. Clinical research trends show that traditional protocols for perioperative mechanical ventilation, using large tidal volumes without positive end-expiratory pressure (PEEP) can cause a sub-clinical lung injury and this injury becomes clinically important when any additional lung injury is added. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of PEEP can decrease the extent of this injury. PMID:18494396

  13. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  14. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  15. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  16. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  17. 21 CFR 146.137 - Frozen orange juice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen orange juice. 146.137 Section 146.137 Food... Beverages § 146.137 Frozen orange juice. (a) Frozen orange juice is orange juice as defined in § 146.135, except that it is frozen. (b) The name of the food is “Frozen orange juice”. Such name may be preceded...

  18. Intraoperative frozen section evaluation of ureteral and urethral margins: studies of 203 consecutive radical cystoprostatectomy for men with bladder urothelial carcinoma.

    PubMed

    Zhou, Haijun; Ro, Jae Y; Truong, Luan D; Ayala, Alberto G; Shen, Steven S

    2014-01-01

    Intraoperative frozen section (FS) evaluation of ureteral and urethral margins is frequently requested during radical cystoprostatectomy in patients with bladder urothelial carcinoma. However, it is still controversial whether intraoperative FSs of ureteral and urethral margins are necessary in all patients with cystoprostatectomy or a risk-based assessment with limited to the high risk patients is the best approach. A total of 203 radical cystoprostatectomy specimens with FS evaluation on margin status from men treated for bladder urothelial carcinoma from 2003 to 2010 in our institution were reviewed. Clinicopathologic features studied include: patients' age, pathologic tumor stage, presence of carcinoma in- situ (CIS), and intraoperative FS diagnosis. All 203 patients had intraoperative FS evaluation of ureter, and of these, 37 patients had additional urethra FS evaluation. Of the 203 ureteral FS cases, 17 (8.4%) had positive margin for CIS (16 cases) or CIS with invasive urothelial carcinoma (1 case). All 17 patients with positive ureteral margin on FS had concomitant CIS in the bladder (15.5%; 17 of 110 patients). In contrast, none of the patients without concomitant CIS (n=93) had positive ureteral margins on FS. Among 37 patients who also had FS evaluation on urethral resection margin, 3 patients (8.1%) had positive margins for CIS and all three of them had concomitant CIS in the bladder. Positive ureteral/urethral margin was not associated with patients' age or tumor stage, but was significantly associated with the presence of CIS in the bladder (p<0.001). Our study demonstrates that presence of concomitant CIS in bladder cancer was often associated with positive ureteral or urethral margin for CIS or invasive carcinoma; therefore, intraoperative FS evaluation may be indicated to these patients with concomitant bladder CIS. In contrast, in patients with no associated concomitant CIS in the bladder, FS of ureteral/urethral margins may not be necessary unless

  19. Use of the virtual slide and the dynamic real-time telepathology systems for a consultation and the frozen section intra-operative diagnosis in thoracic/pulmonary pathology.

    PubMed

    Słodkowska, Janina; Pankowski, Juliusz; Siemiatkowska, Krystyna; Chyczewski, Lech

    2009-01-01

    We report the results of a study designed for assessment of the diagnostic accuracy and usability of internet-based digital microscopy: the dynamic real-time telepathology system (Coolscope) and the Virtual microscopy (Aperio Scan Scope) system, in the context of pulmonary pathology. The systems were implemented to the routine pulmonary pathology workflows and used for the intra-operative frozen-section primary diagnosis as well as for the secondary (consultative) diagnosis. The histological material presented for the teleconsultations included the samples of lung parenchyma, bronchial biopsy and resected lung/bronchi tumours. For the primary diagnosis 4 categories of material can be distinguished (304 samples): 1) the frozen sections of lung tumours, resected bronchial margins and lymph nodes; 2) fine needle aspiration [FNA] biopsies (TBNA; EBUS-TBNA, EUS-FNA; 3) oligobiopsies of bronchus, oesophagus, skin; and 4) exfoliative cytology. The telepathology diagnoses compared with conventional light microscopy diagnoses showed very high concordance for the Coolscope and Aperio Virtual Slide modality: 87.5% and 100%, respectively - within the group of teleconsultations. For the frozen sections, the primary telediagnoses were concordant with the light microscopy paraffin sections diagnoses in 100% for Aperio; and in 97.5% for Coolscope. An excellent agreement (100%) was seen in the telediagnoses and conventional slides diagnoses for FNA, oligobiopsies and cytology - for both telepathology systems. These results provide some encouragement for the implementation of Coolscope and virtual slide-based telepathology (Aperio) system to the routine histopathological diagnostics. PMID:20430738

  20. Perioperative visual loss.

    PubMed

    Kla, Koffi M; Lee, Lorri A

    2016-03-01

    Perioperative visual loss is an infrequent, devastating complication associated with spine surgery, most commonly from ischemic optic neuropathy. Current research and expert opinion indicate that it is associated with procedures that create elevated venous pressure in the head for prolonged periods of time. The largest case-control study on ischemic optic neuropathy associated with spine surgery found six independent and significant risk factors including male sex, obesity, Wilson frame use, longer operative times, greater blood loss, and a lower colloid to crystalloid ratio in the non-blood fluid administration. The American Society of Anesthesiologists developed a practice advisory for the prevention of this complication. In this setting, it is advisable to avoid significant physiologic and hemodynamic perturbations as much as possible, given the uncertainty of the pathophysiology. Because prevention of this complication cannot be guaranteed, consent for perioperative visual loss should be strongly considered in patients at high risk for this complication. PMID:27036604

  1. [Perioperative thermal management].

    PubMed

    Bräuer, A; Perl, T; Quintel, M

    2006-12-01

    Perioperative hypothermia can influence clinical outcome negatively. It triples the incidence of adverse myocardial outcomes, significantly increases perioperative blood loss, significantly augments allogenic transfusion requirements, and increases the incidence of surgical wound infections. The major causes are redistribution of heat from the core of the body to the peripheral tissues and a negative heat balance. Adequate thermal management includes preoperative and intraoperative measures. Preoperative measures, e.g., prewarming, enhance heat content of the peripheral tissues, thereby reducing redistribution of heat from the core to the peripheral tissues after induction of anesthesia. Intraoperative measures are active skin surface warming of a large body surface area with conductive or convective warming systems. Intravenous fluids should be warmed when large volumes of more than 500-1000 ml/h are required. The body surfaces that cannot be actively warmed should be insulated. Airway humidification and conductive warming of the back are less efficient. PMID:17136375

  2. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  3. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  4. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  5. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  6. 7 CFR 58.349 - Frozen cream.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Frozen cream. 58.349 Section 58.349 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Products Bearing Usda Official Identification § 58.349 Frozen cream. The flavor shall be sweet,...

  7. 5 CFR 1650.3 - Frozen accounts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... child support legal process, and child abuse enforcement orders (found in 5 CFR part 1653). (b) A... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Frozen accounts. 1650.3 Section 1650.3... SAVINGS PLAN General § 1650.3 Frozen accounts. (a) All withdrawals from the TSP are subject to the...

  8. Perioperative pain management.

    PubMed

    Pyati, Srinivas; Gan, Tong J

    2007-01-01

    The under-treatment of postoperative pain has been recognised to delay patient recovery and discharge from hospital. Despite recognition of the importance of effective pain control, up to 70% of patients still complain of moderate to severe pain postoperatively. The mechanistic approach to pain management, based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission, provides newer options for clinicians to manage pain effectively. In this article we review the rationale for a multimodal approach with combinations of analgesics from different classes and different sites of analgesic administration. The pharmacological options of commonly used analgesics, such as opioids, NSAIDs, paracetamol, tramadol and other non-opioid analgesics, and their combinations is discussed. These analgesics have been shown to provide effective pain relief and their combinations demonstrate a reduction in opioid consumption. The basis for using non-opioid analgesic adjuvants is to reduce opioid consumption and consequently alleviate opioid-related adverse effects. We review the evidence on the opioid-sparing effect of ketamine, clonidine, gabapentin and other novel analgesics in perioperative pain management. Most available data support the addition of these adjuvants to routine analgesic techniques to reduce the need for opioids and improve quality of analgesia by their synergistic effect. Local anaesthetic infiltration, epidural and other regional techniques are also used successfully to enhance perioperative analgesia after a variety of surgical procedures. The use of continuous perineural techniques that offer prolonged analgesia with local anaesthetic infusion has been extended to the care of patients beyond hospital discharge. The use of nonpharmacological options such as acupuncture, relaxation, music therapy, hypnosis and transcutaneous nerve stimulation as adjuvants to conventional analgesia should be considered and incorporated to

  9. Peri-operative anaphylaxis

    PubMed Central

    Nel, Linda; Eren, Efrem

    2011-01-01

    Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described. PMID:21235622

  10. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  11. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  12. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  13. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  14. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  15. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  16. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  17. 7 CFR 58.650 - Requirements for frozen custard.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Requirements for frozen custard. 58.650 Section 58.650... Products Bearing Usda Official Identification § 58.650 Requirements for frozen custard. The same requirements apply as for ice cream except plain frozen custard shall have a minimum egg yolk solids content...

  18. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  19. 48 CFR 852.246-72 - Frozen processed foods.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed foods. 852.246-72 Section 852.246-72 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Frozen processed foods. As prescribed in 846.302-72, insert the following clause: Frozen Processed...

  20. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  1. 21 CFR 161.175 - Frozen raw breaded shrimp.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen raw breaded shrimp. 161.175 Section 161.175... § 161.175 Frozen raw breaded shrimp. (a) Frozen raw breaded shrimp is the food prepared by coating one... food tests not less than 50 percent of shrimp material as determined by the method prescribed...

  2. 21 CFR 161.175 - Frozen raw breaded shrimp.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen raw breaded shrimp. 161.175 Section 161.175... § 161.175 Frozen raw breaded shrimp. (a) Frozen raw breaded shrimp is the food prepared by coating one... food tests not less than 50 percent of shrimp material as determined by the method prescribed...

  3. 21 CFR 161.175 - Frozen raw breaded shrimp.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen raw breaded shrimp. 161.175 Section 161.175... § 161.175 Frozen raw breaded shrimp. (a) Frozen raw breaded shrimp is the food prepared by coating one... food tests not less than 50 percent of shrimp material as determined by the method prescribed...

  4. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  5. 21 CFR 161.175 - Frozen raw breaded shrimp.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen raw breaded shrimp. 161.175 Section 161.175... § 161.175 Frozen raw breaded shrimp. (a) Frozen raw breaded shrimp is the food prepared by coating one... food tests not less than 50 percent of shrimp material as determined by the method prescribed...

  6. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  7. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  8. 21 CFR 161.176 - Frozen raw lightly breaded shrimp.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen raw lightly breaded shrimp. 161.176 Section... Shellfish § 161.176 Frozen raw lightly breaded shrimp. Frozen raw lightly breaded shrimp complies with the provisions of § 161.175, except that it contains not less than 65 percent of shrimp material, as...

  9. 21 CFR 161.175 - Frozen raw breaded shrimp.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen raw breaded shrimp. 161.175 Section 161.175... § 161.175 Frozen raw breaded shrimp. (a) Frozen raw breaded shrimp is the food prepared by coating one... food tests not less than 50 percent of shrimp material as determined by the method prescribed...

  10. Student Immersion in Perioperative Nursing.

    PubMed

    Penprase, Barbara; Monahan, Janean; Poly-Droulard, Lynda; Prechowski, Stephanie

    2016-02-01

    The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples. PMID:26849984

  11. Mass Spectrometry Imaging of Drug Related Crystal-Like Structures in Formalin-Fixed Frozen and Paraffin-Embedded Rabbit Kidney Tissue Sections

    NASA Astrophysics Data System (ADS)

    Bruinen, Anne L.; van Oevelen, Cateau; Eijkel, Gert B.; Van Heerden, Marjolein; Cuyckens, Filip; Heeren, Ron M. A.

    2016-01-01

    A multimodal mass spectrometry imaging (MSI) based approach was used to characterize the molecular content of crystal-like structures in a frozen and paraffin embedded piece of a formalin-fixed rabbit kidney. Matrix assisted laser desorption/ionization time-of-flight (MALDI-TOF) imaging and desorption electrospray ionization (DESI) mass spectrometry imaging were combined to analyze the frozen and paraffin embedded sample without further preparation steps to remove the paraffin. The investigated rabbit kidney was part of a study on a drug compound in development, in which severe renal toxicity was observed in dosed rabbits. Histological examination of the kidney showed tubular degeneration with precipitation of crystal-like structures in the cortex, which were assumed to cause the renal toxicity. The MS imaging approach was used to find out whether the crystal-like structures were composed of the drug compound, metabolites, or an endogenous compound as a reaction to the drug administration. The generated MALDI-MSI data were analyzed using principal component analysis. In combination with the MS/MS results, this way of data processing demonstrates that the crystal structures were mainly composed of metabolites and relatively little parent drug.

  12. Multiphoton microscopy based cryo-imaging of inflated frozen human lung sections at -60°C in healthy and COPD lungs

    NASA Astrophysics Data System (ADS)

    Abraham, Thomas; Kayra, Damian; Zhang, Angela; Suzuki, Masaru; McDonough, John; Elliott, W. M.; Cooper, Joel D.; Hogg, James C.

    2013-02-01

    Lung is a complex gas exchanger with interfacial area (where the gas exchange takes place) is about the size of a tennis court. Respiratory function is linked to the biomechanical stability of the gas exchange or alveolar regions which directly depends on the spatial distributions of the extracellular matrix fibers such fibrillar collagens and elastin fibers. It is very important to visualize and quantify these fibers at their native and inflated conditions to have correct morphometric information on differences between control and diseased states. This can be only achieved in the ex vivo states by imaging directly frozen lung specimens inflated to total lung capacity. Multiphoton microscopy, which uses ultra-short infrared laser pulses as the excitation source, produces multiphoton excitation fluorescence (MPEF) signals from endogenously fluorescent proteins (e.g. elastin) and induces specific second harmonic generation (SHG) signals from non-centrosymmetric proteins such as fibrillar collagens in fresh human lung tissues [J. Struct. Biol. (2010)171,189-196]. Here we report for the first time 3D image data obtained directly from thick frozen inflated lung specimens (~0.7- 1.0 millimeter thick) visualized at -60°C without prior fixation or staining in healthy and diseased states. Lung specimens donated for transplantation and released for research when no appropriate recipient was identified served as controls, and diseased lung specimens donated for research by patients receiving lung transplantation for very severe COPD (n=4) were prepared as previously described [N. Engl. J. Med. (2011) 201, 1567]. Lung slices evenly spaced between apex and base were examined using multiphoton microscopy while maintained at -60°C using a temperature controlled cold stage with a temperature resolution of 0.1°C. Infrared femto-second laser pulses tuned to 880nm, dry microscopic objectives, and non-de-scanned detectors/spectrophotometer located in the reflection geometry were

  13. Diathermy in perioperative practice.

    PubMed

    Potty, Anish G; Khan, Wasim; Tailor, Hitesh D

    2010-11-01

    Diathermy has revolutionised modern surgery and is an important tool for efficient and safe surgical practice. It has evolved to become the modern day scalpel, being used for cutting and coagulating tissues. This article addresses the functioning and safe use of diathermy in the perioperative setting. The various precautionary checks before surgery, which are prerequisite for safe usage, are highlighted along with the necessary safety drills during and after operation. A specific note is included about the use of electrical equipment in specialised surgeries like cardiac and laparoscopic surgery. The issues regarding the maintenance and repair of equipment are acknowledged and finally, the anticipation for a future with precise and safer cutting and coagulation devices is addressed. PMID:21162356

  14. Evaluation and Treatment of Perioperative Corneal Abrasions

    PubMed Central

    Segal, Kira L.; Fleischut, Peter M.; Kim, Charles; Levine, Ben; Faggiani, Susan L.; Banerjee, Samprit; Gadalla, Farida; Lelli, Gary J.

    2014-01-01

    Purpose. To evaluate perioperative risk factors for corneal abrasion (CA) and to determine current care for perioperative CA in a tertiary care setting. Methods. Hospital-based, cross-sectional study. In Operating Room and Post-Anesthesia Care Units patients, a comparison of cases and controls was evaluated to elucidate risk factors, time to treatment, and most common treatments prescribed for corneal abrasions. Results. 86 cases of corneal abrasion and 89 controls were identified from the 78,542 surgical procedures performed over 2 years. Statistically significant risk factors were age (P = 0.0037), general anesthesia (P < 0.001), greater average estimated blood loss (P < 0.001), eyes taped during surgery (P < 0.001), prone position (P < 0.001), trendelenburg position (P < 0.001), and supplemental oxygen en route to and in the Post-Anesthesia Care Units (P < 0.001). Average time to complaint was 129 minutes. 94% of cases had an inpatient ophthalmology consult, with an average time to consult of 164 minutes. The most common treatment was artificial tears alone (40%), followed by combination treatment of antibiotic ointment and artificial tears (35.3%). Conclusions. Trendelenburg positioning is a novel risk factor for CA. Diagnosis and treatment of perioperative corneal abrasions by an ophthalmologist typically require three hours in the tertiary care setting. PMID:24672709

  15. Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series

    PubMed Central

    Vasdev, Nikhil; Agarwal, Samita; Rai, Bhavan P.; Soosainathan, Arany; Shaw, Gregory; Chang, Sebastian; Prasad, Venkat; Mohan-S, Gowrie; Adshead, James M.

    2016-01-01

    Introduction Nerve sparing during robotic radical prostatectomy (RRP) considerably improves post-operative potency and urinary continence as long as it does not compromise oncological outcome. Excision of the neurovascular bundle (NVB) is often performed in patients with intermediate and high risk prostate cancer to reduce the risk of positive surgical margin raising the risk of urinary incontinence and impotence. We present the first UK series outcomes of such patients who underwent an intra-operative frozen section (IOFS) analysis of the prostate during RRP allowing nerve sparing. Patients and Methods We prospectively analysed the data of 40 patients who underwent an IOFS during RRP at our centre from November 2012 until November 2014. Our IOFS technique involved whole lateral circumferential analysis of the prostate during RRP with the corresponding neurovascular tissue. An intrafascial nerve spare was performed and the specimen was removed intra-operatively via an extension of the 12 mm Autosuture™ camera port without undocking robotic arms. It was then painted by the surgeon and sprayed with “Ink Aid” prior to frozen section analysis. The corresponding NVB was excised if the histopathologist found a positive surgical margin on frozen section. Results Median time to extract the specimen, wound closure and re-establishment of pneumoperitoneum increased the operative time by 8 min. Median blood loss for IOFS was 130 ± 97 ml vs. 90 ± 72 ml (p = NS). IOFS was not associated with major complications or with blood transfusion. PSM decreased significantly from non-IOFS RRP series of 28.7 to 7.8% (p < 0.05). Intra-operative PSM on the prostate specimen was seen in 8/40 margin analysis (20%) leading to an excision of the contra-lateral nerve bundle. On analysis of the nerve bundle on a paraffin embedded block, 6 nerve bundle matched tumor on the specimen whereas 2 NVB were retrospectively removed unnecessarily in our series. All 40 patients have undetectable PSA

  16. The prognostic value of immunohistochemical estrogen receptor analysis in paraffin-embedded and frozen sections versus that of steroid-binding assays.

    PubMed

    Andersen, J; Thorpe, S M; King, W J; Rose, C; Christensen, I; Rasmussen, B B; Poulsen, H S

    1990-04-01

    Estrogen receptors (ER) were independently analyzed using dextran-coated charcoal assays (ER-DCC) and immunohistochemical assays in frozen (ER-ICA) and paraffin-embedded tissue (ER-PAR) from 130 human breast cancer specimens drawn from postmenopausal high-risk patients registered in the Danish Breast Cancer Cooperative Group. ER was best detected with the ER-DCC assay followed by the ER-ICA (relative sensitivity 87%) and the ER-PAR assays (relative sensitivity 71%). The semiquantified staining features of the immunohistochemical assays were statistically significantly correlated with each other and with ER-DCC. Analysis of disease-free interval (DFI) and overall survival (OS) showed that all assays allowed statistically significant discrimination between a high risk and a low risk group, although the sensitivity differences tended to be reflected as small differences in clinical discriminatory power. The patient groups were then stratified according to adjuvant treatment [radiotherapy (RT) versus radiotherapy and tamoxifen (RT + TAM)]. The survival advantage was tied primarily to the receptor status itself in the steroid-binding assays, but was linked to both the receptor status and the adjuvant treatment in the immunohistochemical assays. Thus, the relative risks in terms of DFI and OS were of the same relative magnitude in the RT and RT + TAM groups for ER-DCC assays using a cut-off level of 10 fmol/mg cytosol protein, while there were large differences in the relative risks between RT and RT + TAM groups for ER-ICA and ER-PAR assays. We conclude that an ER assay in fresh tissue should be given first priority, but if there is no fresh tissue, an ER assay in paraffin-embedded tissue offers a reasonably good alternative as a prognosticator and an equivalent alternative as a predictor of the response to endocrine treatment. PMID:1694085

  17. Perioperative Troponin Screening.

    PubMed

    Sessler, Daniel I; Devereaux, P J

    2016-08-01

    Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. Furthermore, mortality at 30 days in patients who have postoperative troponin elevation is a concerning 10%, which represents a 5-fold increase from background risk. Among inpatients ≥45 years of age who are having noncardiac surgery, the number necessary to screen to detect myocardial injury after noncardiac surgery, that would otherwise be missed, is only about 15 patients. Thus, troponin screening seems appropriate for most surgical inpatients who are ≥45 years of age. Potential acute interventions include initiating therapy such as aspirin, statins, and angiotensin-converting enzyme (ACE) inhibitor antihypertensives, along with chronic lifestyle improvements such as smoking cessation, healthful eating, and exercise. PMID:27331782

  18. 21 CFR 101.95 - “Fresh,” “freshly frozen,” “fresh frozen,” “frozen fresh.”

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false âFresh,â âfreshly frozen,â âfresh frozen,â âfrozen fresh.â 101.95 Section 101.95 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements...

  19. Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

    PubMed Central

    Gizzo, Salvatore; Berretta, Roberto; Di Gangi, Stefania; Guido, Maria; Zanni, Giuliano Carlo; Franceschetti, Ilaria; Quaranta, Michela; Plebani, Mario; Nardelli, Giovanni Battista; Patrelli, Tito Silvio

    2014-01-01

    The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events. PMID:25431767

  20. Frozen shoulder - aftercare

    MedlinePlus

    Adhesive capsulitis - aftercare; Frozen shoulder syndrome - aftercare ... Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation . 2nd ed. Philadelphia, PA: Elsevier Saunders;2008: ...

  1. Perioperative Nurse Leaders and Professionalism.

    PubMed

    Whiteside, Dawn

    2016-08-01

    Professionalism in nursing leadership encompasses key elements that include a common body of knowledge, autonomous practice, self-regulation through education and licensure, a set code of ethics, and a commitment to altruism. Perioperative nurse leaders also must embrace collaboration, vision, accountability, and patient and staff member advocacy based on established ethics, values, and standards of care. Nurse leaders who are committed to professional development through pursuit of higher degrees, application of evidence-based practice, collaboration with colleagues, and certification show a strong commitment to their profession and serve as role models for staff members. This article discusses professionalism in nursing and offers information specific to perioperative nurse leaders. PMID:27472973

  2. Perioperative assessment in vascular surgery

    SciTech Connect

    Flanigan, D.P.

    1987-01-01

    This book contains 21 selections. Some of the titles are: The use of ultrasound and computerized tomographic scanning in the diagnosis of vascular pathology; Ancillary techniques in diagnostic angiography; Pre-bypass operative arteriography; Perioperative assessment of in situ bypass grafts; and Early and late evaluation of postoperative carotid restenosis and occlusion.

  3. Cell attachment to frozen sections of injured adult mouse brain: effects of tenascin antibody and lectin perturbation of wound-related extracellular matrix molecules.

    PubMed

    Laywell, E D; Friedman, P; Harrington, K; Robertson, J T; Steindler, D A

    1996-06-01

    Previous studies describing the use of cryoculture methods have focused on the efficacy of the method for studying neuron attachment and neurite outgrowth on intact sections of nerve, and rodent and even human brain. The cryoculture method has shown promise for determining the presence of cell attachment- and neurite-growth-inhibiting molecules in such specimens, and some studies have also attempted to neutralize such molecules with antibodies to myelin inhibitory proteins, nerve growth factor, or factors present in conditioned media that may counteract the repulsiveness of some of these molecules preserved in sections of, for example, myelinated nerves or adult brain white matter. The present study describes the novel use of lesioned central nervous system cryocultures as substrates for investigating the attachment of embryonic neurons and PC12 cells. In addition to demonstrating the use of this novel scar substrate to extend previous 'scar-in-a-dish' models (David et al. (1990) Neuron, 5:463-469; Rudge and Silver (1990) J. Neurosci., 10: 3594-3603; Rudge et al. (1989) Exp. Neurol., 103: 1-16), the present study also describes antibody and lectin perturbations of putative inhibitory molecules that result in an enhanced attachment of cells to cryosection cultures of brain and spinal cord wounds. PMID:8835793

  4. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  5. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  6. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  7. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  8. 21 CFR 146.120 - Frozen concentrate for lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... lemonade is the frozen food prepared from one or both of the lemon juice ingredients specified in paragraph... percent by weight. (b) The lemon juice ingredients referred to in paragraph (a) of this section are: (1) Lemon juice or frozen lemon juice or a mixture of these. (2) Concentrated lemon juice or...

  9. Frozen-intensity test research of frozen coal with steel

    NASA Astrophysics Data System (ADS)

    Zhang, Xiaopeng; Huang, Cheng; Liu, Weibo

    2002-05-01

    As a sort of multiple component, and dispersed state granule aggregation, frozen coal behaves similar to frozen soil. On the basis of its unique ice-cementation effect and not-frozen water along with dynamical balance state between the frameworks of mineral granule, the mechanical behavior of frozen coal is more complex than usual in compact medium, restrictedly with force amount, process time period and temperature. In all factors which impact on frozen intensity of frozen coal frozen with steel plate, water content is relatively easy to control. From results of this test research, values of frozen intensity is changeable under different water content. Up to the critical water content, the value of frozen intensity increase rapidly till a certain steady value. Under a certain temperature and water content condition, the granule component of frozen coal has somewhat effect on the frozen intensity. Usually, the frozen intensity of large granule coal is greater than the small granule's However, the distributing of coal granule size present a steady probability rule. So the effect from granule size is tiny.

  10. The Frozen Price Game

    ERIC Educational Resources Information Center

    Alden, Lori

    2003-01-01

    In this article, the author discusses the educational frozen price game she developed to teach the basic economic principle of price allocation. In addition to demonstrating the advantages of price allocation, the game also illustrates such concepts as opportunity costs, cost benefit comparisons, and the trade-off between efficiency and equity.…

  11. Peri-operative intensive care.

    PubMed

    Walsh, Sandra A; Peters, Mark J

    2015-10-01

    All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins. PMID:26382268

  12. Strategies for Successful Perioperative Orientation.

    PubMed

    Mollohan, Joseph K; Morales, Maria

    2016-08-01

    The successful orientation of new employees facilitates their transition to the complex and demanding world of perioperative nursing. Whether a nurse is a recent graduate or an experienced nurse who has recently joined the facility or department, a new nurse benefits from a transition period during which new skills, processes, and concepts can be learned. Training should offer new employees the opportunity to develop competency, experience, collegial relationships, clinical judgment, and, overall, specialized knowledge for application in the clinical setting. Concerns surrounding orientation and training include the initial costs for training and the possibility of new employees leaving after the completion of training. The associated costs can be staggering, but adopting perioperative nurse residency programs may be a way to provide quality, high-level training and improve retention rates while minimizing long-term costs. PMID:27472970

  13. Pulmonary aspiration in perioperative medicine.

    PubMed

    Abdulla, Susanne

    2013-01-01

    Perioperative aspiration into the lungs is an infrequent but potentially serious cause of anesthesia-related morbidity and mortality. It is still a leading cause of death from pulmonary complications. Aspiration occurs in approximately three per 10.000 anesthetic procedures with higher incidences in special patient populations and emergency situations. Any patient with symptoms following aspiration that last for more than two hours in the recovery room should be admitted to an intensive care unit for further observation and therapy. This article reviews incidence, morbidity and mortality of perioperative aspiration as well as risk factors and preventive measures. Among preventive measures the use of drugs designed to increase gastric pH, recent developments in supraglottic airway devices and application of rapid sequence induction with cricoid pressure are discussed. Also, international fasting guidelines and clinical management following aspiration are provided. PMID:23767172

  14. Communication in the perioperative setting.

    PubMed

    Cvetic, Elizabeth

    2011-09-01

    Poor communication in the perioperative setting contributes to an unsafe OR culture and affects patient safety and employee engagement, decision making, productivity, morale, and retention. Communication breakdowns can lead to surgical delays, patient inconvenience, and serious errors. Simplification and standardization of communication processes and the use of effective communication skills (eg, clear verbal communication, awareness of the effects of nonverbal communication, use of listening and conflict management skills) are ways to improve OR interactions and minimize or prevent errors. PMID:21884846

  15. Prevention of inadvertent perioperative hypothermia.

    PubMed

    Burger, Leona; Fitzpatrick, Jane

    All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient's body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients' short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forced-air warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period. PMID:19966730

  16. Preparing the Next Generation of Perioperative Nurses.

    PubMed

    Chappy, Sharon; Madigan, Patricia D; Doyle, Deborah S; Conradt, Laurie A; Tapio, Nathan C

    2016-01-01

    Perioperative nursing faces a workforce crisis. There are too few perioperative nurses entering the workforce to replace those who will reach retirement age. Further, the costs of orienting perioperative nurses is high, and turnover rates in the first year after graduation are significant. To address these issues, nursing leaders at Theda Clark Medical Center, Neenah, Wisconsin, and the University of Wisconsin Oshkosh College of Nursing partnered with local medical centers to form a precepted clinical immersion program intended to orient senior baccalaureate nursing students to the perioperative setting. The students were hired after graduation, and the cost savings for orienting each new employee was estimated at $16,000 to $25,000 per student. Other benefits include identifying students who are and are not a good fit for perioperative nursing. The collaboration of health care and academic leaders is one solution for addressing the perioperative nursing workforce crisis. PMID:26746037

  17. Foods - fresh vs. frozen or canned

    MedlinePlus

    Frozen foods vs. fresh or canned; Fresh foods vs. frozen or canned; Frozen vegetables versus fresh ... a well-balanced diet. Many people wonder if frozen and canned vegetables are as healthy for you ...

  18. Perioperative management in children with chronic pain.

    PubMed

    Brooks, Meredith R; Golianu, Brenda

    2016-08-01

    Children with chronic pain often undergo surgery and effective perioperative management of their pain can be challenging. Identification of the pediatric chronic pain patient preoperatively and development of a perioperative pain plan may help ensure a safer and more comfortable perioperative course. Successful management usually requires multiple different classes of analgesics, regional anesthesia, and adjunctive nonpharmacological therapies. Neuropathic and oncological pain can be especially difficult to treat and usually requires an individualized approach. PMID:27370517

  19. Texture of Frozen Food

    NASA Astrophysics Data System (ADS)

    Wani, Kohmei

    Quantitative determination of textural quality of frozen food due to freezing and storage conditions is complicated,since the texture is consisted of multi-dimensiona1 factors. The author reviewed the importance of texture in food quality and the factors which is proposed by a priori estimation. New classification of expression words of textural properties by subjective evaluation and an application of four elements mechanical model for analysis of physical characteristics was studied on frozen meat patties. Combination of freezing-thawing condition on the subjective properties and physiochemical characteristics of beef lean meat and hamachi fish (Yellow-tail) meat was studied. Change of the plasticity and the deformability of these samples differed by freezing-thawing rate and cooking procedure. Also optimum freezing-thawing condition was differed from specimens.

  20. Curation of Frozen Samples

    NASA Technical Reports Server (NTRS)

    Fletcher, L. A.; Allen, C. C.; Bastien, R.

    2008-01-01

    NASA's Johnson Space Center (JSC) and the Astromaterials Curator are charged by NPD 7100.10D with the curation of all of NASA s extraterrestrial samples, including those from future missions. This responsibility includes the development of new sample handling and preparation techniques; therefore, the Astromaterials Curator must begin developing procedures to preserve, prepare and ship samples at sub-freezing temperatures in order to enable future sample return missions. Such missions might include the return of future frozen samples from permanently-shadowed lunar craters, the nuclei of comets, the surface of Mars, etc. We are demonstrating the ability to curate samples under cold conditions by designing, installing and testing a cold curation glovebox. This glovebox will allow us to store, document, manipulate and subdivide frozen samples while quantifying and minimizing contamination throughout the curation process.

  1. FROZEN HYDROCARBONS IN COMETS

    SciTech Connect

    Simonia, Irakli

    2011-02-15

    Recent investigations of the luminescence of frozen hydrocarbon particles of icy cometary halos have been carried out. The process of luminescence of organic icy particles in a short-wavelength solar radiation field is considered. A comparative analysis of observed and laboratory data leads to 72 luminescent emission lines in the spectrum of the comet 153P/Ikeya-Zhang. The concept of cometary relict matter is presented, and the creation of a database of unidentified cometary emission lines is proposed.

  2. Frozen cultural plasticity.

    PubMed

    Houdek, Petr; Novakova, Julie

    2016-01-01

    We discuss cultural group selection under the view of the frozen plasticity theory and the different explanatory power and predictions of this framework. We present evidence that cultural adaptations and their influence on the degree of cooperation may be more complex than presented by Richerson et al., and conclude with the gene-environment-culture relationship and its impacts on cultural group selection. PMID:27561647

  3. 7 CFR 52.812 - Score sheet for frozen red tart pitted cherries.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 2 2013-01-01 2013-01-01 false Score sheet for frozen red tart pitted cherries. 52.812 Section 52.812 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING... for Grades of Frozen Red Tart Pitted Cherries Score Sheet § 52.812 Score sheet for frozen red...

  4. 7 CFR 52.812 - Score sheet for frozen red tart pitted cherries.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Score sheet for frozen red tart pitted cherries. 52.812 Section 52.812 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING... for Grades of Frozen Red Tart Pitted Cherries Score Sheet § 52.812 Score sheet for frozen red...

  5. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  6. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  7. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  8. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  9. 40 CFR 407.40 - Applicability; description of the frozen potato products subcategory.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... frozen potato products subcategory. 407.40 Section 407.40 Protection of Environment ENVIRONMENTAL... PROCESSING POINT SOURCE CATEGORY Frozen Potato Products Subcategory § 407.40 Applicability; description of the frozen potato products subcategory. The provisions of this subpart are applicable to...

  10. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  11. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  12. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  13. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  14. 21 CFR 102.26 - Frozen “heat and serve” dinners.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen âheat and serveâ dinners. 102.26 Section... Nonstandardized Foods § 102.26 Frozen “heat and serve” dinners. (a) A frozen “heat and serve” dinner: (1) Shall... consists of all of the following: (1) The phrase “frozen ‘heat and serve’ dinner,” except that the name...

  15. Perioperative management of pediatric trauma patients

    PubMed Central

    Ivashkov, Yulia; Bhananker, Sanjay M

    2012-01-01

    Pediatric trauma presents significant challenges to the anesthesia provider. This review describes the current trends in perioperative anesthetic management, including airway management, choice of anesthesia agents, and fluid administration. The review is based on the PubMed search of literature on perioperative care of severely injured children. PMID:23181208

  16. Epigenetics in the perioperative period

    PubMed Central

    Lirk, P; Fiegl, H; Weber, N C; Hollmann, M W

    2015-01-01

    The perioperative period is characterized by profound changes in the body's homoeostatic processes. This review seeks to address whether epigenetic mechanisms may influence an individual's reaction to surgery and anaesthesia. Evidence from animal and human studies suggests that epigenetic mechanisms can explain many facets of susceptibility to acute and chronic pain, making them potential therapeutic targets. Modern pain management is still based upon opiates, and both the developmental expression of opioid receptors and opioid-induced hyperalgesia have been linked to epigenetic mechanisms. In general, opiates seem to increase global DNA methylation levels. This is in contrast to local anaesthetics, which have been ascribed a global demethylating effect. Even though no direct investigations have been carried out, the potential influence of epigenetics on the inflammatory response that follows surgery seems a promising area for research. There is a considerable body of evidence that supports the involvement of epigenetics in the complex process of wound healing. Epigenetics is an important emerging research topic in perioperative medicine, with a huge potential to positively influence patient outcome. PMID:25073649

  17. Perioperative Acupuncture and Related Techniques

    PubMed Central

    Chernyak, Grigory V.; Sessler, Daniel I.

    2005-01-01

    Acupuncture and related techniques are increasingly practiced in conventional medical settings, and the number of patients willing to use these techniques is increasing. Despite more than 30 years of research, the exact mechanism of action and efficacy of acupuncture have not been established. Furthermore, most aspects of acupuncture have yet to be adequately tested. There thus remains considerable controversy about the role of acupuncture in clinical medicine. Acupuncture apparently does not reduce volatile anesthetic requirement by a clinically important amount. However, preoperative sedation seems to be a promising application of acupuncture in perioperative settings. Acupuncture may be effective for postoperative pain relief but requires a high level of expertise by the acupuncture practitioner. Acupuncture and related techniques can be used for treatment and prophylaxis of postoperative nausea and vomiting in routine clinical practice in combination with, or as an alternative to, conventional antiemetics when administered before induction of general anesthesia. Summary Statement: The use of acupuncture for perioperative analgesia, nausea and vomiting, sedation, anesthesia, and complications is reviewed. PMID:15851892

  18. Frozen Carbon Dioxide

    NASA Technical Reports Server (NTRS)

    2005-01-01

    1 August 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a south polar residual cap landscape, formed in frozen carbon dioxide. There is no place on Earth that one can go to visit a landscape covering thousands of square kilometers with frozen carbon dioxide, so mesas, pits, and other landforms of the martian south polar region are as alien as they are beautiful. The scarps of the south polar region are known from thousands of other MGS MOC images to retreat at a rate of about 3 meters (3 yards) per martian year, indiating that slowly, over the course of the MGS mission, the amount of carbon dioxide in the martian atmosphere has probably been increasing.

    Location near: 86.9oS, 25.5oW Image width: width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Spring

  19. Perioperative medicine. Are the anesthesiologists ready?

    PubMed

    Carli, F

    2001-04-01

    Perioperative medicine starts with preoperative assessment and preparation of patients undergoing various procedures. It includes intraoperative care and continues postproceudral management, from recovery room to intensive care and step-down facilities. Acute pain management must be optimized in order to enhance rehabilitation and restoration of functions. Perioperative medicine also includes management of acute and chronic pain. Potential areas of anesthesia involvement, still unclear, include preoperative and postoperative ward management and complete preparation such as cardiology or pulmonary testing. Further steps to take in the direction of perioperative medicine are the development of a different model of resident training, and the improvement of information technology and medical record. PMID:11376518

  20. Optimal glucose management in the perioperative period.

    PubMed

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. PMID:25814110

  1. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia. PMID:27004381

  2. Peri-operative pulmonary dysfunction and protection.

    PubMed

    Marseu, K; Slinger, P

    2016-01-01

    Pulmonary complications are a major cause of peri-operative morbidity and mortality, but have been researched less thoroughly than cardiac complications. It is important to try and predict which patients are at risk of peri-operative pulmonary complications and to intervene to reduce this risk. Anaesthetists are in a unique position to do this during the whole peri-operative period. Pre-operative training, smoking cessation and lung ventilation with tidal volumes of 6-8 ml.kg(-1) and low positive end-expiratory pressure probably reduce postoperative pulmonary complications. PMID:26620146

  3. Thermoregulation: anesthetic and perioperative concerns.

    PubMed

    Fiedler, M A

    2001-12-01

    Hypothermia has long been common in anesthesia and has largely been seen as an inconvenience. For many years, it was viewed as inevitable. But hypothermia is much more than an inconvenience, and it is no longer inevitable. Hypothermia is closely associated with significant morbidity both intraoperatively and postoperatively. Hypothermia may begin in the preoperative holding area, so efforts to prevent it should begin there as well. Effective intraoperative and postoperative warming methods are known and commonly available, but they remain underused. Understanding how and why core temperature declines in association with anesthesia and surgery and safe, effective methods to prevent that decline will enable nurse anesthetists and perioperative nurses to increase both the comfort and safety of their patients while reducing costs to the institution. PMID:11837152

  4. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  5. [Prevention of Perioperative Aspiration Pneumonitis].

    PubMed

    Fukuda, Kazuhiko

    2016-01-01

    To prevent perioperative aspiration pneumonitis, it is necessary to reduce the volume and acidity of gastric content. The guideline for preoperative fasting published by Japanese Society of Anesthesiologists recommends fasting from intake of clear fluids, breast milk and nonhuman milk at least 2h, 4h and 6h, respectively, before elective procedures requiring general anesthesia, regional anesthesia or sedation/analgesia. Gastrointestinal stimulants, histamine-2 receptor antagonists, proton pump inhibitors, antacids, antiemetics, anticholinergics are effective for reduction of the volume or acidity of gastric content. However, the routine preoperative use of these drugs to reduce the risk of pulmonary aspiration in patients who have no apparent increased risk for pulmonary aspiration is not recommended. PMID:27004383

  6. Perioperative myocardial ischemia reperfusion injury.

    PubMed

    Shernan, Stanton K

    2003-09-01

    Myocardial I-R injury contributes to adverse cardiovascular outcomes after cardiac surgery. The pathogenesis of I-R injury is complex and involves the activation, coordination, and amplification of several systemic and local proinflammatory pathways (Fig. 4). Treatment and prevention of perioperative morbidity associated with myocardial I-R will ultimately require a multifocal approach. Combining preoperative risk stratification (co-morbidity and surgical complexity), minimizing initiating factors predisposing to SIRS, limiting ischemia duration, and administering appropriate immunotherapy directed toward systemic and local proinflammatory mediators of I-R injury, should all be considered. In addition, the role of the genetic-environmental interactions in the pathogenesis of cardiovascular disease is also being examined. Thus, in the near future, preoperative screening for polymorphisms of certain inflammatory and coagulation genes should inevitably help reduce morbidity by permitting the identification of high-risk cardiac surgical patients and introducing the opportunity for gene therapy or pharmacogenetic intervention [42,64]. PMID:14562561

  7. Perioperative thermoregulation and heat balance.

    PubMed

    Sessler, Daniel I

    2016-06-25

    Core body temperature is normally tightly regulated to within a few tenths of a degree. The major thermoregulatory defences in humans are sweating, arteriovenous shunt vasoconstriction, and shivering. The core temperature triggering each response defines its activation threshold. General anaesthetics greatly impair thermoregulation, synchronously reducing the thresholds for vasoconstriction and shivering. Neuraxial anaesthesia also impairs central thermoregulatory control, and prevents vasoconstriction and shivering in blocked areas. Consequently, unwarmed anaesthetised patients become hypothermic, typically by 1-2°C. Hypothermia results initially from an internal redistribution of body heat from the core to the periphery, followed by heat loss exceeding metabolic heat production. Complications of perioperative hypothermia include coagulopathy and increased transfusion requirement, surgical site infection, delayed drug metabolism, prolonged recovery, shivering, and thermal discomfort. Body temperature can be reliably measured in the oesophagus, nasopharynx, mouth, and bladder. The standard-of-care is to monitor core temperature and to maintain normothermia during general and neuraxial anaesthesia. PMID:26775126

  8. [Perioperative Management of PD Patients].

    PubMed

    Reichmann, H

    2016-07-01

    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. PMID:27276074

  9. Perioperative management of obese patients.

    PubMed

    Pelosi, Paolo; Gregoretti, Cesare

    2010-06-01

    Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their respiratory system. Body mass is an important determinant of respiratory function before and during anaesthesia not only in morbidly but also in moderately obese patients. These can manifest as (a) reduced lung volume with increased atelectasis; (b)derangements in respiratory system, lung and chest wall compliance and increased resistance; and (c) moderate to severe hypoxaemia. These physiological alterations are more marked in obese patients with hypercapnic syndrome or obstructive sleep apnoea syndrome. The suggested perioperative ventilation management includes (a) awake and/or facilitated endotracheal intubation by using a video-laryngoscope; (b) tidal volume of 6-10 ml kg(-1) ideal body weight, increasing respiratory rate to maintain physiological PaCO2, while avoiding intrinsic positive end-expiratory pressure (PEEPi); and (c) a recruitment manoeuvre (35-55 cmH2O for 6 s) followed by the application of an end-expiratory pressure (PEEP) of 10 cmH2O. The recruitment manoeuvre should always be performed only when a volemic and haemodynamic stabilisation is reached after induction of anaesthesia. In the postoperative period, beach chair position, aggressive physiotherapy, noninvasive respiratory support and short-term recovery in intermediate critical care units with care of fluid management and pain may be useful to reduce pulmonary complications. PMID:20608558

  10. Perioperative Management of Antithrombotic Therapy

    PubMed Central

    Douketis, James D.; Spyropoulos, Alex C.; Spencer, Frederick A.; Mayr, Michael; Jaffer, Amir K.; Eckman, Mark H.; Dunn, Andrew S.

    2012-01-01

    Background: This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure. Methods: The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results: In patients requiring vitamin K antagonist (VKA) interruption before surgery, we recommend stopping VKAs 5 days before surgery instead of a shorter time before surgery (Grade 1B). In patients with a mechanical heart valve, atrial fibrillation, or VTE at high risk for thromboembolism, we suggest bridging anticoagulation instead of no bridging during VKA interruption (Grade 2C); in patients at low risk, we suggest no bridging instead of bridging (Grade 2C). In patients who require a dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3 days before the procedure instead of alternative strategies (Grade 2C). In moderate- to high-risk patients who are receiving acetylsalicylic acid (ASA) and require noncardiac surgery, we suggest continuing ASA around the time of surgery instead of stopping ASA 7 to 10 days before surgery (Grade 2C). In patients with a coronary stent who require surgery, we recommend deferring surgery > 6 weeks after bare-metal stent placement and > 6 months after drug-eluting stent placement instead of undertaking surgery within these time periods (Grade 1C); in patients requiring surgery within 6 weeks of bare-metal stent placement or within 6 months of drug-eluting stent placement, we suggest continuing antiplatelet therapy perioperatively instead of stopping therapy 7 to 10 days before surgery (Grade 2C). Conclusions: Perioperative antithrombotic management is based on risk assessment for thromboembolism and

  11. Perioperative care of the elderly patient.

    PubMed

    Palmer, Robert M

    2006-03-01

    Perioperative management is typically more complicated in older patients than in younger patients and requires more assessment and evaluation before surgery as well as precautionary steps after surgery to manage these high-risk patients. PMID:16570559

  12. Stress Dose Steroids: Myths and Perioperative Medicine.

    PubMed

    MacKenzie, C Ronald; Goodman, Susan M

    2016-07-01

    Perioperative medication management for patients with systemic autoimmune inflammatory diseases has focused on strategies to improve outcomes and mitigate risks. The emphasis has been to minimize the risk of infection associated with most antirheumatic medications, while attempting to avoid flares of disease precipitated by medication withdrawal. Management of glucocorticoids in the perioperative period has been based on an assumption that supraphysiologic increases in dose were always necessary to avoid hypotension and shock in glucocorticoid treated patients, and alternative strategies were rarely considered despite the known infectious, metabolic, and wound healing risks associated with glucocorticoid administration. This paper will review current recommendations for perioperative glucocorticoid administration for glucocorticoid treated patients with systemic inflammatory autoimmune diseases and discuss glucocorticoid physiology to analyze the basis for these recommendations and consider alternative perioperative management strategies. PMID:27351679

  13. Perioperative assistants are a new resource.

    PubMed

    Speers, A T; Ziolkowski, L

    1998-02-01

    In the current health care environment, buzzwords such as redesign, reengineering, restructuring, right-sizing, customer service, diversity, quality, multiskilled workers, and unlicensed assistive personnel conjure up many notions about how perioperative nurses can meet the needs and wants of their patients. Unlicensed assistive personnel are becoming commonplace in our hospitals and have assumed a variety of positions and functions. This article describes a project that one hospital undertook to create unlicensed, multiskilled workers in the perioperative area. PMID:9505122

  14. The musculoskeletal effects of perioperative smoking.

    PubMed

    Argintar, Evan; Triantafillou, Kostas; Delahay, John; Wiesel, Brent

    2012-06-01

    Although the carcinogenic consequences of smoking are well known, further research is needed on the effects of smoking on musculoskeletal health and surgical outcomes. Orthopaedic perioperative complications of smoking include impaired healing, increased infection, delayed and/or impaired fracture union and arthrodesis, and inferior arthroplasty outcomes. The incorporation of smoking cessation protocols such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period may result in substantial benefits for patients' musculoskeletal and general health. PMID:22661565

  15. Ethical dilemmas in perioperative nursing practice.

    PubMed

    Reeder, J M

    1989-12-01

    Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways. PMID:2685781

  16. Safety and pitfalls in frozen elephant trunk implantation.

    PubMed

    Damberg, Anneke; Schälte, Gereon; Autschbach, Rüdiger; Hoffman, Andras

    2013-09-01

    The frozen elephant trunk (FET) procedure, or open stent grafting, is a tool for the combined open and endovascular treatment via a median sternotomy of extensive aortic disease involving both aortic arch and descending thoracic aorta. The technique aims to stabilize the maximum extent of the thoracic aorta in one step, with the goal of either rendering a secondary intervention to the downstream aorta unnecessary or producing an easy landing zone for secondary thoracic endovascular aortic repair (TEVAR) or open surgery. Even though large case series have reported good results, we still have no conclusive evidence as to which patients and what kind of pathologies benefit from this technique. The surgical sequences described for total arch replacement with the FET procedure are just as varied as the associated devices and indications. This article focuses on important perioperative and surgical aspects, as well as potential complications during FET procedures. PMID:24109583

  17. Frozen beverage machine

    SciTech Connect

    Williams, J.D.

    1988-04-12

    A frozen beverage machine is described, comprising: a. a frame having an exterior, an interior, a front and a back; b. a cylinder, having an interior and an exterior as well as first and second ends and further having an opening in each of the ends, the cylinder being horizontally and fixedly positioned within the interior of the frame with the second end facing the front of the frame; c. a means, sealingly attached to the opening in the second end of the cylinder, for emptying the cylinder; d. a means, positioned within the frame and communicating with the exterior of the cylinder, for removing heat from the cylinder; e. at least one support bracket; f. a shaft, rotatably attached within the opening in the support bracket and rotatably and sealingly attached within the opening in the first end of the cylinder and extending to the interior of the cylinder; g. a motor assembly, operatively connected to a portion of the shaft exterior to the cylinder and suspended from the shaft such that the weight of the motor assembly is supported only by the shaft; h. a contact switch; and i. a resilient means, connected to the frame and the motor assembly, for maintaining the position of the motor assembly relative to the shaft until a desired threshold resistance to rotation of the shaft within the cylinder occur, and then allowing the motor assembly to rotate to a desired position relative to the shaft.

  18. Perioperative Assessment of Myocardial Deformation

    PubMed Central

    Duncan, Andra E.; Alfirevic, Andrej; Sessler, Daniel I.; Popovic, Zoran B.; Thomas, James D.

    2014-01-01

    Evaluation of left ventricular performance improves risk assessment and guides anesthetic decisions. However, the most common echocardiographic measure of myocardial function, the left ventricular ejection fraction (LVEF), has important limitations. LVEF is limited by subjective interpretation which reduces accuracy and reproducibility, and LVEF assesses global function without characterizing regional myocardial abnormalities. An alternative objective echocardiographic measure of myocardial function is thus needed. Myocardial deformation analysis, which performs quantitative assessment of global and regional myocardial function, may be useful for perioperative care of surgical patients. Myocardial deformation analysis evaluates left ventricular mechanics by quantifying strain and strain rate. Strain describes percent change in myocardial length in the longitudinal (from base to apex) and circumferential (encircling the short-axis of the ventricle) direction and change in thickness in the radial direction. Segmental strain describes regional myocardial function. Strain is a negative number when the ventricle shortens longitudinally or circumferentially and is positive with radial thickening. Reference values for normal longitudinal strain from a recent meta-analysis using transthoracic echocardiography are (mean ± SD) −19.7 ± 0.4%, while radial and circumferential strain are 47.3 ± 1.9 and −23.3 ± 0.7%, respectively. The speed of myocardial deformation is also important and is characterized by strain rate. Longitudinal systolic strain rate in healthy subjects averages −1.10 ± 0.16 sec−1. Assessment of myocardial deformation requires consideration of both strain (change in deformation), which correlates with LVEF, and strain rate (speed of deformation), which correlates with rate of rise of left ventricular pressure (dP/dt). Myocardial deformation analysis also evaluates ventricular relaxation, twist, and untwist, providing new and noninvasive methods to

  19. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection... PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.80 Applicability; description of the ice cream, frozen desserts, novelties and other...

  20. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection... PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.80 Applicability; description of the ice cream, frozen desserts, novelties and other...

  1. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection... PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.80 Applicability; description of the ice cream, frozen desserts, novelties and other...

  2. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection... PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.80 Applicability; description of the ice cream, frozen desserts, novelties and other...

  3. 40 CFR 405.80 - Applicability; description of the ice cream, frozen desserts, novelties and other dairy desserts...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... cream, frozen desserts, novelties and other dairy desserts subcategory. 405.80 Section 405.80 Protection... PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.80 Applicability; description of the ice cream, frozen desserts, novelties and other...

  4. 40 CFR 405.70 - Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... fluid mix for ice cream and other frozen desserts subcategory. 405.70 Section 405.70 Protection of... PROCESSING POINT SOURCE CATEGORY Fluid Mix for Ice Cream and Other Frozen Desserts Subcategory § 405.70 Applicability; description of the fluid mix for ice cream and other frozen desserts subcategory. The...

  5. Tuberous Sclerosis Complex: Perioperative Considerations

    PubMed Central

    Rabito, Matthew J.; Kaye, Alan David

    2014-01-01

    Background Tuberous sclerosis complex (TSC), also known as Bourneville disease, is an inherited, progressive neurocutaneous disorder characterized by the potential for hamartoma formation throughout the body. TSC is an autosomal dominant genetic disorder, but more than two-thirds of cases are sporadic. Methods Clinical manifestations and treatment options are discussed. Both surgical and anesthetic perioperative considerations are described in this review. Results Routine monitoring is appropriate for minor surgical procedures for patients with TSC who have mild disease manifestations. More extensive monitoring is indicated for major procedures that have the potential for significant blood loss and for patients with more severe pathology. Postoperatively, TSC patients should be admitted for monitoring and treatment after more extensive procedures or if significant organ dysfunction occurs. Postoperative complications, which may be related to either the surgery or the TSC pathology itself, may have origins in many different organs and may include seizures, severe hypertension, and bradyarrhythmias. Conclusion TSC is a rare disease with a highly variable clinical presentation and provides a multitude of challenges for the patient, the family, and the healthcare team. PMID:24940133

  6. Perioperatively acquired disorders of coagulation

    PubMed Central

    Grottke, Oliver; Fries, Dietmar; Nascimento, Bartolomeu

    2015-01-01

    Purpose of review To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. Recent findings Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy. Particularly, fibrin(ogen) deficits are observable after cardiopulmonary bypass in cardiac surgery, on arrival at the emergency room in trauma patients, and with ongoing bleeding after child birth. Regarding antithrombotic therapy, although new oral anticoagulants offer the possibility of efficacy and relative safety compared with vitamin K antagonists, reversal of their anticoagulant effect with nonspecific agents, including prothrombin complex concentrate, has provided conflicting results. Specific antidotes, currently being developed, are not yet licensed for clinical use, but initial results are promising. Summary Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleterious outcomes. Although there are specific guidelines for reversing anticoagulation in patients treated with antiplatelet agents or warfarin, there is currently little evidence to advocate comprehensive recommendations to treat drug-induced coagulopathy associated with new oral anticoagulants. PMID:25734869

  7. The new frozen spin target at MAMI

    NASA Astrophysics Data System (ADS)

    Thomas, A.; Borisov, N. S.; Arends, H.-J.; Fedorov, A. N.; Gurevich, G. M.; Kondratiev, R. L.; Korolija, M.; Lazarev, A. B.; Martinez, M.; Meyer, W.; Mironov, S. V.; Neganov, A. B.; Pavlov, V. N.; Ortega, H.; Reicherz, G.; Usov, Yu. A.

    2013-11-01

    The new frozen spin polarized target for experiments at the polarized beam of the real photon facility A2 of the MAMI accelerator is described. The A2-collaboration at the Mainz Microtron MAMI is measuring photon absorption cross section using circularly and linearly polarized photons up to the energy of 1.5 GeV. The photons are produced in the' Bremsstrahlungs' process. In the years 2005/2006 the Crystal Ball detector with its unique capability to cope with multi photon final states was set up in Mainz. Since 2010 the experimental apparatus has been completed by a polarized target. The horizontal dilution refrigerator of the Frozen-Spin Target has been constructed and is operated in close cooperation with the Joint Institute for Nuclear Research in Dubna, Russia. The system offers the opportunity to provide longitudinally and transversely polarized protons and deuteron. In this paper the operation experience of this new Frozen-Spin Target and first results from the runs in 2010 and 2011 are presented.

  8. Narrative Review of Perioperative Acupuncture for Clinicians.

    PubMed

    Gliedt, Jordan A; Daniels, Clinton J; Wuollet, Adam

    2015-10-01

    Acupuncture is one of the oldest forms of the natural healing arts. The exact mechanisms of action are unknown at this time; however, current theories to explain the benefits experienced after acupuncture include Traditional Chinese Medicine and Western medicine concepts. Acupuncture may improve the quality of perioperative care and reduce associated complications. Perioperative acupuncture is apparently effective in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain. The Pericardium-6 (P-6; Nei Guan), Yintang (Extra 1), and Shenmen acupuncture points are the most studied and effective acupuncture points in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain experiences. Intraoperatively administered acupuncture may reduce immunosuppression in patients and lessen intraoperative anesthetic requirements, although the clinical usefulness of acupuncture in the intraoperative period remains inconclusive. Perioperative acupuncture is a promising intervention, but additional studies are needed to further understand and define acupuncture's role throughout the perioperative period and determine its clinical usefulness. The purpose of this article is to provide a brief clinical review concerning acupuncture and its application for common issues that occur in the perioperative period. PMID:26433805

  9. Perioperative use of oxygen: variabilities across age.

    PubMed

    Habre, W; Peták, F

    2014-12-01

    Enormous interest has emerged in the perioperative use of high concentrations of inspired oxygen in an attempt to increase tissue oxygenation and thereby improve postoperative outcome. An extensive debate has arisen regarding the risk/benefit ratio of oxygen therapy, with some researchers advocating the benefits of perioperative hyperoxia, particularly with regard to surgical site infection, whereas others emphasize its detrimental consequences on multiple organs, particularly the lungs and the brain. As one aspect of this debate, there is increased awareness of effects of reactive oxygen metabolites, a feature that contributes to the complexity of achieving consensus regarding optimum oxygen concentration in the perioperative period. Many reviews have discussed the pros and cons in the use of perioperative oxygen supplementation, but the potential importance of age-related factors in hyperoxia has not been addressed. The present narrative review provides a comprehensive overview of the physiological mechanisms and clinical outcomes across the age range from neonates to the elderly. Risks greatly outweigh the benefits of hyperoxia both in the very young, where growth and development are the hallmarks, and in the elderly, where ageing increases sensitivity to oxidative stress. Conversely, in middle age, benefits of short-term administration of perioperative oxygen therapy exceed potential adverse change effects, and thus, oxygen supplementation can be considered an important therapy to improve anaesthesia management. PMID:25498579

  10. [Perioperative infusion therapy in children].

    PubMed

    Altemeyer, K H; Kraus, G B

    1990-03-01

    An incorrect fluid therapy can lead to serious complications considerably more rapidly in children, especially in newborns and infants, than in adults. The pediatric patient has a limited range of compensation for maintenance of fluid and electrolyte balance. Precise knowledge of the physiological age-dependent fluid balance, i.e. the large extracellular space, the developing renal function, the increased metabolism, the acid-base state, the electrolyte balance with the relatively higher sodium and chloride requirements must be the basis of an adequate fluid therapy. The basic fluid requirement (normal fluid and electrolyte requirement) varies with age and is influenced considerably by environmental conditions, body temperature and metabolism. For substitution of this basic fluid requirement one-third to one-half strength electrolyte solution in 5% dextrose is used, the amount depending on age. The perioperative fluid requirement, however, has to be calculated with due consideration for the characteristic changes in fluid and electrolyte balance during anaesthesia and surgery, the preoperative fasting period, drug effects of anesthetics, hormonal changes and ventilation; it is higher than the basic fluid requirement (infants 6-8 ml.kg-1.h-1, toddlers 4-6 ml.kg.h-1, schoolchildren 2-4 ml.kg-1.h-1). For intraoperative fluid therapy infusions with an increased sodium concentration (70-100 mmol/l) or Ringer's lactate (Na+ = 130 mmol/l) must be used. On no account must electrolyte-free solutions, e.g., 5-10% glucose, be used intraoperatively, as they can lead to water intoxication. The third-space requirements compensate for the additional losses by drainage, third-space deficits by evaporation and gastric and enteral secretions.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2184693

  11. Using concept maps in perioperative education.

    PubMed

    Noonan, Pam

    2011-11-01

    Critical thinking and clinical decision making are essential components of the knowledge and skills acquired in the perioperative education process. Although traditional didactic teaching methods remain predominant teaching strategies in perioperative nursing education, programs should include a variety of methods and tools to enhance learning of a considerable amount of complex material. Concept mapping is an active teaching strategy that can be used in nursing education to facilitate the development of critical thinking and decision-making skills. A concept map is a tool consisting of a main idea, subconcepts, and cross-links that organizes knowledge by showing relationships between concepts. Different types of maps can be used to present different types of learning material, depending on the focus of the lesson. Complex knowledge (eg, perioperative technology) can be better learned and retained when the brain works to organize information in a hierarchical framework and the information is built up with interacting concepts. PMID:22035816

  12. Thermal care in the perioperative period.

    PubMed

    Kurz, Andrea

    2008-03-01

    Perioperative hypothermia is a common and serious complication of anesthesia and surgery. Core body temperature, which is normally regulated to within a few tenths of a degree centigrade, can fall by as much as 6 degrees C during anesthesia. The combination of anesthetic-induced impairment of thermoregulatory control and exposure to a cool operating room environment causes most surgical patients to become hypothermic. Mild intraoperative hypothermia triples the incidence of postoperative wound infections, triples the incidence of postoperative myocardial events and increases perioperative blood loss. Furthermore, it prolongs postoperative recovery and prolongs the duration of action of almost all anesthestic drugs. Effective methods are available for preventing inadvertent perioperative hypothermia. Consequently, it is now routine to maintain intraoperative normothermia. There is no widely accepted definition for the term 'mild hypothermia'. Furthermore, the term is not used consistently within the literature. For the purpose of this review, mild hypothermia refers to core temperatures between 34 and 36 degrees C. PMID:18494388

  13. Imaging radar observations of frozen Arctic lakes

    NASA Technical Reports Server (NTRS)

    Elachi, C.; Bryan, M. L.; Weeks, W. F.

    1976-01-01

    A synthetic aperture imaging L-band radar flown aboard the NASA CV-990 remotely sensed a number of ice-covered lakes about 48 km northwest of Bethel, Alaska. The image obtained is a high resolution, two-dimensional representation of the surface backscatter cross section, and large differences in backscatter returns are observed: homogeneous low returns, homogeneous high returns and/or low returns near lake borders, and high returns from central areas. It is suggested that a low return indicates that the lake is frozen completely to the bottom, while a high return indicates the presence of fresh water between the ice cover and the lake bed.

  14. Dry Zones Around Frozen Droplets

    NASA Astrophysics Data System (ADS)

    Bisbano, Caitlin; Nath, Saurabh; Boreyko, Jonathan; Nature-Inspired Fluids; Interfaces Team

    2015-11-01

    The saturation pressure of water vapor above supercooled water exceeds that above ice at the same temperature. A frozen droplet will therefore grow by harvesting water vapor from neighboring supercooled condensate, which has recently been demonstrated to be a primary mechanism of in-plane frost growth on hydrophobic surfaces. The underlying physics of this source-sink interaction is still poorly understood. In this work, a deposited water droplet is frozen on a dry hydrophobic surface initially held above the dew point. We demonstrate that when the surface is then cooled beneath the dew point, the frozen droplet harvests nearby water vapor in the air. This results in an annular dry zone that forms between the frozen droplet and the forming supercooled condensation. For a given ambient temperature and humidity, the length of the dry zone varied strongly with surface temperature and weakly with droplet volume. The dependence of the dry zone on surface temperature is due to the fact that the vapor pressure gradients between the ambient and the surface and between the liquid and frozen water are both functions of temperature.

  15. Perioperative morbidity of intracavitary gynecologic brachytherapy

    SciTech Connect

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N.

    1994-07-30

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  16. An automated reminder for perioperative glucose regulation improves protocol compliance.

    PubMed

    Polderman, Jorinde A W; de Groot, Fleur A; Zamanbin, Alaleh; Hollmann, Markus W; Holleman, Frits; Preckel, Benedikt; Hermanides, Jeroen

    2016-06-01

    A growing proportion of patients presenting for surgery have diabetes. Unfortunately, perioperative diabetes protocol compliance is low. Using digitalization of the perioperative environment, an automated reminder in the preoperative assessment platform proved to increase compliance and we advocate its use throughout the perioperative process. PMID:27321319

  17. Laboratory and diagnostic testing: a perioperative update.

    PubMed

    Pagana, Kathleen D

    2007-04-01

    Perioperative nurses are challenged to stay informed about the rapidly changing field of diagnostic and laboratory testing. The brain natriuretic peptide test primarily is used to differentiate dyspnea caused by heart failure from dyspnea that results from other causes. Virtual colonoscopy is a promising new alternative for detecting colorectal polyps and cancers. The microalbumin urine test provides an early indication of the development of diabetic complications. This update of relatively new laboratory tests and diagnostic studies also provides implications for perioperative nurses. PMID:17418132

  18. Perioperative Management in Sickle Cell Disease.

    PubMed

    Paschal, Rita D

    2016-09-01

    Many patients with sickle cell disease (SCD) will require surgical intervention during the course of their lifetime. Common surgeries include orthopedic and abdominal procedures. Perioperative complications occur commonly and can be related to the surgical procedure or the underlying hemoglobinopathy. The complication rate may be reduced by preoperative optimization of disease and careful attention to the patient in the postoperative period. This review examines the perioperative management of patients with SCD. For patients undergoing both elective and emergent surgery, attempts should be made to coordinate care with an SCD specialist. PMID:27598361

  19. Understanding the pathophysiology of perioperative pain

    PubMed Central

    2004-01-01

    Abstract Managing perioperative pain effectively is one the most important tasks that clinical veterinarians perform on a daily basis. The purpose of this article is to provide veterinarians with a basic understanding of the pathophysiology of perioperative pain and a working knowledge of the principles of effective therapy. First, the concepts of nociception, inflammatory pain, and neural plasticity are introduced. Second, the nociceptive and antinociceptive pathways that mediate normal physiological pain are described. Next, neural plasticity and the development of pathological pain are explained. And last, the concepts of preemptive, multimodal, and mechanism-based therapy are discussed. PMID:15206589

  20. [Perioperative psychobehavioural changes in children].

    PubMed

    Cohen-Salmon, D

    2010-04-01

    during induction has been shown to effectively reduce preoperative anxiety in children in certain contexts (when the parent is calm and the child is anxious). It is worthwhile if it is integrated into a family-centered anxiety management program and remains one of several options offered to families. Overall, taking into account the child's psychological needs should be considered an essential part of paediatric anaesthesia. Tools and techniques are available for assessing and managing the perioperative distress experienced by children. PMID:20359845

  1. Microheterogeneity in Frozen Protein Solutions

    PubMed Central

    Twomey, Alan; Kurata, Kosaku; Nagare, Yutaka; Takamatsu, Hiroshi; Aksan, Alptekin

    2015-01-01

    In frozen and lyophilized systems, the biological to be stabilized (e.g. therapeutic protein, biomarker, drug-delivery vesicle) and the cryo-/lyoprotectant should be co-localized for successful stabilization. During freezing and drying, many factors cause physical separation of the biological from the cryo-/lyoprotectant, called microheterogeneity (MH), which may result in poor stabilization efficiency. We have developed a novel technique that utilized confocal Raman microspectroscopy in combination with counter-gradient freezing to evaluate the effect of a wide range of freezing temperatures (−20 < TF < 0°C) on the MH generated within a frozen formulation in only a few experiments. The freezing experiments conducted with a model system (albumin and trehalose) showed the presence of different degrees of MH in the freeze-concentrated liquid (FCL) in all solutions tested. Mainly, albumin tended to accumulate near the ice interface, where it was physically separated from the cryoprotectant. In frozen 10 wt% trehalose solutions, heterogeneity in FCL was relatively low at any TF. In frozen 20 wt% trehalose solutions, the optimum albumin to trehalose ratio in the FCL can only be ensured if the solution was frozen within a narrow range of temperatures (−16 < TF < −10°C). In the 30 wt% trehalose solutions, freezing within a much more narrow range (−12 < TF < −10°C) was needed to ensure a fairly homogeneous FCL. The method developed here will be helpful for the development of uniformly frozen and stable formulations and freezing protocols for biological as MH is presumed to directly impact stability. PMID:25888798

  2. Microheterogeneity in frozen protein solutions.

    PubMed

    Twomey, Alan; Kurata, Kosaku; Nagare, Yutaka; Takamatsu, Hiroshi; Aksan, Alptekin

    2015-06-20

    In frozen and lyophilized systems, the biological to be stabilized (e.g. therapeutic protein, biomarker, drug-delivery vesicle) and the cryo-/lyo-protectant should be co-localized for successful stabilization. During freezing and drying, many factors cause physical separation of the biological from the cryo-/lyo-protectant, called microheterogeneity (MH), which may result in poor stabilization efficiency. We have developed a novel technique that utilized confocal Raman microspectroscopy in combination with counter-gradient freezing to evaluate the effect of a wide range of freezing temperatures (-20frozen formulation in only a few experiments. The freezing experiments conducted with a model system (albumin and trehalose) showed the presence of different degrees of MH in the freeze-concentrated liquid (FCL) in all solutions tested. Mainly, albumin tended to accumulate near the ice interface, where it was physically separated from the cryoprotectant. In frozen 10wt% trehalose solutions, heterogeneity in FCL was relatively low at any TF. In frozen 20wt% trehalose solutions, the optimum albumin to trehalose ratio in the FCL can only be ensured if the solution was frozen within a narrow range of temperatures (-16frozen and stable formulations and freezing protocols for biological as MH is presumed to directly impact stability. PMID:25888798

  3. Assessment of an updated double-vasopressor automated system using Nexfin for the maintenance of haemodynamic stability to improve peri-operative outcome during spinal anaesthesia for caesarean section.

    PubMed

    Sng, B L; Wang, H; Assam, P N; Sia, A T

    2015-06-01

    Hypotension occurs commonly during spinal anaesthesia for caesarean section, associated with maternal and fetal adverse effects. We developed a double-vasopressor automated system with a two-step algorithm and continuous non-invasive haemodynamic monitoring using the Nexfin device. The system delivered 25 μg phenylephrine every 30 s when systolic blood pressure was between 90% and 100% of baseline, or 2 mg ephedrine at this blood pressure range and heart rate < 60 beats.min(-1) ; and 50 μg phenylephrine or 4 mg ephedrine when systolic blood pressure was < 90% of baseline with the same heart rate criterion. Fifty-seven women received standardised spinal anaesthesia. Twenty-seven (47.4%) had at least one reading of hypotension defined as systolic blood pressure < 80% baseline. Systolic blood pressure was within 20% of the baseline in a mean (SD) of 79.8 (20.9)% of measurements. Fifty-three (93.0%) women required phenylephrine before delivery while 10 (17.5%) required ephedrine. Six women (10.5%) experienced nausea and three (5.3%) vomited. The system was able to achieve a low incidence of maternal hypotension with good maternal and fetal outcomes. PMID:25627651

  4. Overhead transparency skills for perioperative nurse educators.

    PubMed

    Beitz, J M

    1996-10-01

    Successful design of creative overhead transparencies should be part of the instructional repertoire of perioperative educators. Personal computers and user-friendly software have revolutionized overhead transparencies' dynamic, imaginative production. This article reviews the advantages and disadvantages of overhead projection, presents practical suggestions for generating and using transparencies, and displays computer designed examples. PMID:8893964

  5. Clinical risk scores to guide perioperative management.

    PubMed

    Barnett, Sarah; Moonesinghe, Suneetha Ramani

    2011-08-01

    Perioperative morbidity is associated with reduced long term survival. Comorbid disease, cardiovascular illness, and functional capacity can predispose patients to adverse surgical outcomes. Accurate risk stratification would facilitate informed patient consent and identify those individuals who may benefit from specific perioperative interventions. The ideal clinical risk scoring system would be objective, accurate, economical, simple to perform, based entirely on information available preoperatively, and suitable for patients undergoing both elective and emergency surgery. The POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scoring systems are the most widely validated perioperative risk predictors currently utilised; however, their inclusion of intra- and postoperative variables precludes validation for preoperative risk prediction. The Charlson Index has the advantage of consisting exclusively of preoperative variables; however, its validity varies in different patient cohorts. Risk models predicting cardiac morbidity have been extensively studied, despite the relatively uncommon occurrence of postoperative cardiac events. Probably the most widely used cardiac risk score is the Lee Revised Cardiac Risk Index, although it has limited validity in some patient populations and for non-cardiac outcomes. Bespoke clinical scoring systems responding to dynamic changes in population characteristics over time, such as those developed by the American College of Surgeons National Surgical Quality Improvement Program, are more precise, but require considerable resources to implement. The combination of objective clinical variables with information from novel techniques such as cardiopulmonary exercise testing and biomarker assays, may improve the predictive precision of clinical risk scores used to guide perioperative management. PMID:21257993

  6. [Perioperative acute kidney injury and failure].

    PubMed

    Chhor, Vibol; Journois, Didier

    2014-04-01

    Perioperative period is very likely to lead to acute renal failure because of anesthesia (general or perimedullary) and/or surgery which can cause acute kidney injury. Characterization of acute renal failure is based on serum creatinine level which is imprecise during and following surgery. Studies are based on various definitions of acute renal failure with different thresholds which skewed their comparisons. The RIFLE classification (risk, injury, failure, loss, end stage kidney disease) allows clinicians to distinguish in a similar manner between different stages of acute kidney injury rather than using a unique definition of acute renal failure. Acute renal failure during the perioperative period can mainly be explained by iatrogenic, hemodynamic or surgical causes and can result in an increased morbi-mortality. Prevention of this complication requires hemodynamic optimization (venous return, cardiac output, vascular resistance), discontinuation of nephrotoxic drugs but also knowledge of the different steps of the surgery to avoid further degradation of renal perfusion. Diuretics do not prevent acute renal failure and may even push it forward especially during the perioperative period when venous retourn is already reduced. Edema or weight gain following surgery are not correlated with the vascular compartment volume, much less with renal perfusion. Treatment of perioperative acute renal failure is similar to other acute renal failure. Renal replacement therapy must be mastered to prevent any additional risk of hemodynamic instability or hydro-electrolytic imbalance. PMID:24656890

  7. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model.

    PubMed

    Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime

    2016-02-01

    Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine. PMID:26613678

  8. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  9. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  10. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  11. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  12. 49 CFR 173.229 - Chloric acid solution or chlorine dioxide hydrate, frozen.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Chloric acid solution or chlorine dioxide hydrate, frozen. 173.229 Section 173.229 Transportation Other Regulations Relating to Transportation PIPELINE AND... Than Class 1 and Class 7 § 173.229 Chloric acid solution or chlorine dioxide hydrate, frozen. When...

  13. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  14. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  15. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  16. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  17. 9 CFR 327.21 - Inspection procedures for chilled fresh and frozen boneless manufacturing meat.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... fresh and frozen boneless manufacturing meat. 327.21 Section 327.21 Animals and Animal Products FOOD... MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION IMPORTED PRODUCTS § 327.21 Inspection procedures for chilled fresh and frozen boneless manufacturing meat. (a)...

  18. 77 FR 20008 - Certain Frozen Fish Fillets From the Socialist Republic of Vietnam: Initiation of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-03

    ... Fillets From the Socialist Republic of Vietnam, 68 FR 47909 (August 12, 2003). Pursuant to section 751(a... International Trade Administration Certain Frozen Fish Fillets From the Socialist Republic of Vietnam... antidumping duty order on certain frozen fish fillets (``fish'') from the Socialist Republic of...

  19. 76 FR 16384 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Initiation of Antidumping...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... the Socialist Republic of Vietnam, 70 FR 5152 (February 1, 2005) (``Order''). Pursuant to section 751... International Trade Administration Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam... antidumping duty order on certain frozen warmwater shrimp (``shrimp'') from the Socialist Republic of...

  20. 78 FR 33344 - Certain Frozen Warmwater Shrimp From India: Preliminary Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from India. The period of investigation is April 1, 2011, through March 31, 2012. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the Act), the final determination will be issued......

  1. 78 FR 33345 - Certain Frozen Warmwater Shrimp From Malaysia: Preliminary Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from Malaysia. The period of investigation (POI) is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the Act), the final determination......

  2. 78 FR 33346 - Certain Frozen Warmwater Shrimp From the People's Republic of China: Preliminary Countervailing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from the People's Republic of China (PRC). The period of investigation (POI) is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the......

  3. 78 FR 33342 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Preliminary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from the Socialist Republic of Vietnam (Vietnam). The period of investigation is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the......

  4. 78 FR 33350 - Certain Frozen Warmwater Shrimp From Thailand: Preliminary Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from Thailand. The period of investigation is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the Act), the final determination will......

  5. 78 FR 33349 - Certain Frozen Warmwater Shrimp From Indonesia: Negative Preliminary Countervailing Duty...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (the Department) preliminarily determines that countervailable subsidies are not being provided to producers and exporters of certain frozen warmwater shrimp (frozen shrimp) from Indonesia. The period of investigation is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the Act), the final determination......

  6. 75 FR 76754 - Non-Frozen Apple Juice Concentrate From China

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-09

    ... review * * *'' (75 FR 69628). Accordingly, pursuant to section 751(c) of the Tariff Act of 1930 (19 U.S.C... COMMISSION Non-Frozen Apple Juice Concentrate From China AGENCY: United States International Trade Commission... 2010 to determine whether revocation of the antidumping duty order on non- frozen apple...

  7. Frozen Scope and Grammatical Optimization

    ERIC Educational Resources Information Center

    Freedman, Michael

    2014-01-01

    The literature on quantifier scope has repeatedly observed that some otherwise expected permutations of scope taking elements are unavailable. Various methods have been proffered explaining these facts. This thesis aims to unify three disparate areas where the scope of operators seems to be frozen: the interaction of universal quantifiers with…

  8. Frozen shoulder: a sympathetic dystrophy?

    PubMed

    Müller, L P; Müller, L A; Happ, J; Kerschbaumer, F

    2000-01-01

    Diagnostic and clinical features of the frozen shoulder syndrome and the Sudeck syndrome are similar in many aspects. Radioisotope bone scan shows an increased uptake in affected areas in both diseases, while native radiographs show a progressive demineralisation. Measurement of bone mineral density (BMD) by quantitative digital radiography objectified these local decalcification processes in an early stage of the frozen shoulder syndrome; 10 of 12 patients with primary frozen shoulder had BMD decreases greater 21% in the humeral head of the affected shoulder compared to the non-affected side. In the immobilised control group with degenerative changes of the rotator cuff, calcifying tendinitis and shoulder instability (n = 12) and in the group of healthy probands (n = 20), the difference between the affected and non-affected side (left and right humerus of the healthy probands) was only more than 21% in one case each. There are several references in the literature that assume frozen shoulder to be an algoneurodystrophic process; our observations support this hypothesis, possibly leading to earlier diagnoses and extended therapeutic management. PMID:10653111

  9. [Perioperative treatment after esophagogastric surgery].

    PubMed

    Nagy, K; Murányi, M; Nádas, G; Tapolcsányi, E; Vimláti, L

    2001-06-01

    Extended gastric and esophageal resection is still associated with high postoperative morbidity and mortality. We performed a retrospective analysis of the perioperative management of 72 patients who had undergone such operations during a one-year period. Patient and management variables were analyzed by multivariate statistical methods to identify pre-, intra-, and postoperative factors which influence the results. The investigation of preoperative data revealed an increase of esophageal cancer among younger (< 55 years) patients (12 patients underwent gastrectomy and 22 esophageal resection). The intensity of smoking was significantly higher compared to the elderly (11.27 vs. 7.4 cigarettes/day; p < 0.05); and the same applies to alcohol consumption. In older patients (> 55 years of age), the duration of postoperative artificial ventilation was significantly longer (10.1 vs. 4 hours, p < 0.05) and the prevalence of septic complication was higher, than in younger patients. All three postoperative deaths recorded in this series occurred in the group of elderly patients. A preoperative weight loss exceeding 10 per cent of body weight was associated with significantly longer postoperative stay (21.6 vs. 17.4 days; p < 0.001), as well as with need for longer parenteral feeding (13.05 vs. 10.06 days; p < 0.005). Operations longer than 6 hours were associated with significantly longer postoperative ventilation period (14.44 vs. 5.31 hours; p < 0.02), need for longer stay intensive care unit (10.56 vs. 6.55 days; p < 0.001) and longer postoperative stay (21.56 vs. 17.64 days; p < 0.05). The prevalence of pulmonary complications was connected to the duration of the operation (10/16 vs. 3/55). We also describe and analyse two contemporary methods designed for monitoring circulatory parameters (PICCO) and tissue oxygenation (gastrotonometry). The analysis of postoperative data demonstrates that postoperative pain control with continuous epidural analgesia is superior to

  10. The Eccentric Behavior of Nearly Frozen Orbits

    NASA Technical Reports Server (NTRS)

    Sweetser, Theodore H.; Vincent, Mark A.

    2013-01-01

    Frozen orbits are orbits which have only short-period changes in their mean eccentricity and argument of periapse, so that they basically keep a fixed orientation within their plane of motion. Nearly frozen orbits are those whose eccentricity and argument of periapse have values close to those of a frozen orbit. We call them "nearly" frozen because their eccentricity vector (a vector whose polar coordinates are eccentricity and argument of periapse) will stay within a bounded distance from the frozen orbit eccentricity vector, circulating around it over time. For highly inclined orbits around the Earth, this distance is effectively constant over time. Furthermore, frozen orbit eccentricity values are low enough that these orbits are essentially eccentric (i.e., off center) circles, so that nearly frozen orbits around Earth are bounded above and below by frozen orbits.

  11. Perioperative and Anesthesia-Related Mortality

    PubMed Central

    Pignaton, Wangles; Braz, José Reinaldo C.; Kusano, Priscila S.; Módolo, Marília P.; de Carvalho, Lídia R.; Braz, Mariana G.; Braz, Leandro G.

    2016-01-01

    Abstract In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital. In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/condition-related. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs). A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0–19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7–16.9) followed by surgery-related (2.2, 95% CI: 1.0–3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III–V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001). There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings

  12. The JLab Frozen Spin Target

    SciTech Connect

    Keith, C. D.

    2009-08-04

    A polarized, frozen spin target has been designed and constructed at Jefferson Lab for use inside the CEBAF Large Acceptance Spectrometer. Protons in TEMPO-doped butanol are polarized via dynamic nuclear polarization (DNP) to approximately 90% using microwaves and an external, 5 T solenoid magnet. The target sample is then cooled to approximately 30 mK while an internal 0.56 T superconducting magnet is used to maintain the polarization. Relaxation times in excess of 3500 hours have been observed.

  13. [New oral anticoagulants in perioperative medicine].

    PubMed

    Giebl, A; Gürtler, K

    2014-04-01

    New oral anticoagulants (NOAC) inhibit factor Xa (Stuart-Prower factor) or factor IIa (thrombin) and are alternatives to vitamin K antagonists. Perioperative indications are deep vein thrombosis prophylaxis for prosthetic hip and knee replacement, therapeutic anticoagulation for deep vein thrombosis as well as the prophylaxis of stroke for patients with atrial fibrillation. Patients on NOACs pose multiple perioperative challenges for all medical disciplines involved. For non-emergency surgery, patients should be evaluated by an anesthesiolgist as early as possible to assess an optimal appointment for surgery and bridging strategy. Management of emergency procedures for patients on NOACs requires an interdisciplinary approach. The individual risk for uncontrolled bleeding versus the urgency for surgery needs to be evaluated on an individual basis. The determination of drug serum levels enables a rough estimation of anticoagulant activity. Emergency procedures in coagulopathy due to active bleeding are treated with the unspecific administration of blood products and coagulation factor concentrates. PMID:24696299

  14. Optimal perioperative management of arterial blood pressure

    PubMed Central

    Lonjaret, Laurent; Lairez, Olivier; Minville, Vincent; Geeraerts, Thomas

    2014-01-01

    Perioperative blood pressure management is a key factor of patient care for anesthetists, as perioperative hemodynamic instability is associated with cardiovascular complications. Hypertension is an independent predictive factor of cardiac adverse events in noncardiac surgery. Intraoperative hypotension is one of the most encountered factors associated with death related to anesthesia. In the preoperative setting, the majority of antihypertensive medications should be continued until surgery. Only renin-angiotensin system antagonists may be stopped. Hypertension, especially in the case of mild to moderate hypertension, is not a cause for delaying surgery. During the intraoperative period, anesthesia leads to hypotension. Hypotension episodes should be promptly treated by intravenous vasopressors, and according to their etiology. In the postoperative setting, hypertension predominates. Continuation of antihypertensive medications and postoperative care may be insufficient. In these cases, intravenous antihypertensive treatments are used to control blood pressure elevation. PMID:25278775

  15. Perioperative Research Fellowship: Planning, Implementation, Experience

    PubMed Central

    Memtsoudis, Stavros G; Mazumdar, Madhu; Stundner, Ottokar; Hargett, Mary J.

    2014-01-01

    Perioperative outcomes research has gained widespread interest and is viewed as increasingly important among different specialties, including anesthesiology. Outcome research studies serve to help in the adjustment of risk, allocation of resources, and formulation of hypotheses to guide future research. Pursuing high quality research projects requires familiarity with a wide range of research methodologies, and concepts are ideally learned in a dedicated setting. Skills associated with the use of these methodologies as well as with scientific publishing in general, however, are increasingly challenging to acquire. This article is intended to describe the curriculum and implementation of the Perioperative Medicine and Regional Anesthesia Research Fellowship at the Hospital for Special Surgery. We also propose a methodology to evaluate the success of a research fellowship curriculum. PMID:24942850

  16. Developing critical thinking in the perioperative environment.

    PubMed

    Jones, Jackie H

    2010-02-01

    Critical thinking is considered an essential skill for nurses by many, including major accrediting agencies, health care administrators, and AORN. This is in part because of the environment in which nurses function. Health care, medicine, technology, and nursing are dynamic and constantly changing. The perioperative environment is complex, fast paced, unique, and oftentimes unpredictable. Critical thinking skills enable perioperative nurses to function effectively and evolve in this ever-changing environment. Nursing education programs are mandated to teach critical thinking skills. It is the practice arena, however, that refines, hones, and grows these skills. This article provides an overview of critical thinking in the context of nursing, as well as strategies and interventions designed to teach critical thinking skills. PMID:20152198

  17. Heat Diffusion with Frozen Boundary

    NASA Astrophysics Data System (ADS)

    Florescu, Laura; Ganguly, Shirshendu; Peres, Yuval; Spencer, Joel

    2015-11-01

    Consider "frozen random walk" on Z: n particles start at the origin. At any discrete time, the leftmost and rightmost lfloor {n/4}rfloor particles are "frozen" and do not move. The rest of the particles in the "bulk" independently jump to the left and right uniformly. The goal of this note is to understand the limit of this process under scaling of mass and time. To this end we study the following deterministic mass splitting process: start with mass 1 at the origin. At each step the extreme quarter mass on each side is "frozen". The remaining "free" mass in the center evolves according to the discrete heat equation. We establish diffusive behavior of this mass evolution and identify the scaling limit under the assumption of its existence. It is natural to expect the limit to be a truncated Gaussian. A naive guess for the truncation point might be the 1 / 4 quantile points on either side of the origin. We show that this is not the case and it is in fact determined by the evolution of the second moment of the mass distribution.

  18. Acidity of frozen electrolyte solutions.

    PubMed

    Robinson, Carmen; Boxe, C S; Guzman, M I; Colussi, A J; Hoffmann, M R

    2006-04-20

    Ice is selectively intolerant to impurities. A preponderance of implanted anions or cations generates electrical imbalances in ice grown from electrolyte solutions. Since the excess charges are ultimately neutralized via interfacial (H(+)/HO(-)) transport, the acidity of the unfrozen portion can change significantly and permanently. This insufficiently recognized phenomenon should critically affect rates and equilibria in frozen media. Here we report the effective (19)F NMR chemical shift of 3-fluorobenzoic acid as in situ probe of the acidity of extensively frozen electrolyte solutions. The sign and magnitude of the acidity changes associated with freezing are largely determined by specific ion combinations, but depend also on solute concentration and/or the extent of supercooling. NaCl solutions become more basic, those of (NH(4))(2)SO(4) or Na(2)SO(4) become more acidic, while solutions of the 2-(N-morpholino)ethanesulfonic acid zwitterion barely change their acidity upon freezing. We discuss how acidity scales based on solid-state NMR measurements could be used to assess the degree of ionization of weak acids and bases in frozen media. PMID:16610849

  19. Developing behavioral objectives for perioperative staff development.

    PubMed

    Beitz, J M

    1996-07-01

    Behavioral objectives (i.e., clear statements that describe intended instructional outcomes) are a crucial component of educational planning for perioperative staff development. Properly written objectives promote positive learning outcomes such as increased motivation, better retention of information, and improved instructional accountability. This article describes the advantages of using behavioral objectives, gives a historical perspective of their development, presents a practical "how-to" approach to formulating them, and delineates their link to the selection of appropriate evaluation methods. PMID:8827333

  20. Perioperative management of severe anorexia nervosa.

    PubMed

    Hirose, K; Hirose, M; Tanaka, K; Kawahito, S; Tamaki, T; Oshita, S

    2014-02-01

    As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential. PMID:24366724

  1. Perioperative complications in infant cleft repair

    PubMed Central

    Fillies, Thomas; Homann, Christoph; Meyer, Ulrich; Reich, Alexander; Joos, Ulrich; Werkmeister, Richard

    2007-01-01

    Background Cleft surgery in infants includes special risks due to the kind of the malformation. These risks can be attributed in part to the age and the weight of the patient. Whereas a lot of studies investigated the long-term facial outcome of cleft surgery depending on the age at operation, less is known about the complications arising during a cleft surgery in early infancy. Methods We investigated the incidence and severity of perioperative complications in 174 infants undergoing primary cleft surgery. The severity and the complications were recorded during the intraoperative and the early postoperative period according to the classification by Cohen. Results Our study revealed that minor complications occurred in 50 patients. Severe complications were observed during 13 operations. There was no fatal complication in the perioperative period. The risk of complications was found to be directly correlated to the body weight at the time of the surgery. Most of the problems appeared intraoperatively, but they were also followed by complications immediately after the extubation. Conclusion In conclusion, cleft surgery in infancy is accompanied by frequent and sometimes severe perioperative complications that may be attributed to this special surgical field. PMID:17280602

  2. The bariatric patient: an overview of perioperative care.

    PubMed

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn

    2015-08-01

    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  3. The influence of context on role behaviors of perioperative nurses.

    PubMed

    McGarvey, Helen E; Chambers, Mary G A; Boore, Jennifer R P

    2004-12-01

    Using a case study approach, researchers conducted a focused exploration of the role of perioperative nurses. Data were collected in three different hospitals during 358 hours of observation and 34 hours of interviews with 35 nurses. Researchers also analyzed nursing documents, including the care plans of 230 patients. Findings show that various contextual mechanisms are influential in the role performance of perioperative nurses. This study highlights the importance of providing adequate support for perioperative nurses to perform their role in an intensely stressful environment. Patient-focused leadership and the promotion of a caring philosophy are needed to strengthen perioperative nursing and, ultimately, improve patient care. PMID:15641664

  4. Strategies for decreasing patient anxiety in the perioperative setting.

    PubMed

    Bailey, Laila

    2010-10-01

    Perioperative patient anxiety is a pervasive problem that can have far-reaching effects. Among these effects are increased postoperative pain, increased risk for infection, and longer healing times. Many factors affect perioperative patient anxiety, including the need for surgery, perceived loss of control, fear of postoperative pain, and alteration of body image. This systematic review of current literature was undertaken to identify evidence-based interventions for decreasing patient anxiety in perioperative practice. According to the current research literature, perioperative education and music therapy can be used to successfully reduce surgical patients' anxiety. PMID:20888947

  5. Perioperative lung protective ventilation in obese patients.

    PubMed

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PMID:25907273

  6. Prevention of perioperative hypothermia in plastic surgery.

    PubMed

    Young, V Leroy; Watson, Marla E

    2006-01-01

    While inadvertent perioperative hypothermia has received serious attention in many surgical specialties, few discussions of hypothermia have been published in the plastic surgery literature. This article reviews the physiology of thermoregulation, describes how both general and regional anesthesia alter the normal thermoregulatory mechanisms, indicates risk factors particularly associated with hypothermia, and discusses the most effective current methods for maintaining normothermia. Hypothermia is typically defined as a core body temperature of /=36.5 degrees C is maintained. Unless preventive measures are instituted, inadvertent hypothermia occurs in 50% to 90% of surgical patients, even those undergoing relatively short procedures lasting one to one-and-a-half hours. During either general or regional anesthesia, a patient's natural behavioral and autonomic responses to cold are unavailable or impaired, and the combination of general and neuraxial anesthesia produces the highest risk for inadvertent perioperative hypothermia. Unless hypothermia is prevented, the restoration of normothermia can take more than 4 hours once anesthesia is stopped. Consequences of hypothermia are serious and affect surgical outcomes in plastic surgery patients. Potential complications include morbid cardiac events, coagulation disorders and blood loss, increased incidence of surgical wound infection, postoperative shivering, longer hospital stays, and increased costs associated with surgery. Measures for preventing hypothermia are emphasized in this article, especially those proven most effective in prospective and controlled clinical studies. Perhaps the most important step in maintaining normothermia is to prewarm patients in the preoperative area with forced-air heating systems. Intraoperative warming with forced-air and fluid warming are also essential. Other strategies

  7. Supply chain optimization for pediatric perioperative departments.

    PubMed

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. PMID:21884843

  8. Perioperative Therapy for Surgically Resectable Pancreatic Adenocarcinoma.

    PubMed

    Du, Lingling; DeFoe, Melissa; Ruzinova, Marianna B; Olsen, Jeffrey R; Wang-Gillam, Andrea

    2015-08-01

    It is estimated that 10% to 20% of patients with pancreatic cancer present with resectable disease. Although surgery offers curative intent, the median survival after curative resection is less than 2 years. To improve clinical outcomes in this patient population, clinical studies have investigated the role of perioperative therapy, including neoadjuvant and adjuvant treatment in resectable pancreatic cancer. The role of adjuvant therapy has been well established by large randomized phase III studies, whereas benefit of the neoadjuvant approach remains inconclusive. Here, we review various treatment modalities and their clinical benefits in resectable pancreatic cancer. PMID:26226906

  9. Perioperative Care of the Liver Transplant Patient.

    PubMed

    Keegan, Mark T; Kramer, David J

    2016-07-01

    With the evolution of surgical and anesthetic techniques, liver transplantation has become "routine," allowing for modifications of practice to decrease perioperative complications and costs. There is debate over the necessity for intensive care unit admission for patients with satisfactory preoperative status and a smooth intraoperative course. Postoperative care is made easier when the liver graft performs optimally. Assessment of graft function, vigilance for complications after the major surgical insult, and optimization of multiple systems affected by liver disease are essential aspects of postoperative care. The intensivist plays a vital role in an integrated multidisciplinary transplant team. PMID:27339683

  10. Perioperative management of classic bladder exstrophy

    PubMed Central

    Massanyi, Eric Z; Gearhart, John P; Kost-Byerly, Sabine

    2013-01-01

    The exstrophy-epispadias complex is a rare congenital malformation of the genitourinary system, abdominal wall muscles, and pelvic structures. Modern surgical repairs focus on reconstruction of the bladder and its adjacent structures, with the goal of achieving urinary continence, a satisfactory cosmetic result, and a high quality of life. Complex surgery in neonates and young children, as well as a prolonged postoperative course require close collaboration between surgeons, anesthesiologists, intensivists, pediatricians, and an experienced nursing staff. This article will review the spectrum of bladder exstrophy anomalies, the surgical repair, and the perioperative interdisciplinary management. PMID:24400236

  11. Perioperative nutritional therapy in liver transplantation.

    PubMed

    Hammad, Ahmed; Kaido, Toshimi; Uemoto, Shinji

    2015-03-01

    Protein-energy malnutrition is frequently seen in patients with end-stage liver disease who undergo liver transplantation. This causes a deterioration of the patients' clinical condition and affects their post-transplantation survival. Accurate assessment of the nutritional status and adequate intervention are prerequisites for perioperative nutritional treatment. However, the metabolic abnormalities induced by liver failure make the traditional assessment of the nutritional status difficult. The methods that were recently developed for accurately assessing the nutritional status by body bioelectrical impedance may be implemented in pre-transplant management. Because preoperative malnutrition and the loss of skeletal muscle mass, called sarcopenia, have a significant negative impact on the post-transplantation outcome, it is essential to provide adequate nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the necessary caloric intake. We herein discuss both bioelectrical impedance and the latest findings in the current perioperative nutritional interventions in liver transplant patients regarding synbiotics, micronutrients, branched-chain amino acid supplementation, the use of immune system modulating formulas, the fluid balance and the offering of nocturnal meals. PMID:24473669

  12. [Progress in perioperative neuromonitoring: preface and comments].

    PubMed

    Fukuda, Satoru

    2006-03-01

    The aims of the neuromonitoring during perioperative period are 1) to detect the brain, spinal cord and peripheral nerve ischemia immediately and hence prevention from neuronal injury, 2) to measure the depth of anesthesia, especially sedative effect of anesthetics and 3) to evaluate brain death. For the detection of brain and spinal cord ischemia during operation, we have to bear in mind 1) whether we truly monitor the possible ischemic risk sites in the brain and spinal cord; 2) whether we know the false-negative and false-positive ratio of the neuromonitoring with account being taken of the effect of anesthetics, the patient's own pathologies, the body temperature etc. If we detect the abnormal change through neuromonitoring, we should immediately warn the surgeon to improve his subsequent procedures and confirm his decision to prevent neuronal damage. To understand these reviews, we have to know the fundamental basic knowledge such as International 10-20 System on EEG monitoring, the expression of negative wave and positive wave in evoked potential, the meaning of near-field potential and far-field potential, temporal dispersion and so on. In this issue, the recent progress in neuromonitoring is described by the specialists in each fields. I hope the anesthesiologists understand the significance of neuromonitoring and apply these techniques for the patient undergoing the neurological operation during perioperative periods. PMID:16541775

  13. Developing a perioperative educational video web site.

    PubMed

    O'Dowd Bell, Lynn

    2012-04-01

    Nurses frequently have to adjust to changes in technology, particularly in the OR, but cataloging the wealth of resources commonly used in the OR (eg, equipment, supplies, how to use them) has not kept pace. To address this, I worked with the information systems administrative coordinator at the University of Texas Medical Branch, Galveston, to design and implement a perioperative intranet site that includes videos and fact sheets about equipment and supplies and that can be accessed by all perioperative staff members. This required promoting the idea and getting stakeholder sign-on, soliciting videotapes and DVDs and screening all submissions for appropriateness, choosing and formatting applicable resources for use on the site, working with members of the information systems department to create a web site after the video library was assembled, and helping staff members use and accept the site as a valuable educational resource. This intranet web site has been available to staff members for two years, and data from a recent survey of staff members and from mandatory intranet inservice compliance programs show evidence of its effectiveness. PMID:22464619

  14. Perioperative Interventions to Reduce Chronic Postsurgical Pain

    PubMed Central

    Carroll, Ian; Hah, Jennifer; Mackey, Sean; Ottestad, Einar; Kong, Jiang Ti; Lahidji, Sam; Tawfik, Vivianne; Younger, Jarred; Curtin, Catherine

    2016-01-01

    Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. Animal studies of posttraumatic nerve injury pain demonstrate that there is a critical time frame before and immediately after nerve injury in which specific interventions can reduce the incidence and intensity of chronic neuropathic pain behaviors–so called “preventative analgesia.” In animal models, perineural local anesthetic, systemic intravenous local anesthetic, perineural clonidine, systemic gabapentin, systemic tricyclic antidepressants, and minocycline have each been shown to reduce pain behaviors days to weeks after treatment. The translation of this work to humans also suggests that brief perioperative interventions may protect patients from developing new chronic postsurgical pain. Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan. PMID:23463498

  15. Perioperative management for patients with hereditary angioedema

    PubMed Central

    Williams, Anesu H.

    2015-01-01

    Hereditary angioedema (HAE) is a rare autosomal dominant disease that results from mutations in the C1-esterase inhibitor (C1-INH) gene. HAE is characterized by recurrent episodes of angioedema of the skin (face, extremities, genitalia, trunk), the gastrointestinal tract, and respiratory tract. Symptoms experienced can be debilitating, may impact quality of life, and can be life threatening. Preventing attacks particularly for patients undergoing procedures is critical. Patients with HAE may now treat acute attacks or prevent attacks with medications that have recently become available in the United States; however, these same medications can be used for perioperative management for patients undergoing medical, surgical, and dental procedures. Periprocedural planning is important for patients to reduce the incidence of acute attacks. Education is critical and increasing awareness of short-term prophylaxis options will allow providers to develop an appropriate action plan for their patients. The goal of this review is to increase awareness for HAE treating physicians, surgeons, anesthesia, and emergency room physicians by examining the available treatment options, researching the literature, and summarizing available data for periprocedural management. The availability of treatment options has increased over the past few years, expanding options for physicians and patients living with HAE and improve safety during the perioperative period and at the time of other procedures. PMID:25860171

  16. Clinical implication of perioperative inflammatory cytokine alteration.

    PubMed

    Hsing, Chung-Hsi; Wang, Jhi-Joung

    2015-03-01

    Cytokines are key modulators of inflammatory responses, and play an important role in the defense and repair mechanisms following trauma. After traumatic injury, an immuno-inflammatory response is initiated immediately, and cytokines rapidly appear and function as a regulator of immunity. In pathologic conditions, imbalanced cytokines may provide systemic inflammatory responses or immunosuppression. Expression of perioperative cytokines vary by different intensities of surgical trauma and types of anesthesia and anesthetic agents. Inflammatory cytokines play important roles in postoperative organ dysfunction including central nervous system, cardiovascular, lung, liver, and kidney injury. Inhibition of cytokines could protect against traumatic injury in some circumstances, therefore cytokine inhibitors or antagonists might have the potential for reducing postoperative tissue/organ dysfunction. Cytokines are also involved in wound healing and post-traumatic pain. Application of cytokines for the improvement of surgical wound healing has been reported. Anesthesia-related immune response adjustment might reduce perioperative morbidity because it reduces proinflammatory cytokine expression; however, the overall effects of anesthetics on postoperative immune-inflammatory responses needs to be further investigated. PMID:25837846

  17. Testing the frozen flow approximation

    NASA Technical Reports Server (NTRS)

    Lucchin, Francesco; Matarrese, Sabino; Melott, Adrian L.; Moscardini, Lauro

    1993-01-01

    We investigate the accuracy of the frozen-flow approximation (FFA), recently proposed by Matarrese, et al. (1992), for following the nonlinear evolution of cosmological density fluctuations under gravitational instability. We compare a number of statistics between results of the FFA and n-body simulations, including those used by Melott, Pellman & Shandarin (1993) to test the Zel'dovich approximation. The FFA performs reasonably well in a statistical sense, e.g. in reproducing the counts-in-cell distribution, at small scales, but it does poorly in the crosscorrelation with n-body which means it is generally not moving mass to the right place, especially in models with high small-scale power.

  18. The use of emergency manuals in perioperative crisis management: a cautious approach.

    PubMed

    Szabo, Ashley; August, David A; Klainer, Suzanne; Miller, Andrew D; Kaye, Alan D; Raemer, Daniel B; Urman, Richard D

    2015-01-01

    When an unexpected perioperative crisis arises, simulation studies have suggested that the use of an emergency manual (EM) may offset the large cognitive load involved in crisis management, facilitating the efficient performance of key steps in treatment. However, little is known about how well EMs will translate into actual practice and what is required to use them optimally. While EMs are a promising tool in the management of perioperative critical events, more research is needed to define best practices and their limitations. In the interim, cautious use of these cognitive aids is recommended, especially when the diagnosis is not straightforward, falls "in between" sections of the EM, or falls outside of the EM itself. Further research should focus on the efficacy of EMs as measured by the percentage of critical steps correctly performed by their users in scenarios that do not closely mirror one of the listed EM scenarios from the beginning or as the situation evolves. PMID:26062310

  19. 76 FR 61668 - Certain Frozen Warmwater Shrimp From India and Thailand: Notice of Extension of Time Limits for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-05

    ... Administrative Reviews, 76 FR 18157 (Apr. 1, 2011). Extension of Time Limit of Preliminary Results Section 751(a... International Trade Administration Certain Frozen Warmwater Shrimp From India and Thailand: Notice of Extension... frozen warmwater shrimp From India and Thailand covering the period February 1, 2010, through January...

  20. 76 FR 67418 - Certain Frozen Warmwater Shrimp From the Socialist Republic of Vietnam: Extension of Time Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-01

    ... Antidumping Duty New Shipper Review, 76 FR 16384 (March 23, 2011). \\3\\ See Certain Frozen Warmwater Shrimp... Shipper Review, 76 FR 55350 (September 7, 2011). Statutory Time Limits Section 751(a)(2)(B)(iv) of the... Order: Certain Frozen Warmwater Shrimp from the Socialist Republic of Vietnam, 70 FR 5152 (February...

  1. 75 FR 61127 - Non-Frozen Apple Juice Concentrate from the People's Republic of China: Extension of Time Limit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-04

    ... Shipper Review, 75 FR 47270 (August 5, 2010). Extension of Time Limit for Final Results of Review Section... International Trade Administration Non-Frozen Apple Juice Concentrate from the People's Republic of China... shipper review of the antidumping duty order on non-frozen apple juice concentrate from the...

  2. A review of perioperative anaphylaxis at a Singapore tertiary hospital

    PubMed Central

    Chen, Xuanxuan; Thong, Sze Ying; Chong, Yong Yeow; Ng, Shin Yi

    2016-01-01

    INTRODUCTION Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution. METHODS We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012. RESULTS After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients. CONCLUSION To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis. PMID:26996282

  3. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases.

    PubMed

    Beppu, Toru; Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-02-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  4. Optimal perioperative medical management of the vascular surgery patient.

    PubMed

    Singh, Saket; Maldonado, Yasdet; Taylor, Mark A

    2014-09-01

    Perioperative medical management of patients undergoing vascular surgery can be challenging because they represent the surgical population at highest risk. β-Blockers should be continued perioperatively in patients already taking them preoperatively. Statins may be used in the perioperative period in patients who are not on statin therapy preoperatively. Institutional guidelines should be used to guide insulin replacement. Recent research suggests that measurement of troponins may provide some risk stratification in clinically stable patients following vascular surgery. Multimodal pain therapy including nonopioid strategies is necessary to improve the efficacy of pain relief and decrease the risk of side effects and complications. PMID:25113724

  5. Managing Opioid-Tolerant Patients in the Perioperative Surgical Home.

    PubMed

    Wenzel, John T; Schwenk, Eric S; Baratta, Jaime L; Viscusi, Eugene R

    2016-06-01

    Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge. PMID:27208711

  6. KNOWLEDGE AND SKILLS ENHANCEMENT THROUGH PERIOPERATIVE NURSING SIMULATION LAB TRAINING.

    PubMed

    Whelan, Trish; Shi, Xinzhe; Yorke, Sue; Andony, Keith; Andony, Keith; McKenzie, Mary Lou

    2016-06-01

    In Edmonton Zone, the attrition rate among new perioperative nursing staff is an issue of concern and many ORs are facing noticeable staffing challenges. In the Edmonton area there are approximately 79 surgical suites. A series of simulation labs were established in 2015 to provide perioperative nurses in order to increase their comfort on the job and to help build confidence levels. The expectations for this simulation are an overall improvement in perioperative nurses' competency, a reduction in OR orientation and training time, and a decrease in the attrition rates among OR nurses. PMID:27509765

  7. Antiphospholipid syndrome and perioperative hemostatic management of cardiac valvular surgery.

    PubMed

    Hogan, W J; McBane, R D; Santrach, P J; Plumhoff, E A; Oliver, W C; Schaff, H V; Rodeheffer, R J; Edwards, W D; Duffy, J; Nichols, W L

    2000-09-01

    Hemostatic aspects of antiphospholipid syndrome (APS) present unique challenges to clinicians and laboratory personnel alike, particularly in the perioperative period. These challenges are especially evident in patients requiring cardiac valve replacement surgery. However, the literature outlining the optimal approach in such patients is limited. We present the case of a 25-year-old woman with severe aortic regurgitation as a result of APS with particular reference to the precautions necessary during perioperative care. Particularly important are the prevention of thrombotic or hemorrhagic complications, management of associated thrombocytopenia, and laboratory methods of perioperative anticoagulation monitoring in the setting of prolonged clotting times. PMID:10994834

  8. Effective Perioperative Communication to Enhance Patient Care.

    PubMed

    Garrett, J Hudson

    2016-08-01

    Breakdowns in health care communication are a significant cause of sentinel events and associated patient morbidity and mortality. Effective communication is a necessary component of a patient safety program, which enables all members of the interdisciplinary health care team to effectively manage their individual roles and responsibilities in the perioperative setting; set expectations for safe, high-reliability care; and measure and assess outcomes. To sustain a culture of safety, effective communication should be standardized, complete, clear, brief, and timely. Executive leadership and support helps remove institutional barriers and address challenges to support the engagement of patients in health care communication, which has been shown to improve outcomes, reduce costs, and improve the patient experience. PMID:27472971

  9. [Correlation between pholcodine and perioperative anaphylaxis].

    PubMed

    Dumancić, Jelena; Marković, Asja Stipić

    2012-05-01

    A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents. PMID:23437637

  10. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

    Massey, S R; Pitsis, A; Mehta, D; Callaway, M

    2000-05-01

    Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality. PMID:10844846

  11. Surgical diagnosis: frozen section and the extent of surgery.

    PubMed

    Nixon, Iain J; Shaha, Ashok R; Patel, Snehal G

    2014-08-01

    This article outlines features of the biology of well differentiated thyroid cancer, and how these impact on systems of risk prediction. It covers salient points that the surgeon should consider from the clinical history and examination in the office, and outlines the procedures available for surgical management of thyroid cancer. The article then examines the choices that face thyroid surgeons both in relation to planning primary thyroid surgery and the approach to regional lymphadenectomy. In addition, key findings in the operating room are discussed in relation to their impact on decision making. Long-term outcomes are presented for patients following surgery. PMID:25041955

  12. Perioperative leadership: managing change with insights, priorities, and tools.

    PubMed

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors. PMID:24973182

  13. Guidelines for Perioperative Management of the Diabetic Patient.

    PubMed

    Sudhakaran, Sivakumar; Surani, Salim R

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  14. Pharmacological modification of the perioperative stress response in noncardiac surgery.

    PubMed

    Priebe, Hans-Joachim

    2016-06-01

    The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as "stress response." The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system, resulting in cardiovascular instability (hypertension, tachycardia, and arrhythmia), morbidity (myocardial ischemia, myocardial infarction, and stroke), and mortality (cardiac death and fatal stroke), particularly in patients at an elevated cardiovascular risk and with reduced cardiovascular reserve. Various strategies have been used to ameliorate the adverse perioperative cardiovascular sequelae of the perioperative stress response. Effective pharmacologic blunting of the stress response plays a crucial role in perioperative cardiac risk reduction strategies. In this context, the role of beta-adrenoceptor blockers, alpha2-adrenoceptor agonists, and statins has been extensively examined. This chapter evaluates the available evidence with respect to treatment efficacy of these commonly prescribed drugs in patients undergoing noncardiac surgery. PMID:27396805

  15. Guidelines for Perioperative Management of the Diabetic Patient

    PubMed Central

    Surani, Salim R.

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  16. An Agenda for Improving Perioperative Code Status Discussion.

    PubMed

    Hickey, Thomas R; Cooper, Zara; Urman, Richard D; Hepner, David L; Bader, Angela M

    2016-06-15

    Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD. PMID:27301059

  17. Colour coding scrubs as a means of improving perioperative communication.

    PubMed

    Litak, Dominika

    2011-05-01

    Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is 'object communication', the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contributiontowards improvement of patient outcomes, deserves consideration. PMID:21834289

  18. Chemical Effects during Storage of Frozen Foods.

    ERIC Educational Resources Information Center

    Powrie, W. D.

    1984-01-01

    Discusses (1) characteristics, interrelationships, and distribution of food constituents (including water) in unfrozen food systems; (2) the freezing process; and (3) chemical changes in food during frozen storage. Protein alterations and lipid oxidation are emphasized. (JN)

  19. Frozen shoulder--an algoneurodystrophic process?

    PubMed

    Müller, L P; Rittmeister, M; John, J; Happ, J; Kerschbaumer, F

    1998-12-01

    The frozen shoulder syndrome and the Sudeck syndrome are clinically in many aspects similar. Radioisotope bone scan shows an increased uptake in the affected areas in both diseases, while standard radiographs show a progressive demineralization. With measurement of bone-mineral density by quantitative digital radiography these local decalcification processes were diagnosed in an early stage of the frozen shoulder syndrome: of 12 patients with primary frozen shoulder 10 had a bone-mineral density decrease of more than 21% in the humeral head of the affected shoulder compared to the unaffected side. In the control groups (n = 32) the difference between affected and unaffected side (left and right humerus of the healthy probands) was in only one case each above 21%. There are several indications in the literature assuming the frozen shoulder to be an algoneurodystrophic process. Our observation supports this hypothesis, and may possibly lead to earlier diagnosis and improved therapeutic management. PMID:9922549

  20. Material effects in photoconductive frozen wave generators

    NASA Astrophysics Data System (ADS)

    Oconnell, Robert M.; Thaxter, J. B.; Bell, Richard E.

    1991-04-01

    Linear photoconductive gallium arsenide (GaAs) fast closing switches for microwave applications, such as frozen wave pulse generation, are analyzed and compared to experimental measurements. Material effects in photo-conductive frozen wave generators fabricated in semiconductor-based microstrip transmission line are studied from three perspectives; frozen wave propagation in the line; the spacing between the switches in a frozen wave generator and their maximum number; and the switching behavior of the gap-switch itself, which is modeled as a lumped-element, modified Ebers-Moll equivalent circuit. The experimental transient behavior of hybrid gap-switches fabricated on semi-insulating GaAs with ohmic and non-ohmic contacts is compared with predicted performance. Picosecond laser pulses, doubled to 527 micron wavelength are used to excite linear photoconductivity in 75 micron gap switches mounted in a test fixture of 50 ohm microstrip lines on alumina.

  1. Foods - fresh vs. frozen or canned

    MedlinePlus

    ... canned vegetables. Try to buy those without added salt and don't overcook any vegetable, whether fresh, frozen, or canned. Instead of boiling them in water for longer periods of time, they should be ...

  2. Group for frozen soil and rock

    NASA Astrophysics Data System (ADS)

    The American Society for Testing and Materials wants participants for D18.19, its new subcommittee on frozen soil and rock. The group will write standards for engineering practices in northern Canada, Alaska, and other areas where soil and rock are commonly in the frozen or recently thawed state. Three standards are currently under development: axial compressive load tests o n piles in frozen soils, laboratory rate of frost-heave tests, and laboratory creep testing of frozen soil.The next D18.19 meeting is June 26 in St. Louis, Mo. Scientists who want to work on the subcommittee should contact Bill Lovell, School of Civil Engineering, Purdue University, West Lafayette, IN 47904, tel. 317-494- 5034; or Wendy Dyer, ASTM, 1916 Race Street, Philadelphia, PA 19103, tel. 215-299-5526.

  3. [Perioperative management of intracranial tumours: the neurosurgeon's role].

    PubMed

    Polo-Torres, C; Moscote-Salazar, L R; Alvis-Miranda, H R; Villa-Delgado, R

    2013-01-01

    The perioperative management of patients with brain tumours is a challenge for the neurosurgeon and the entire surgical team. The treating physician should consider factors such as the type of tumour, extent of disease, treatment received, the presence of comorbidities and prognosis of the disease itself. The successful execution of all aspects involved in perioperative management in patients with brain tumours will help prolong the life and improve the quality of life of patients. PMID:24008533

  4. Perioperative Considerations in Crohn Disease and Ulcerative Colitis.

    PubMed

    Nickerson, T Paul; Merchea, Amit

    2016-06-01

    The management of inflammatory bowel disease (IBD) is medically and surgically complex. Numerous patient- and disease-oriented factors must be considered in treating patients with IBD, including nutritional replenishment/support, effect of immunosuppressive medications, extent of resection, and use of proximal diversion. Perioperative planning and optimization of the patient is imperative to ensuring favorable outcomes and limiting morbidity. These perioperative considerations in Crohn disease and ulcerative colitis are reviewed here. PMID:27247531

  5. Frozen singularities in M and F theory

    NASA Astrophysics Data System (ADS)

    Tachikawa, Yuji

    2016-06-01

    We revisit the duality between ALE singularities in M-theory and 7-branes on a circle in F-theory. We see that a frozen M-theory singularity maps to a circle compactification involving a rotation of the plane transverse to the 7-brane, showing an interesting correspondence between commuting triples in simply-laced groups and Kodaira's classification of singular elliptic fibrations. Our analysis strongly suggests that the O7+ plane is the only completely frozen F-theory singularity.

  6. Artificial insemination of cranes with frozen semen

    USGS Publications Warehouse

    Gee, G.F.; Sexton, T.J.

    1979-01-01

    For the first time (1978) artificial insemination (AI) with frozen greater sandhill crane (Grus canadensis tabida) semen resulted in fertile eggs and chicks. During the 2 year (1977-78) study, 6 of 27 eggs produced were fertile. Three chicks hatched. Semen samples used for insemination were frozen and stored in liquid nitrogen for two months or less. Recent improvements in the laboratory indicated that a more effective sample can be prepared and greater fertility rates should be expected.

  7. Shoulder pain in primary care: frozen shoulder.

    PubMed

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound. PMID:27477374

  8. Adhesive capsulitis of the ankle (frozen ankle).

    PubMed

    van Moppes, F I; van den Hoogenband, C R; Greep, J M

    1979-09-01

    Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome. PMID:508071

  9. Continuous interprofessional coordination in perioperative work: an exploratory study.

    PubMed

    Lillebo, Borge; Faxvaag, Arild

    2015-03-01

    Coordination of perioperative work is challenging. Advancements in diagnostic and therapeutic possibilities have not been followed by similar advancements in the ability to coordinate care. In this paper, we report on a study that explored the nature of continuous coordination as practiced by perioperative staff in order to coordinate their own activities with respect to those of their colleagues. We conducted in-depth interviews (n = 14), and combined observations and focused interviews (n = 31) with perioperative staff (physicians, nurses, technicians, and cleaners) at a major university hospital in Norway. Data were analysed qualitatively with systematic text condensation. The results indicated that a surgical schedule was important for informing staff members about the cases and tasks they had been assigned. Staff also depended on ad hoc, explicit communication to ensure timeliness of particular perioperative activities. This, however, left little room for adjustments of other activities. Hence, to be able to proactively coordinate their own work some staff tried to predict future perioperative activities by observing the workplace, monitoring the surgical scheduling software for changes, and sharing their colleagues' progress updates and predictions. These findings could be important for those developing support for perioperative coordination. PMID:25158118

  10. Priority patient safety issues identified by perioperative nurses.

    PubMed

    Steelman, Victoria M; Graling, Paula R; Perkhounkova, Yelena

    2013-04-01

    Much of the work done by perioperative nurses focuses on patient safety. Perioperative nurses are aware that unreported near misses occur every day, and they use that knowledge to prioritize activities to protect the patient. The purpose of this study was to identify the highest priority patient safety issues reported by perioperative RNs. We sent a link to an anonymous electronic survey to all AORN members who had e-mail addresses in AORN's member database. The survey asked respondents to identify top perioperative patient safety issues. We received 3,137 usable responses and identified the 10 highest priority safety issues, including wrong site/procedure/patient surgery, retained surgical items, medication errors, failures in instrument reprocessing, pressure injuries, specimen management errors, surgical fires, perioperative hypothermia, burns from energy devices, and difficult intubation/airway emergencies. Differences were found among practice settings. The information from this study can be used to inform the development of educational programs and the allocation of resources to enhance safe perioperative patient care. PMID:23531307

  11. Promoting Patient Safety With Perioperative Hand-off Communication.

    PubMed

    Robinson, Nancy Leighton

    2016-06-01

    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment. PMID:27235961

  12. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Frozen concentrate for colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  13. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Frozen concentrate for colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  14. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Frozen concentrate for colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  15. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Frozen concentrate for colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  16. 21 CFR 146.126 - Frozen concentrate for colored lemonade.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Frozen concentrate for colored lemonade. 146.126... Fruit Juices and Beverages § 146.126 Frozen concentrate for colored lemonade. (a) Frozen concentrate for colored lemonade conforms to the definition and standard of identity prescribed for frozen concentrate...

  17. Mineralization of cellulose in frozen boreal soils

    NASA Astrophysics Data System (ADS)

    Oquist, Mats G.; Segura, Javier; Sparrman, Tobias; Nilsson, Mats; Schleucher, Jurgen

    2015-04-01

    Soils of high-latitude ecosystems store a large fraction of the global soil carbon. In boreal forests, the microbial mineralization of soil organic matter (SOM) during winter can affect the ecosystems net carbon balance. Recent research has shown that microorganisms in the organic surface layer of boreal forest soil can mineralize and grow on simple, soluble monomeric substrates under frozen conditions. However, any substantial impacts of microbial activity in frozen soils on long-term soil carbon balances ultimately depends on whether soil microorganisms can utilize and grow the more complex, polymeric constituents of SOM. In order to evaluate the potential for soil microorganisms to metabolize carbon polymers at low temperatures, we incubated boreal forest soil samples amended with [13C]-cellulose and studied the microbial catabolic and anabolic utilization of the substrate under frozen and unfrozen conditions (-4 and +4°C). Freezing of the soil markedly reduced microbial utilization of the cellulose. The [13C]-CO2 production rate in the samples at +4°C were 0.52 mg CO2 SOM -1 day-1 while rates in the frozen samples (-4°C) were 0.01 mg CO2 SOM -1 day-1. However, newly synthetized [13C]-enriched cell membrane lipids, PLFAs, were detected in soil samples incubated both above and below freezing, confirming that cellulose can sustain also anabolic activity of the microbial populations under frozen conditions. The reduced metabolic rates induced by freezing indicate constraints on exoenzymatic activity, as well as substrate diffusion rates that we can attribute to reduced liquid water content of the frozen soil. We conclude that the microbial population in boreal forest soil has the capacity to metabolize, and grow, on polymeric substrates at temperatures below zero, which involves maintaining exoenzymatic activity in frozen soils. This capacity manifests the importance of SOM mineralization during the winter season and its importance for the net carbon balance of

  18. Perioperative complications following total joint replacement.

    PubMed

    Talmo, Carl T; Aghazadeh, Mehran; Bono, James V

    2012-08-01

    Total joint arthroplasty is a safe and highly effective treatment for moderate to severe osteoarthritic symptoms and other causes of joint derangement in the elderly population. Significant improvements in pain, function, and quality of life are nearly universal, with a low rate of complications and adverse outcomes. Because of its success and cost-effectiveness, the rate of utilization of TJR is increasing, and all health care providers must be familiar with the potential complications and perioperative management of these patients. Elderly patients may be at a higher risk for postoperative medical complications; however, the majority of these complications are minor and many are avoidable with appropriate preoperative screening and careful postoperative management. As with all patients undergoing TJR, patients should be prophylactically treated for infection and thromboembolism and carefully followed for the development of these potential complications as well as fracture, hip dislocation, and neurovascular dysfunction. Postoperative delirium may be minimized and prophylactically treated in appropriate elderly patients to maximize recovery and promote safety. PMID:22840309

  19. Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.

    PubMed

    Toddenroth, Dennis; Ganslandt, Thomas; Drescher, Caroline; Weith, Thomas; Prokosch, Hans-Ulrich; Schuettler, Juergen; Muenster, Tino

    2016-01-01

    Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots. We aggregated the severity and duration of hypotensive episodes by calculating the average area under different mean arterial pressure (MAP) thresholds. We applied these methods to 30,452 de-identified MAP series, and analyzed the similarity between alternative indices via hierarchical clustering. To explore the potential utility of these propositional metrics, we computed their statistical association with presumed complications due to cardiovascular instability. We observed that hierarchical clustering reliably segregated features that had been designed to quantify dissimilar aspects. Summaries of temporary hypotension turned out to be significantly increased among patient subgroups with subsequent signs of a complicated recovery. These associations were even stronger for measures that were specifically geared to capturing short-term MAP variability. These observations suggest the potential capability of our proposed algorithms for quantifying heterogeneous aspects of short-term MAP fluctuations. Future research might also target a wider selection of outcomes and other attributes that may be subject to intraoperative variability. PMID:27577440

  20. Perioperative morbidity of radical cystectomy: A review

    PubMed Central

    Kulkarni, Jagdeesh N.

    2011-01-01

    A systematic review of the literature on perioperative morbidity (POM) was done using Medline software with a combination of keywords like mortality, morbidity, and complications. In addition, we review the analysis of our hospital data of 261 Radical cystectomies (RCs) performed in an 11-year period and our latest clinical pathway for RC. Age range in our series was 50 to 81 years with 240 males and 21 females. RCs were performed by intraperitoneal method in 172 patients and by our extraperitoneal (EP) method in 89 patients. Urinary diversion was ileal conduit in 159 patients and neobladder in 102 patients. Blood loss ranged between 500 and 1500 ccs. Postoperative mortality occurred in eight patients (3%). Among the other early post-op complications, major urinary leak was seen in nine and minor in 11, requiring PCN in five patients and reoperation in four patients. Bowel leak or obstruction was seen in six and four patients, respectively, requiring reoperation in six patients. EP RC in our series showed some benefit in reduction of POM. The mortality of RC has declined but the POM still ranges from 11 to 68%, as reported in 23 series (1999-2008) comprising of 14 076 patients. Various risk factors leading to POM and some corrective measures are discussed in detail. However, most of these series are retrospective and lack standard complication reporting, which limits the comparison of outcomes. Various modifications in open surgical technique and laparoscopic and Robotic approaches are aimed at reduction in mortality and POM of RC. PMID:21814314

  1. LOEYS-DIETZ SYNDROME: PERIOPERATIVE ANESTHESIA CONSIDERATIONS.

    PubMed

    Johnson, Judy G; Bray, Jacob P; Risher, William H; Kaye, Alan David

    2016-06-01

    Loeys-Dietz syndrome (LDS) is a rare autosomal dominant disease related to genetic mutations in receptors for the cytokine transforming growth factor-receptor type 1 (TGFB-R1) or 2 gene (TGFB-R2) on the cell surface. LDS results in abnormal protein synthesis and dysfunctional connective tissue, which can result in unique cardiovascular anesthesia challenges related to perioperative management. Patients with LDS may manifest hypertelorism, bifid uvula or cleft palate, and arterial tortuosity. Virtually all LDS patients show some type of abnormal skin findings and bleeding tendency. These patients may show a rapid progression of aortic dilation, regurgitation, and a propensity towards rupture and/or dissection at a much earlier age and smaller aneurysm size. LDS patients who require surgical intervention require meticulous vigilance from the anesthesiologist. We describe a 26 year old patient with documented LDS type 1 who presented for repair of an ascending/root aneurysm in this case report. Recognition of LDS and intra-operative management of the cardiovascular manifestations of this disease is paramount in ensuring successful surgical outcome and to limit morbidity and mortality. PMID:27487644

  2. Management of hyperglycemia during the perioperative period.

    PubMed

    Pichardo-Lowden, Ariana; Gabbay, Robert A

    2012-02-01

    Hyperglycemia is frequently encountered in the inpatient setting and is distinctly associated with poor clinical outcomes. Recent literature suggests an association between stringent glycemic control and increased mortality, thus keeping optimal glycemic targets a relevant subject of debate. In the surgical population, hyperglycemia with or without diabetes mellitus may be unrecognized. Factors contributing to hyperglycemia in the hospital include critical illness, use of certain drugs, use of enteral or parenteral nutrition, and variability in oral or nutritional intake as can occur when patients are prepared for procedures or surgery. A sensible approach to managing hyperglycemia in this population includes preoperative recognition of diabetes mellitus and risks for inpatient hyperglycemia. Judicious control of glycemia during the pre-, intra-, and postoperative time periods with avoidance of hypoglycemia mandates the need for a strategy for patient management that extend to time of discharge. We review the consequences of uncontrolled perioperative hyperglycemia, discuss current clinical guidelines and recent controversies, and provide practical tools for glycemic control in the surgical population. PMID:22086363

  3. Evaluation of perioperative risk in elderly patients.

    PubMed

    Aubrun, F; Gazon, M; Schoeffler, M; Benyoub, K

    2012-05-01

    From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain. PMID:22269928

  4. Perioperative concerns in neurosurgical patients with human immunodeficiency virus infection

    PubMed Central

    Agarwal, Jyotsna; Ganjoo, Pragati; Hansda, Upendra; Sharma, Megha U.; Tandon, Monica S.; Singh, Daljit

    2016-01-01

    Background: The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries. Aim: To present our experience in the perioperative management of HIV-infected patients who underwent neurosurgery at our institute in the past 5 years and highlight the relevant perioperative issues. Materials and Methods: A retrospective analysis of the records of HIV-infected neurosurgical patients was undertaken to determine their HIV status and ART, anesthesia and surgery details, perioperative complications, and instances of postoperative worsening of HIV disease or its transmission, if any. Results: Seven HIV infected patients with variable severity of HIV infection and systemic disease underwent neurosurgery for different indications. Their perioperative management was modified in accordance with the co-morbidities and the type of neurosurgery. There was no obvious adverse impact of the HIV disease on the anesthetic outcome, no obvious clinical evidence of post-surgery worsening of the HIV disease, and no instance of HIV transmission in our patients. Conclusion: A goodunderstanding of the HIV disease and its perioperative implications during neurosurgery helps in better patient management and enables a safe outcome. PMID:27057214

  5. Cytoplasmic structure in rapid-frozen axons

    PubMed Central

    1982-01-01

    Turtle optic nerves were rapid-frozen from the living state, fractured, etched, and rotary shadowed. Stereo views of fractured axons show that axoplasm consists of three types of longitudinally oriented domains. One type consists of neurofilament bundles in which individual filaments are interconnected by a cross-bridging network. Contiguous to neurofilament domains are domains containing microtubules suspended in a loose, granular matrix. A third domain is confined to a zone, 80-100 nm wide, next to the axonal membrane and consists of a dense filamentous network connecting the longitudinal elements of the axonal cytoskeleton to particles on the inner surface of the axolemma. Three classes of membrane-limited organelles are distinguished: axoplasmic reticulum, mitochondria, and discrete vesicular organelles. The vesicular organelles must include lysosomes, multivesicular bodies, and vesicles which are retrogradely transported in axons, though some vesicular organelles may be components of the axoplasmic reticulum. Organelles in each class have a characteristic relationship to the axonal cytoskeleton. The axoplasmic reticulum enters all three domains of axoplasm, but mitochondria and vesicular organelles are excluded from the neurofilament bundles, a distribution confirmed in thin sections of cryoembedded axons. Vesicular organelles differ from mitochondria in at least three ways with respect to their relationships to adjacent axoplasm: (a) one, or sometimes both, of their ends are associated with a gap in the surrounding granular axoplasm; (b) an appendage is typically associated with one of their ends; and (c) they are not attached or closely apposed to microtubules. Mitochondria, on the other hand, are only rarely associated with gaps in the axoplasm, do not have an appendage, and are virtually always attached to one or more microtubules by an irregular array of side-arms. We propose that the longitudinally oriented microtubule domains are channels within which

  6. Cryogenic Structure of Perennially Frozen Lacustrine Sediments

    NASA Astrophysics Data System (ADS)

    Kanevskiy, M.; Shur, Y.; Jorgenson, T.

    2007-12-01

    section includes lens of syngenetically frozen lacustrine sediments with small ice wedges, which was presumably formed during the period of lowering of the water level in the lake.

  7. Maintaining perioperative normothermia in the patient undergoing cesarean delivery.

    PubMed

    Carpenter, Lavenia; Baysinger, Curtis L

    2012-07-01

    Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery. PMID:22926250

  8. Perioperative management of the patient with rheumatoid arthritis.

    PubMed

    Krause, Megan L; Matteson, Eric L

    2014-07-18

    A multidisciplinary approach is required to care for patients with rheumatoid arthritis (RA) in the perioperative period. In preparation for surgery, patients must have a cardiovascular risk assessment performed due to the high risk of heart disease in patients with RA. Treatment of RA is with immunomodulatory medications, which present unique challenges for the perioperative period. Currently, there is no consensus on how to manage disease modifying antirheumatic drug (DMARD) therapy in the perioperative setting. Much of the data to guide therapy is based on retrospective cohort data. Choices regarding DMARDs require an individualized approach with collaboration between surgeons and rheumatologists. Consensus regarding biologic therapy is to hold the therapy in the perioperative period with the length of time dictated by the half-life of the medication. Special attention is required at the time of surgery for potential need for stress dose steroids. Further, there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine disease. There are no consensus guidelines regarding the requirement for cervical spine radiographs prior to surgery. However, history and exam alone cannot be relied upon to identify cervical spine disease. Patients with RA who undergo joint replacement arthroplasty are at higher risk for infection and dislocation compared to patients with osteoarthritis, necessitating particular vigilance in postoperative follow up. This review summarizes available evidence regarding perioperative management of patients with RA. PMID:25035831

  9. Perioperative management of the patient with rheumatoid arthritis

    PubMed Central

    Krause, Megan L; Matteson, Eric L

    2014-01-01

    A multidisciplinary approach is required to care for patients with rheumatoid arthritis (RA) in the perioperative period. In preparation for surgery, patients must have a cardiovascular risk assessment performed due to the high risk of heart disease in patients with RA. Treatment of RA is with immunomodulatory medications, which present unique challenges for the perioperative period. Currently, there is no consensus on how to manage disease modifying antirheumatic drug (DMARD) therapy in the perioperative setting. Much of the data to guide therapy is based on retrospective cohort data. Choices regarding DMARDs require an individualized approach with collaboration between surgeons and rheumatologists. Consensus regarding biologic therapy is to hold the therapy in the perioperative period with the length of time dictated by the half-life of the medication. Special attention is required at the time of surgery for potential need for stress dose steroids. Further, there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine disease. There are no consensus guidelines regarding the requirement for cervical spine radiographs prior to surgery. However, history and exam alone cannot be relied upon to identify cervical spine disease. Patients with RA who undergo joint replacement arthroplasty are at higher risk for infection and dislocation compared to patients with osteoarthritis, necessitating particular vigilance in postoperative follow up. This review summarizes available evidence regarding perioperative management of patients with RA. PMID:25035831

  10. Soil organic matter mineralization in frozen soils

    NASA Astrophysics Data System (ADS)

    Harrysson Drotz, S.; Sparrman, T.; Schleucher, J.; Nilsson, M.; Öquist, M. G.

    2009-12-01

    Boreal forest soils are frozen for a large part of the year and soil organic matter mineralization during this period has been shown to significantly influence the C balance of boreal forest ecosystems. Mineralization proceeds through heterotrophic microbial activity, but the understanding of the environmental controls regulating soil organic matter mineralization under frozen conditions is poor. Through a series of investigations we have addressed this issue in order to elucidate to what extent a range of environmental factors control mineralization processes in frozen soils and also the microbial communities potential to oxidize organic substrates and grow under such conditions. The unfrozen water content in the frozen soils was shown to be an integral control on the temperature response of biogenic CO2 production across the freezing point of bulk soil water. We found that osmotic potential was an important contributor to the total water potential and, hence, the unfrozen water content of frozen soil. From being low and negligible in an unfrozen soil, the osmotic potential was found to contribute up to 70% of the total water potential in frozen soil, greatly influencing the volume of liquid water. The specific factors of how soil organic matter composition affected the unfrozen water content and CO2 production of frozen soil were studied by CP-MAS NMR. We concluded that abundance of aromatics and recalcitrant compounds showed a significant positive correlation with unfrozen water content and these were also the major soil organic fractions that similarly correlated with the microbial CO2 production of the frozen soils. Thus, the hierarchy of environmental factors controlling SOM mineralization changes as soils freeze and environmental controls elucidated from studies of unfrozen systems can not be added on frozen conditions. We have also investigated the potential activity of soil microbial communities under frozen conditions in order to elucidate temperature

  11. [Pathophysiology and management of perioperative hypothermia].

    PubMed

    Witkowski, Wojciech; Maj, Jakub

    2006-06-01

    The paper is a review of pathophysiology and management of perioperative hypothermia. The advanced methods of rewarming, such as passive and active: external and core used in clinic allow for efficient management ant prophylactics of hypothermia. Thermotherapy with use of infrared ceiling heaters CTS and mobile MTC as well as Infutherm system applying by authors are desirable and even indispensable in contemporary equipment of surgery clinics, cardiovascular surgery clinics and burn centers. The ideal rewarming method should be safe and enable fast, reliable and predictable warming or rewarming. The clinical parameter to determine the efficacy of rewarming is the change of core temperature. There is no doubt that active warming with forced-air warmers (Warm Touch 5700 and Bair Hugger 500) or radiative heaters (IR-A:Hydrosun 500, IR-C radiation: CTC X, MTC) is more effective than use of standard, passive insulation hospital blankets or convectional heaters. Actually the forced-air warmers are counted to be more useful in cardiovascular surgery hypothermia management, because of fast rate core temperature rise and faster rise in mean skin temperature compared to the control group. CTC X and MTC Aragona radiative heaters are useful in burn management being the most effective when the distance of heater from the patient body is less than 80 cm. The observation of 60 consecutive extensive burns leads to conclusion that long-lasting dressings in burn patients when the whole body is not covered and protected, can be performed safely only in conditions excluding heat losses and core temperature drop. While the cold intravenous fluids may significantly contribute to the temperature drop depending on the volume infused, the use of fluids warming systems as well as external heat application is absolutely indicated to improve the heat balance of the patient body. PMID:17007255

  12. Delirium: a key challenge for perioperative care.

    PubMed

    O'Regan, N A; Fitzgerald, J; Timmons, S; O'Connell, H; Meagher, D

    2013-01-01

    Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. Delirium presents most commonly with hypoactive features (e.g. withdrawal and reduced spontaneous movement and speech). The common stereotype of hyperactive delirium tremens (e.g. agitation, hallucinations), although more visible, is less common. All presentations share acute disimprovement of cognitive function. Delirium is a highly predictable and preventable occurrence, however a major barrier to improving delirium care and impacting upon outcomes is that it remains poorly detected, particularly in surgical populations and especially in patients with hypoactive presentations. Routine ward-based screening for delirium, particularly in high-risk populations, and improved staff awareness of the significance of the problem can improve detection rates. Preventative strategies, particularly multicomponent approaches, have been most efficacious in improving patient outcomes. Optimising perioperative risk factors can lead to reduced incidence. Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment. PMID:23277227

  13. Improving the quality of perioperative services in an era of reform.

    PubMed

    Daihl, Ed

    2013-12-01

    To improve performance in the surgical services arena, healthcare leaders should focus on: Improving perioperative outcomes. Meeting value-based purchasing quality targets. Reducing readmissions. Improving the perioperative experience. PMID:24380252

  14. Implementing a Perioperative RN Training Program for Recent Graduates.

    PubMed

    Byrd, Debra; Mullen, Linda; Renfro, David; Harris, Theodore A

    2015-09-01

    In 2010, nurse educators at one health care facility implemented a new program that emphasized placing new graduates in specialty areas, including the hemodialysis unit, the gastroenterology unit, and the OR. Managers in the OR faced staffing challenges because of the difficulty in recruiting and retaining experienced perioperative nurses and the expected retirement of a significant number of staff members. Surgical services managers agreed to participate in the new graduate program and decided to use AORN's Periop 101™ course and a series of monthly simulation training sessions to supplement the program and provide recently graduated nurses with a strong perioperative nursing foundation. In three years, a total of nine newly graduated RNs successfully completed the program. The three-year retention rate was 78%. PMID:26323221

  15. Effects of perioperative fasting on haemodynamics and intravascular volumes.

    PubMed

    Jacob, Matthias; Chappell, Daniel

    2012-12-01

    Maintaining cardiac preload throughout the perioperative period is a generally accepted target. As perioperative fasting is believed to cause intravascular hypovolaemia it traditionally triggers aggressive preemptive intravenous fluid infusion. Physiology suggests that extracellular losses via urinary output and evaporation decrease the extracellular compartment. Representing a relevant part of the latter, the intravascular space is also affected, even without blood loss. Measurements in humans, however, have revealed that even a prolonged fasting period does not decrease absolute blood volume. Beyond that, modern fasting guidelines recommend to refrain from clear liquids only two hours prior to surgery. Nevertheless, an intravenous colloid challenge can increase stroke volume after induction of anaesthesia in the majority of surgical patients. While perioperative stroke volume maximisation in high-risk surgery probably improves outcome, the implication of this observation for the routine patient remains unclear. It appears as though there are two important targets to preserve cardiac preload: normovolaemia and vasotension. PMID:23351229

  16. Optimizing perioperative decision making: improved information for clinical workflow planning.

    PubMed

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  17. Role of perioperative antibiotic treatment in parotid gland surgery

    PubMed Central

    Shkedy, Yotam; Alkan, Uri; Roman, Benjamin R.; Hilly, Ohad; Feinmesser, Raphael; Bachar, Gideon; Mizrachi, Aviram

    2016-01-01

    Background The value of routine prophylactic antibiotic treatment in parotid gland surgery remains undetermined. Methods A retrospective analysis was conducted of all patients who underwent parotidectomy at a university-affiliated tertiary care center between 1992 and 2009. Patients with insufficient data, specifically regarding postoperative complications and antibiotic administration were excluded from the study cohort. Results A total of 593 patients underwent parotidectomy during the study period. After exclusion, 464 patients were eligible for the study. Perioperative antibiotic treatment was given to 206 patients (45%). There was no difference in wound infection rates between patients who received perioperative antibiotic therapy and those who did not (p = .168). Multivariate analysis showed that female sex, neck dissection, and drain output >50 cc/24 hours were predictive of postoperative wound infection. Conclusion Routine prophylactic antibiotic treatment has no role in parotid gland surgery. Perioperative antibiotic treatment is recommended for patients undergoing extensive parotid gland surgery with neck dissection. PMID:26702565

  18. Optimizing Perioperative Decision Making: Improved Information for Clinical Workflow Planning

    PubMed Central

    Doebbeling, Bradley N.; Burton, Matthew M.; Wiebke, Eric A.; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40–70% of hospital revenues and 30–40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  19. An Overview of Preoperative Glucose Evaluation, Management, and Perioperative Impact

    PubMed Central

    Sheehy, Ann M.; Gabbay, Robert A.

    2009-01-01

    Perioperative hyperglycemia is a common phenomenon affecting patients both with and without a known prior history of diabetes. Despite an exponential rise in publications and studies of inpatient hyperglycemia over the last decade, many questions still exist as to what defines optimal care of these patients. Initial enthusiasm for tight glycemic control has waned as the unanticipated reality of hypoglycemia and mortality has been realized in some prospective studies. The recent dramatic modification of national practice guidelines to endorse more modest inpatient glycemic targets highlights the dynamic nature of current knowledge as the next decade approaches. This review discusses perioperative hyperglycemia and the categories of patients affected by it. It reviews current recommendations for ambulatory diabetes screening and its importance in preoperative patient care. Finally, it concludes with a review of current practice guidelines, as well as a discussion of future direction and goals for inpatient perioperative glycemic control. PMID:20144379

  20. Tranexamic Acid: From Trauma to Routine Perioperative Use

    PubMed Central

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  1. Gender and its implications for cardiothoracic perioperative care and anesthesia.

    PubMed

    Schopper, Miriam; Irnich, Dominik

    2013-01-01

    Differences in gender can influence perioperative outcome, with men and women being differently affected by adverse events in the perioperative period. Differences relating to specific drug effects, comorbidities and outcomes after anesthesia or intensive care have been demonstrated. There is a gender bias in diagnosis and therapy. While knowledge regarding this field is still growing, certain aspects have already been integrated into clinical practice (prevention of postoperative nausea and vomiting, target-controlled infusion, male-only policy with production of blood products). There is a need to study the influence of gender, age, and race on perioperative outcome to optimize treatment and move toward more individualized therapy. This article highlights already identified differences and discusses potential underlying mechanisms. PMID:23225515

  2. Transdermal rotigotine for the perioperative management of restless legs syndrome

    PubMed Central

    2012-01-01

    Background Immobilisation, blood loss, sleep deficiency, and (concomitant) medications during perioperative periods might lead to acute exacerbation of symptoms in patients with the restless legs syndrome (RLS). Continuous transdermal delivery of the dopamine agonist rotigotine provides stable plasma levels over 24 h and may provide RLS patients with a feasible treatment option for perioperative situations. To assess the feasibility of use of rotigotine transdermal patch for the perioperative management of moderate to severe RLS, long-term data of an open-label extension of a rotigotine dose-finding study were retrospectively reviewed. Methods The data of all 295 patients who had entered the 5-year study were screened independently by two reviewers for the occurrence of surgical interventions during the study period. The following data were included in this post-hoc analysis: patient age, sex, surgical intervention and outcome, duration of hospital stay, rotigotine maintenance dose at the time of surgery, rotigotine dose adjustment, and continuation/discontinuation of rotigotine treatment. All parameters were analysed descriptively. No pre-specified efficacy assessments (e.g. IRLS scores) were available for the perioperative period. Results During the study period, 61 surgical interventions were reported for 52 patients (median age, 63 years; 67% female); the majority of patients (85%) had one surgical intervention. The mean rotigotine maintenance dose at time of surgery was 3.1 ± 1.1 mg/24 h. For most interventions (95%), rotigotine dosing regimens were maintained during the perioperative period. Administration was temporarily suspended in one patient and permanently discontinued in another two. The majority (96%) of the patients undergoing surgery remained in the study following the perioperative period and 30 of these patients (61%) completed the 5-year study. Conclusions Although the data were obtained from a study which was not designed to assess

  3. [Perioperative cardiovascular evaluation and management for noncardiac surgery].

    PubMed

    Furuichi, Yuko; Sakamoto, Atsuhiro

    2014-03-01

    As a population ages, an increase in the number of patients with cardiac complications who undergo non-cardiac surgeries is observed. The perioperative mortality for noncardiac surgery is approximately 1-5%; approximately 20-35% of these cases are due to cardiovascular complications. Among them, perioperative myocardiac infarction/ischemia is a factor that leads to poor prognosis, and the ACC/AHA guidelines emphasize this aspect. An important task of the anesthesiologist is to accurately assess risks in patients undergoing noncardiac surgeries and avoid adverse cardiovascular events. PMID:24724438

  4. Utilizing the Perioperative Nursing Data Set in a surgical setting.

    PubMed

    Westendorf, Jennifer J

    2007-01-01

    The Perioperative Nursing Data Set (PNDS) is the standardized nursing language for documentation by perioperative nurses. The usage of this language is the essential framework for documentation standardization in the operating room. This article explores 2 specific patient outcomes and how the usage of the PNDS helps guide actions taken by registered nurses in the operating room. Furthermore, this article gives a brief overview of the history of the PNDS, and how this language helps improve nursing outcomes and promotes the profession of nursing. PMID:18165723

  5. Ethics in perioperative practice--values, integrity, and social policy.

    PubMed

    King, Cecil A; Broom, Catherine

    2002-12-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. PMID:12528493

  6. Recognition and Management of Perioperative Stroke in Hospitalized Patients.

    PubMed

    Vlisides, Phillip E; Mashour, George A; Didier, Thomas J; Shanks, Amy M; Weightman, Adam; Gelb, Adrian W; Moore, Laurel E

    2016-08-01

    We sought to characterize stroke management and outcomes in a postoperative population. By using the electronic medical records, we identified 39 patients suffering perioperative stroke after noncardiac and nonneurosurgical procedures for whom documentation of management and outcomes was available. Thirty-three strokes occurred during admission, whereas 6 occurred after discharge and were recognized upon return to the hospital. Perioperative stroke was associated with delayed recognition, infrequent intervention, and significant rates of morbidity and mortality, suggesting the need for improved screening and more rapid treatment. There may be disparities in care and outcomes between in-hospital and out-of hospital stroke patients, though further study is warranted. PMID:27490452

  7. On a Frozen Fellow and Melding Media.

    ERIC Educational Resources Information Center

    Wheeler, David

    1996-01-01

    Describes an art project that constructed a realistic model of a frozen prehistoric cadaver including its clothing and tool kit. Originally conceived as a way to introduce students to art materials, ancient history, and different cultures, the project grew to include a traveling exhibit and instructional puppet shows. (MJP)

  8. Using frozen sugarcane for alcohol production

    SciTech Connect

    Irvine, J.E.

    1980-01-01

    The three areas that produce sugarcane in the mainland US are subject to crop-damaging freezes. Florida has fewer freezes. Texas and Louisiana are hurt frequently. Hard freezes end processing for sugar production when dextrans form and prevent crystallization. Dextran is formed from sugar by bacteria. Work at the Audubon Sugar Institute, LSU, has shown that crystallization of sucrose can be achieved with juice from frozen sugarcane when enzymes are used to reduce the size of the dextran molecule. Frozen cane may also be processed for alcohol production. How long the cane would be suitable as feedstock was questioned; its use would depend on sugar content. Sugarcane has been tested for post-freeze deterioration at the US Sugarcane Field Laboratory for over 50 years, and the emphasis has been on the response of varieties selected for sugar production in post-freeze deterioration. The data indicated that juice from frozen sugarcane in any of the tests would be adequate for alcohol production; fermentation based on mash with a sugar content of 9 to 11% for rum, and 15% for industrial alcohol. Total fermentable carbohydrates in frozen cane would be even higher since the data did not include invert sugars or starch. 1 table. (DP)

  9. [Clinical applications of MALDI imaging using sliced sections of formalin-fixed paraffin-embedded tissues and longitudinal sliced hairs].

    PubMed

    Nakanishi, Toyofumi; Ito, Minako; Ueda, Kazuhito; Wada, Shinichi; Fujioka, Shigekazu; Tsuji, Motomu; Takubo, Takayuki

    2012-02-01

    MALDI-imaging MS (IMS) with MSMS analysis is a new powerful tool for the identification of not only disease-related proteins in formalin-fixed paraffin-embedded (FFPE) tissue sections but also protein/peptides/drugs/medicine in fresh-frozen tissues. IMS is used to reveal the mass profiles and spatial distribution of proteins in tissue sections and/or digested peptides derived from deposited protein in pathologic organs and then MSMS analysis identifies the amino acid sequence of the detected proteins in the tissue section. Moreover, on-tissue digestion combined with the MALDI-IM-TOF-IMS approach allows a proteomics "bottom-up" strategy with clinical samples, especially perioperative isolated tissues and FFPE tissues conserved for a long time in a clinical sample bank. The mass barcode-like image (MBI) on a longitudinal sliced hair by IMS is used in the selected reaction monitoring mode for serially chronological monitoring and traceability every few hours after drug and medicine intake. The advances of quantitative MBI for sliced sections of hair allow a new universal standardized assessment of drugs and medicines throughout the drug history. PMID:22568093

  10. 75 FR 54847 - Certain Frozen Warmwater Shrimp from Thailand: Final Results and Partial Rescission of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ..., 74 FR 5638, 5639 (January 30, 2009) (Section 129 Determination); Certain Frozen Warmwater Shrimp from..., 74 FR 52452 (October 13, 2009). Based on our analysis of the comments received, we have made certain... Duty Administrative Review, 75 FR 12188 (March 15, 2010) (Preliminary Results). We invited parties...

  11. 75 FR 47546 - Certain Frozen Warmwater Shrimp from the Socialist Republic of Vietnam: Preliminary Results of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-06

    ... with section 751(c) of the Act. See Initiation of Five-year (``Sunset'') Review, 75 FR 103 (January 4... Results of Full Five-year (``Sunset'') Review of Antidumping Duty Order, 75 FR 24883 (May 6, 2010). The...-frozen) and peeled shrimp; 2) to which a ``dusting'' layer of rice or wheat flour of at least 95...

  12. 78 FR 33347 - Certain Frozen Warmwater Shrimp From Ecuador: Preliminary Negative Countervailing Duty Determination

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ...The Department of Commerce (``the Department'') preliminarily determines that countervailable subsidies are not being provided to producers and exporters of certain frozen warmwater shrimp from Ecuador. The period of investigation is January 1, 2011, through December 31, 2011. Pursuant to section 705(a)(1) of the Tariff Act of 1930, as amended (the Act), the final determination will be issued......

  13. Three-dimensional reconstruction of frozen and thawed plant tissues from microscopic images

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Histological analysis of frozen and thawed plants has been conducted for many years but the observation of individual sections only provides a 2 dimensional representation of a 3 dimensional phenomenon. Most techniques for viewing internal plant structure in 3 dimensions is either low in resolution...

  14. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  15. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  16. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  17. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  18. 9 CFR 381.148 - Processing and handling requirements for frozen poultry products.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... for frozen poultry products. 381.148 Section 381.148 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS INSPECTION...

  19. Ranitidine-induced perioperative anaphylaxis: A rare occurrence and successful management

    PubMed Central

    Neema, Shekhar; Sen, Subrato; Chatterjee, Manas

    2016-01-01

    Perioperative anaphylaxis is a rare and catastrophic event. Anaphylaxis during perioperative period changes the entire management plan for the patient. Since a large number of drugs are administered to the patient during the short span of time, it becomes difficult to identify the culprit drug. This has an impact on the management of the patients who have to undergo surgery. Ranitidine is considered a safe drug used in perioperative period; however, rarely it can lead to perioperative anaphylaxis. We present one such case of ranitidine-induced perioperative anaphylaxis which was successfully managed by early diagnosis and avoidance of drug. PMID:27127327

  20. Ranitidine-induced perioperative anaphylaxis: A rare occurrence and successful management.

    PubMed

    Neema, Shekhar; Sen, Subrato; Chatterjee, Manas

    2016-01-01

    Perioperative anaphylaxis is a rare and catastrophic event. Anaphylaxis during perioperative period changes the entire management plan for the patient. Since a large number of drugs are administered to the patient during the short span of time, it becomes difficult to identify the culprit drug. This has an impact on the management of the patients who have to undergo surgery. Ranitidine is considered a safe drug used in perioperative period; however, rarely it can lead to perioperative anaphylaxis. We present one such case of ranitidine-induced perioperative anaphylaxis which was successfully managed by early diagnosis and avoidance of drug. PMID:27127327

  1. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  2. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  3. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  4. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  5. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  6. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  7. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  8. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  9. 48 CFR 846.302-72 - Frozen processed foods.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Frozen processed foods... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 846.302-72 Frozen processed foods. The contracting officer shall insert the clause at 852.246-72, Frozen processed foods, in solicitations and contracts...

  10. 48 CFR 870.111-5 - Frozen processed food products.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Frozen processed food... DEPARTMENT SUPPLEMENTARY REGULATIONS SPECIAL PROCUREMENT CONTROLS Controls 870.111-5 Frozen processed food products. (a) The following frozen processed food products must have a label complying with the...

  11. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  12. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  13. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  14. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  15. 21 CFR 864.9145 - Processing system for frozen blood.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Processing system for frozen blood. 864.9145... Blood and Blood Products § 864.9145 Processing system for frozen blood. (a) Identification. A processing system for frozen blood is a device used to glycerolize red blood cells prior to freezing to...

  16. Perioperative Diabetic Consultation: A Plea for Improved Training

    ERIC Educational Resources Information Center

    Rudd, Peter; And Others

    1978-01-01

    To determine the clinical and educational impact of an academic general internal medicine consultation service, the perioperative management of diabetes mellitus was examined. The findings indicate that consultative skills must be taught more effectively if medical consultations are to have maximal impact. (Author/LBH)

  17. Dyskeratosis congenita induced cirrhosis for liver transplantation-perioperative management

    PubMed Central

    Singh, Anshuman; Pandey, VK; Tandon, Manish; Pandey, CK

    2015-01-01

    Dyskeratosis congenita (DC) is an inherited disorder with progressive multisystem involvement. End stage liver disease (ESLD) in patients with DC is rare. We describe the perioperative management of a patient with DC induced ESLD and severe hepatopulmonary syndrome for living donor liver transplantation. PMID:26019357

  18. Preoperative myocardial ischaemia: its relation to perioperative infarction.

    PubMed Central

    Yousif, H; Davies, G; Westaby, S; Prendiville, O F; Sapsford, R N; Oakley, C M

    1987-01-01

    One hundred consecutive patients undergoing coronary artery bypass surgery were randomly allocated to a preoperative (24 h) intravenous infusion of isosorbide dinitrate (1.5-15 mg/hr) (50 patients) or to placebo (50 patients). The characteristics of the two groups were similar. Evidence of acute myocardial ischaemia was sought by continuous electrocardiographic Holter recordings and acute myocardial infarction by the appearance of new Q waves and increased activity of the creatine kinase MB isoenzyme. Episodes of acute myocardial ischaemia were found in 18% of patients in the control group and in none of those who received isosorbide dinitrate. None the less, the frequency of perioperative myocardial infarction was similar (22% and 18% respectively) in the two groups. Perioperative infarction was significantly more common in women, in patients with unstable angina or poor left ventricular function, in those who had coronary endarterectomy, and in those in whom the aortic clamping time was greater than 50 minutes. These factors may have obscured any effect that prevention of preoperative ischaemia had on perioperative infarction. Preoperative infusion of isosorbide dinitrate eliminated preoperative ischaemia but did not influence the occurrence of perioperative infarction. The probable benefits of prevention of preoperative ischaemia on postoperative left ventricular function, which is a determinant of long term survival, remain to be established. PMID:3304371

  19. [Perioperative management of patients for living-donor liver transplantation].

    PubMed

    Matsumoto, Atsuhiro; Fujino, Yuji

    2014-05-01

    Living-donor liver transplantation has become a standard and effective treatment for end stage liver disease patients. As a result of remarkable progress in immunosuppressive drugs, surgical device, anesthetics, and appropriate perioperative management, liver-transplanted patients may experience fewer complications, shorter length of ICU stay, and a better overall outcome. However, unexpected perioperative complications remain substantial. Therefore, we take care in several points in perioperative period. First, we should appropriately evaluate general preoperative conditions, such as coagulopathy, ascites, respiratory and renal function. Second, we need to maintain hemodynamic stabilization, electrolyte balance, correction of coagulopathy and prevention of portal hypertention during operation. And third, in postoperative period we should perform strict monitoring and focus on infection prophylaxis, early weaning from mechanical ventilation, appropriate administration of fluid and transfusion, maintaining renal function and preservation of graft function. Appropriate knowledge and understanding of perioperative management in liver transplantation are required to improve patient's outcome. Furthermore, it is important for performing liver transplantation to boost mutual understanding and trust in the medical team including health-care providers. PMID:24864574

  20. The long-term fate of fresh and frozen orthotopic bone allografts in genetically defined rats.

    PubMed

    Bos, G D; Goldberg, V M; Gordon, N H; Dollinger, B M; Zika, J M; Powell, A E; Heiple, K G

    1985-01-01

    Fresh and frozen orthotopic iliac crest bone grafts in rats were studied histologically for determination of the long-term effects of histocompatibility matching and the freezing process on orthotopic bone graft incorporation. Grafts exchanged between groups of inbred rats, syngeneic or differing with respect to major or minor histocompatibility loci, were studied histologically at 20, 30, 40, 50, and 150 days after bone transplantation. A numerical histologic scoring system was developed and used by three observers for evaluation of coded hematoxylin and eosin sections. All frozen graft groups had the same fate regardless of histocompatibility relations between donors and recipients, and all grafts were inferior to fresh syngeneic grafts. Both fresh allograft groups received similar scores and initially at 20 and 30 days had scores similar to those of the fresh syngeneic groups. In the later intervals, however, the fresh allografts were inferior to the fresh syngeneic grafts and similar to the frozen groups. This is consistent with an older model describing two distinct phases of osteogenesis. In the long term, frozen syngeneic and fresh and frozen allografts across major and minor histocompatibility barriers were comparable, but all were significantly inferior to fresh syngeneic bone grafts. PMID:3893828

  1. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    PubMed

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  2. Student Perceptions about the Influence of a Perioperative Nursing Elective on Career Preferences.

    PubMed

    Schmidt, Nola A; Brown, Janet M; Holmes, Linda

    2016-01-01

    It has been suggested that offering perioperative nursing courses will increase the number of nurses and new graduates who enter the perioperative area. There is little research to support that students' career choices are influenced by immersion in perioperative content. The purpose of this qualitative study was to describe student perceptions of perioperative nursing as a career option following completion of an elective in perioperative nursing. Two focus groups were held involving students (N=19) who completed the course. One hour sessions were audio taped as students described their perceptions about perioperative nursing. Tapes were transcribed verbatim and analysed for themes. Four themes were identified: 1) opening their eyes: career advantages, 2) being captive: career disadvantages, 3) paradox unrecognized, and 4) I'll be a better nurse. Although students were not persuaded to alter their primary employment intentions, they acknowledged the possibility of a future career in the perioperative area. PMID:27447242

  3. The Jefferson Lab Frozen Spin Target

    SciTech Connect

    Christopher Keith, James Brock, Christopher Carlin, Sara Comer, David Kashy, Josephine McAndrew, David Meekins, Eugene Pasyuk, Joshua Pierce, Mikell Seely

    2012-08-01

    A frozen spin polarized target, constructed at Jefferson Lab for use inside a large acceptance spectrometer, is described. The target has been utilized for photoproduction measurements with polarized tagged photons of both longitudinal and circular polarization. Protons in TEMPO-doped butanol were dynamically polarized to approximately 90% outside the spectrometer at 5 T and 200-300 mK. Photoproduction data were acquired with the target inside the spectrometer at a frozen-spin temperature of approximately 30 mK with the polarization maintained by a thin, superconducting coil installed inside the target cryostat. A 0.56 T solenoid was used for longitudinal target polarization and a 0.50 T dipole for transverse polarization. Spin relaxation times as high as 4000 hours were observed. We also report polarization results for deuterated propanediol doped with the trityl radical OX063.

  4. Frozen multipartite entanglement in photonic crystals

    NASA Astrophysics Data System (ADS)

    Wu, Wei; Xu, Jing-Bo

    2016-06-01

    We investigate the multipartite entanglement dynamics of a many-body system consisting of N identical two-level atoms locally embedded in their own band-gap photonic crystals. It is shown that the tripartite entanglement of this photonic-crystal system can be frozen in a stationary state. We also find that a double-sudden-change phenomenon of four-partite entanglement occurs in this photonic-crystal system during the decoherence process under certain suitable conditions.

  5. Frozen yogurt with added inulin and isomalt.

    PubMed

    Isik, U; Boyacioglu, D; Capanoglu, E; Erdil, D Nilufer

    2011-04-01

    The objective of this study was to produce a frozen yogurt containing low fat and no added sugar. Samples containing 5% polydextrose, 0.065% aspartame and acesulfame-K mixture, and different levels of inulin and isomalt (5.0, 6.5, and 8.0%) were produced at pilot scale and analyzed for their physical and chemical properties including proximate composition, viscosity, acidity, overrun, melting rate, heat shock stability, as well as sensory characteristics, and viability of lactic acid bacteria. With the addition of inulin and isomalt, viscosity increased by 19 to 52% compared with that of sample B (reduced-fat control). The average calorie values of samples substituted with sweeteners were about 43% lower than that of original sample. Low-calorie frozen yogurt samples melted about 33 to 48% slower than the reduced-fat control sample at 45 min. Based on quantitative descriptive profile test results, statistically significant differences among products were observed for hardness, iciness, foamy melting, whey separation, and sweetness characteristics. The results of principal component analysis showed that the sensory properties of the sample containing 6.5% inulin and 6.5% isomalt were similar to those of control. Lactic acid bacteria counts of frozen yogurt were found to be between 8.12 and 8.49 log values, 3 mo after the production. The overall results showed that it is possible to produce an attractive frozen yogurt product with the incorporation of inulin and isomalt with no added sugar and reduced fat. PMID:21426952

  6. Frozen soil barriers for hazardous waste confinement

    SciTech Connect

    Dash, J.G.; Leger, R.; Fu, H.Y.

    1997-12-31

    Laboratory and full field measurements have demonstrated the effectiveness of artificial ground freezing for the containment of subsurface hazardous and radioactive wastes. Bench tests and a field demonstration have shown that cryogenic barriers are impenetrable to aqueous and non aqueous liquids. As a result of the successful tests the US Department of Energy has designated frozen ground barriers as one of its top ten remediation technologies.

  7. Making Thin Laminae Of Frozen Alloy Slurries

    NASA Technical Reports Server (NTRS)

    Ghosh, A. K.; Holmes, L. M.; Houston, R. B.; Ecer, G. M.

    1992-01-01

    In new technique, primary objective to develop method to distribute uniformly-thin powder-metal-alloy layers between alternate fiber layers prior to consolidation. Involves use of sheets of frozen alloy powder. These laminae, interspersed with fiber mats, used to make metal/fiber composites. In addition to aerospace applications, this technique, appropriately modified, has potential in the manufacture of future automobile engines or components including molded ceramics.

  8. Existence of frozen-in coordinate systems

    NASA Technical Reports Server (NTRS)

    Chertkov, A. D.

    1995-01-01

    The 'frozen-in' coordinate systems were first introduced in the works on 'reconnection' and 'magnetic barrier' theories (see review by M.l.Pudovkin and V.S.Semenov, Space Sci. Rev. 41,1 1985). The idea was to utilize the mathematical apparatus developed for 'general relativity' theory to simplify obtaining solutions to the ideal MHD equations set. Magnetic field (B), plasma velocity (v), and their vector product were used as coordinate vectors. But there exist no stationary solutions of ideal MHD set that satisfies the required boundary conditions at infinity (A.D.Chertkov, Solar Wind Seven Conf.,Pergamon Press,1992,165) having non-zero vector product of v and B where v and B originate from the same sphere. The existence of a solution is the hidden mine of the mentioned theories. The solution is constructed in the coordinate system, which is unknown and indeterminate before obtaining this solution. A substitution of the final solution must be done directly into the initial MHD set in order to check the method. One can demonstrate that 'solutions' of Petschek's problem, obtained by 'frozen-in' coordinate systems, does not satisfy just the 'frozen-in' equation, i.e. induction equation. It stems from the fact that Petschek's 're-connection' model, treated as a boundary problem, is over determined. This problem was incorrectly formulated.

  9. Rapid detection of irradiated frozen hamburgers

    NASA Astrophysics Data System (ADS)

    Delincée, Henry

    2002-03-01

    DNA comet assay can be employed as a rapid and inexpensive screening test to check whether frozen ground beef patties (hamburgers) have been irradiated as a means to increase their safety by eliminating pathogenic bacteria, e.g. E. coli O157:H7. Such a detection procedure will provide an additional check on compliance with existing regulations, e.g. enforcement of labelling and rules in international trade. Frozen ready prepared hamburgers from the market place were `electron irradiated' with doses of 0, 1.3, 2.7, 4.5 and 7.2kGy covering the range of potential commercial irradiation. DNA fragmentation in the hamburgers was made visible within a few hours using the comet assay, and non-irradiated hamburgers could be easily discerned from the irradiated ones. Even after 9 months of frozen storage, irradiated hamburgers could be identified. Since DNA fragmentation may also occur with other food processes (e.g. temperature abuse), positive screening tests shall be confirmed using a validated method to specifically prove an irradiation treatment, e.g. EN 1784 or EN 1785.

  10. VISCOUS ENERGY DISSIPATION IN FROZEN CRYOGENS

    SciTech Connect

    Meitner, S. J.; Pfotenhauer, J. M.; Andraschko, M. R.

    2008-03-16

    ITER is an international research and development project with the goal of demonstrating the feasibility of fusion power. The fuel for the ITER plasma is injected in the form of frozen deuterium pellets; the current injector design includes a batch extruder, cooled by liquid helium. A more advanced fuel system will produce deuterium pellets continuously using a twin-screw extruder, cooled by a cryocooler. One of the critical design parameters for the advanced system is the friction associated with the shearing planes of the frozen deuterium in the extruder; the friction determines the required screw torque as well as the cryocooler heat load.An experiment has been designed to measure the energy dissipation associated with shearing frozen deuterium. Deuterium gas is cooled to its freezing point in the gap between a stationary outer canister and a rotating inner cylinder. The dissipation is measured mechanically and through calorimetric means. The experiment has also been used to measure dissipation in other cryogens, such as neon, as a function of rotational velocity and temperature. This paper describes the design and construction of the experiment and presents measurements over a range of cryogens and test conditions.

  11. A healthy patient with bilateral frozen hips preceding bilateral frozen shoulders: a cautionary tale.

    PubMed

    Miller, Abigail R; Arnot, Dean; Wake, Melissa

    2015-01-01

    Adhesive capsulitis of the shoulder (frozen shoulder) is a common disease characterised by spontaneous onset of pain and restriction of movement, followed by 'thawing', with complete or near-complete resolution. Adhesive capsulitis of the hip has been reported in around a dozen patients. This report describes an otherwise-healthy middle-aged woman with apparent sequential resolving adhesive capsulitis of all four ball-and-socket joints over a 9-year period, initially affecting each hip and then each shoulder sequentially. The likely hip diagnosis became clear only retrospectively with development of the second frozen shoulder, 5 years after the first pain. All joints subsequently resolved within the expected timeframe and the patient remains healthy, other than having mild hypertension. This case illustrates that, when hip precedes shoulder involvement, there is the potential for the frozen hip to receive alternate diagnoses for which invasive open hip surgery could unnecessarily be recommended. PMID:26564111

  12. A Comparison of Raman Spectral Features of Frozen and Deparaffinized Tissues in Neuroblastoma and Ganglioneuroma

    NASA Astrophysics Data System (ADS)

    Devpura, Suneetha; Thakur, Jagdish S.; Poulik, Janet M.; Rabah, Raja; Naik, Vaman M.; Naik, Ratna

    2012-02-01

    We have investigated the cellular regions in neuroblastoma and ganglioneuroma using Raman spectroscopy and compared their spectral characteristics with those of normal adrenal gland. Thin sections from both frozen and deparaffinized tissues, obtained from the same tissue specimen, were studied in conjunction with the pathological examination of the tissues. We found a significant difference in the spectral features of frozen sections of normal adrenal gland, neuroblastoma, and ganglioneuroma when compared to deparaffinized tissues. The quantitative analysis of the Raman data using chemometric methods of principal component analysis and discriminant function analysis obtained from the frozen tissues show a sensitivity and specificity of 100% each. The biochemical identification based on the spectral differences shows that the normal adrenal gland tissues have higher levels of carotenoids, lipids, and cholesterol compared to the neuroblastoma and ganglioneuroma frozen tissues. However, deparaffinized tissues show complete removal of these biochemicals in adrenal tissues. This study demonstrates that Raman spectroscopy combined with chemometric methods can successfully distinguish neuroblastoma and ganglioneuroma at cellular level.

  13. Evaluating Enhancements to a Perioperative Nurse Liaison Program.

    PubMed

    Hanson-Heath, Cathy Ann; Muller, Linda M; Cunningham, Maureen F

    2016-04-01

    The impetus for the perioperative nurse liaison (PNL) program at our cancer center was to reduce anxiety for family members of patients undergoing surgery by improving communication between the family and the perioperative team. The purpose of our quality improvement project was to increase contact with family members during the patient's surgery and to support families and surgeons during the postoperative family consult when findings were unexpected. After implementing process changes, the PNLs evaluated the program using a short survey given to families after the postoperative consult. Families reported a reduction in stress and anxiety when intraoperative updates were received either in person or by telephone. In addition, when the PNL accompanied family members to the postoperative consult, the family felt supported when receiving unexpected findings. Further, family contact with the PNL increased from 77% to 98%, and the number of consults with surgeons that included the PNL rose from an average of 254 to 500 per year. PMID:27004504

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

    PubMed

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

    2015-08-01

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

  15. Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

    PubMed Central

    Shamoun, Fadi; Obeid, Hiba; Ramakrishna, Harish

    2015-01-01

    Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring. Both United States and European Guidelines recommend NOACs for stroke prevention in patients with atrial fibrillation. This review discusses each of the NOACs, along with their efficacy and safety data. It explores the most recent guidelines regarding their perioperative use in atrial fibrillation patients. It also discusses bleeding complications, perioperative management, and reversal agents. PMID:26221593

  16. Technological advances in perioperative monitoring: Current concepts and clinical perspectives

    PubMed Central

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any. PMID:25788767

  17. Inhaled therapy for the management of perioperative pulmonary hypertension

    PubMed Central

    Thunberg, C. A.; Morozowich, S. T.; Ramakrishna, Harish

    2015-01-01

    Patients with pulmonary hypertension (PH) are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP). Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO), has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil), NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite), and phosphodiesterase inhibitors (milrinone, sildenafil) may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators. PMID:26139748

  18. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030

  19. Peri-operative warming devices: performance and clinical application.

    PubMed

    John, M; Ford, J; Harper, M

    2014-06-01

    Since the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment. PMID:24720346

  20. [Peri-operative atelectasis and alveolar recruitment manoeuvres].

    PubMed

    Rama-Maceiras, Pablo

    2010-06-01

    Respiratory complications are a significant cause of post-operative morbidity and mortality. Peri-operative atelectasis, in particular, affects 90% of surgical patients and its effects can be prolonged, due to changes in respiratory mechanics, pulmonary circulation and hypoxaemia. Alveolar collapse is caused by certain predisposing factors, mainly by compression and absorption mechanisms. To prevent or treat these atelectasis several therapeutic strategies have been proposed, such as alveolar recruitment manoeuvres, which has become popular in the last few years. Its application in patients with alveolar collapse, but without a previous significant acute lung lesion, has some special features, therefore its use is not free of uncertainties and complications. This review describes the frequency, pathophysiology, importance and treatment of peri-operative atelectasis. Special attention is paid to treatment with recruitment manoeuvres, with the purpose of providing a basis for the their rational and appropriate use. PMID:19959274

  1. Using YouTube in perioperative nursing education.

    PubMed

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material. PMID:22464620

  2. Intravenous sub-anesthetic ketamine for perioperative analgesia

    PubMed Central

    Gorlin, Andrew W; Rosenfeld, David M; Ramakrishna, Harish

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain. PMID:27275042

  3. Perioperative Complications After Living Kidney Donation: A National Study.

    PubMed

    Lentine, K L; Lam, N N; Axelrod, D; Schnitzler, M A; Garg, A X; Xiao, H; Dzebisashvili, N; Schold, J D; Brennan, D C; Randall, H; King, E A; Segev, D L

    2016-06-01

    We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors. PMID:26700551

  4. A Comprehensive Evaluation of Perioperative Adjuncts During Minimally Invasive Parathyroidectomy

    PubMed Central

    Chen, Herbert; Mack, Eberhard; Starling, James R.

    2005-01-01

    Objective: To determine the utility of several perioperative adjuncts for parathyroid localization during parathyroid surgery, we prospectively compared the accuracy of sestamibi–single photon emission computed tomography (SPECT) scanning, radioguided surgery, and intraoperative parathyroid hormone (ioPTH) testing. Summary and Background Data: Minimally invasive parathyroidectomy (MIP) is rapidly becoming the procedure of choice in patients with primary hyperparathyroidism (HPT). Several perioperative adjuncts can be used to localize parathyroid adenomas, including sestamibi-SPECT scanning, radioguided surgery, and ioPTH testing. However, the relative value of each of these technologies is unclear. Methods: Between March 2001 through September 2004, 254 patients with primary HPT underwent parathyroidectomy. All patients had preoperative imaging studies and underwent radioguided surgery with a gamma probe and ioPTH testing. The use of each perioperative adjunct was determined based on the intraoperative findings. Results: The mean age of patients was 61 ± 1 year. The mean calcium and parathyroid hormone levels were 11.4 ± 0.1 mg/dL and 136 ± 6 pg/mL, respectively. Of the 254 patients, 206 (81%) had a single parathyroid adenoma, 28 (11%) had double adenomas, 19 (8%) had hyperplasia, and one had parathyroid cancer. All resected parathyroid glands were hypercellular (mean weight = 895 ± 86 mg). The cure rate after parathyroidectomy was 98%. The positive predictive values for sestamibi scanning, radioguided surgery, and ioPTH testing were 81%, 88%, and 99.5%, respectively. Conclusions: This series is one of the largest to date that prospectively compares the use of sestamibi scanning, radioguided surgery, and ioPTH testing. Of all the perioperative adjuncts used during parathyroid surgery, ioPTH testing has the highest sensitivity, positive predictive value, and accuracy. Thus, the inherent variability of sestamibi scanning and radioguided techniques emphasizes

  5. Perioperative fluid administration: historical highlights and implications for practice.

    PubMed

    Srinivasa, Sanket; Hill, Andrew G

    2012-12-01

    Perioperative fluid administration is an important aspect of surgical care but is often poorly understood. Surgeons have historically made a considerable contribution to the evidence base governing current practice. This review provides an overview of the history of perioperative fluid therapy and its relevance to modern practice.Intravenous fluids (IVF) first gained therapeutic importance in the treatment of cholera in the 1830s. From the 1880s, IVF began to be administered perioperatively to compensate for the "injurious" effects of anaesthesia. Clinical improvements were consequently noted, though the adverse effects of saline were observed. The work of Ringer, Hartmann, and others emphasized the importance of the composition of IVF and laid the foundations for the balanced solutions in use today.The intravenous "drip" was introduced by Rudolph Matas in 1924. As the metabolic response to injury was increasingly investigated in the 1940s and 1950s, the cause of post-operative oliguria was debated widely with the most prominent surgeons being Moore and Shires. These differences in opinion, coupled with reports of injured soldiers from the Korean War receiving large IVF infusions and surviving, dictated the surgical practice of liberal IVF administration until very recently.Newer work in fluid therapy has explored the concept of fluid restriction. Shoemaker and colleagues also pioneered the concept of fluid administration to achieve supranormal indices of cardiorespiratory function, which has led to the advent of goal-directed fluid therapy. Alongside the development of balanced solutions, the renewed focus on perioperative fluid therapy has led to IVF administration being guided by physiological principles with a new consideration of the lessons gleaned from history. PMID:22824855

  6. Perioperative normothermia during major surgery: is it important?

    PubMed

    Esnaola, Nestor F; Cole, David J

    2011-01-01

    PH caused by anesthesia-induced thermoregulatory inhibition and exposure to cold operating room environments still occurs in a significant proportion of patients undergoing major surgery. Although the association between specific perioperative temperatures (in and of themselves) and postoperative morbidity remains unclear, there is fair evidence to suggest that perioperative active warming may reduce the risk of postoperative cardiac events, bleeding, and SSIs. As such, proactive efforts by surgical teams to prevent PH are warranted and have become the standard of care at many institutions. Continued intraoperative monitoring of core temperature (ideally using esophageal probes) is recommended in all cases lasting more than 30 minutes, both to detect malignant hyperthermia and to maintain normothermia. Preoperative and/or intraoperative use of warmed forced-air devices is an effective way to minimize redistribution hypothermia following induction, whereas intraoperative use of warmed i.v. fluids helps reduce the potential for fluid-induced hypothermia and, in turn, optimizes rates of perioperative normothermia. PMID:21954692

  7. Managing a chronic pain patient in the perioperative period.

    PubMed

    Kopf, Andreas

    2013-12-01

    The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303836

  8. Perioperative transoesophageal echocardiography: current status and future directions.

    PubMed

    Mahmood, Feroze; Shernan, Stanton Keith

    2016-08-01

    Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions. Additionally, 3D imaging has facilitated the advent of minimally invasive and percutaneous interventions for structural heart disease. Information derived from TEE is routinely used to evaluate a patient's suitability for an intervention, provide guidance during the intervention and eventually comment on the quality and success of the procedure. Expertise in perioperative TEE is an integral component of a cardiac anaesthesiologist's skill sets. With structural heart disease interventions becoming more minimally invasive, the intraoperative guidance provided by TEE will continue to be a critical component of these procedures. With improving computational and processing power, the expectations from TEE will continue to be incremental in the perioperative arena. PMID:27048769

  9. The effects of information technology on perioperative nursing.

    PubMed

    Sweeney, Paula

    2010-11-01

    Numerous advances in technology during the past decade require that nurses not only be knowledgeable in nursing science but that they also become educated in information technology (IT). Perioperative IT has the potential to improve the quality of health care, reduce costs, decrease medication administration errors, reduce time spent on paperwork, increase management efficacy, and allow affordable access to health care. Nursing knowledge is needed for designing, implementing, and updating software, including an electronic health record (EHR). With the support of EHR data, nurses will be able to develop best practices for patient care and support research for evidence-based practice. When a standardized terminology, such as the Perioperative Nursing Data Set, is incorporated into an EHR, consistent documentation can be shared among systems. With advances in technology, perioperative nursing roles are expanding in relation to IT requirements and nurses are pursuing additional education. In addition to traditional methods, e-learning is an effective way to provide ongoing technological education. PMID:21040817

  10. Update on perioperative management of the child with asthma

    PubMed Central

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-01-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child. PMID:22802997

  11. Perioperative corticosteroid reduces hospital stay after fronto-orbital advancement.

    PubMed

    Clune, James E; Greene, Arin K; Guo, Chao-Yu; Gao, Lin Lin; Kim, Sendia; Meara, John G; Proctor, Mark R; Mulliken, John B; Rogers, Gary F

    2010-03-01

    Facial swelling is common after fronto-orbital advancement. Edema and closure of the palpebral fissures can lead to prolonged hospitalization. The purpose of this study was to determine if perioperative corticosteroid shortens hospital stay after this procedure.We retrospectively studied consecutive children younger than 2 years who underwent primary fronto-orbital advancement between 1990 and 2008. Patients were categorized into 2 groups: group 1 patients were not given corticosteroid; group 2 patients received tapered perioperative dexamethasone. Primary outcome variables included length of hospital stay and infection rate.A total of 161 patients were included in the study. Hospitalization was significantly shorter (P = 0.008) for group 2 (n = 65; median duration, 3.0 d) than group 1 (n = 96; median duration, 5.0 d). Infection rates did not differ between groups (group 1, 2.1%; group 2, 1.5%; P = 0.8).Perioperative corticosteroid shortens hospitalization after fronto-orbital advancement without increasing the incidence of postoperative infection. The cost of postoperative hospital care was reduced by 27.2%. PMID:20186083

  12. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    PubMed

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users. PMID:27195633

  13. [The hygiene of refrigerated and frozen foods].

    PubMed

    Sinell, H J

    1989-04-01

    Health and spoilage hazards arising from refrigerated and deep frozen foods may be due to - raw materials, e.g. pathogenic microorganisms which come from infected living animals or contaminate raw foods during handling. Psychrotrophic organisms have particular significance as pathogens or spoilage organisms as they can multiply also during refrigeration; - improper processing. Temperature abuse and incorrect time/temperature relations are main causes for microorganisms being not destroyed at the expected rate or even getting a chance of multiplying. Proper handling after refrigeration or frozen storage of foods ("hygiene of thawing") deserves also particular attention. - contamination, i.e. initial contamination of raw products which are ready for consumption without further processing (fruits, raw salads). Recontamination which follows a heat process is much more important and occurs before, during and after application of cold. In those cases, again, one has to distinguish between products which (a) are ready for consumption without a process (bakery and confectionary goods, ice cream, drinking milk) and (b) have to pass a process which reduces the bacterial load before consuming the food (ready to eat dishes or other foods ready for reheating in the home). Sites of increased hygienic hazard are a) lack of partitioning "clean" and "unclean" areas and processes, b) defects of sanitation and hygiene of personnel, c) defects of packaging, d) leakage during aseptic filling. Hazards are controlled through product and plant specific analysis of the process flow followed by continuous monitoring the "Critical Control Points". As an example, a report is given on a study on random samples taken from 180.000 prepackaged deep frozen menus which had been produced for a mass meeting. Microbiological monitoring of the process revealed time/temperature relations as critical control points of primary importance. Particular problems arose from any stoppage at the production line

  14. Frozen shoulder and other shoulder disturbances in Parkinson's disease.

    PubMed

    Riley, D; Lang, A E; Blair, R D; Birnbaum, A; Reid, B

    1989-01-01

    The frequency of shoulder disturbances, particularly frozen shoulder, has not been assessed previously in Parkinson's disease. In a survey of 150 patients compared with 60 matched control subjects a significantly higher incidence of both a history of shoulder complaints (43% vs. 23%) and frozen shoulder (12.7% vs. 1.7%) was found in the Parkinson's disease population. Those developing a frozen shoulder had initial disease symptoms indicative of akinesia twice as frequently as tremor while the ratio was reversed in those without frozen shoulder. In at least 8% of the patients frozen shoulder was the first symptom of disease, occurring 0-2 years prior to the onset of more commonly recognised features. Parkinson's disease should be added to the list of causes of frozen shoulder, and clinicians must be aware that the latter is often the presenting symptom of Parkinson's disease. PMID:2709037

  15. Perioperative Hemostatic Management in Ehlers-Danlos Syndrome: A Report of 2 Cases and Literature Review.

    PubMed

    Lindsay, Holly; Lee-Kim, YoungNa J; Srivaths, Lakshmi V

    2016-03-01

    Ehlers-Danlos syndrome (EDS) is associated with easy bruising and bleeding complications in the majority. Although bleeding complications are frequently observed during surgery in these patients, the perioperative hemostatic prophylaxis of patients with EDS is not standardized. We present 2 cases of effective perioperative hemostatic management of patients with EDS and review the literature to raise awareness of hemostatic issues during surgery and discuss medical options to consider for perioperative hemostatic management based on our clinical experience and literature review. PMID:26334432

  16. Comparison of frozen and freeze-dried particulate bone allografts.

    PubMed

    Malinin, Theodore; Temple, H Thomas

    2007-10-01

    Freeze-dried and frozen particulate bone allografts are used interchangeably on the assumption that the biologic behavior of these grafts is similar. Dissimilarities in biologic behavior and differences in the rate and extent of bone incorporation of freeze-dried and frozen particulate grafts were demonstrated in a comparative study using a non-human primate model. Freeze-dried particulate allografts induced new bone formation and healing of the osseous defects much faster than the frozen allografts. PMID:17658506

  17. Partnerships and new learning models to create the future perioperative nursing workforce.

    PubMed

    Gregory, Sabrina; Bolling, Deborah R; Langston, Nancy F

    2014-01-01

    To create new and sustainable approaches for development of the perioperative nursing workforce, perioperative nursing leaders at a hospital collaborated with administrators and faculty at a school of nursing to create an innovative learning model that reintroduces perioperative experiences to students in a nursing baccalaureate program. Key components of the initial approaches included an externship for nursing students and a revised internship for experienced nurses who wished to work in perioperative nursing. Project leaders then expanded the nursing student learning opportunity by adding two additional elective perioperative courses to the curriculum. Formation of perioperative clinical placement sites within the senior-level adult acute care course was an additional positive outcome of these initial initiatives. These initiatives resulted in decreased use of agency nurses at the clinical site where the externships take place and increased numbers of younger nurses working in the perioperative areas where they externed, with high levels of satisfaction reported by nurses involved in the program. Through this innovative collaboration, the perioperative nurse shortage at the hospital has abated, and the opportunity to continually recruit new colleagues into the practice of perioperative nursing has been established. PMID:24369975

  18. Study on radiation preservation of frozen egg liquid

    NASA Astrophysics Data System (ADS)

    Fengmei, Li; Yongbao, Gu; Dianhua, Chen

    2000-03-01

    In this paper the preservation process of γ-irradiated frozen egg liquid has been studied. It shows that the proper absorbed dose is 2 kGy and there is no significant difference in nutrient components, vitamins content between the irradiated frozen egg liquid and the control. A study of a diet including γ-irradiated frozen egg liquid was carried out with 58 volunteers who, during a 70-day test, indicated that the frozen egg liquid exposed to radiation is hygienic and safe.

  19. Frozen spin targets in ribosomal structure research.

    PubMed

    Stuhrmann, H B

    1991-01-01

    Polarized neutron scattering strongly depends on nuclear spin polarisation, particularly on proton spin polarisation. A single proton in a deuterated environment then is as efficient as 10 electrons in X-ray anomalous diffraction. Neutron scattering from the nuclear spin label is controlled by the polarisation of neutron spins and nuclear spins. Pure deuteron spin labels and proton spin labels are created by NMR saturation. We report on results obtained from the large subunit of E. coli ribosomes which have been obtained at the research reactor of GKSS using the polarized target facility developed by CERN. The nuclear spins were oriented with respect to an external field by dynamic nuclear polarisation. Proton spin polarisations of more than 80% were obtained in ribosomes at temperatures below 0.5 K. At T = 130 mK the relaxation time of the polarized target is one month (frozen spin target). Polarized small-angle neutron scattering of the in situ structure of rRNA and the total ribosomal protein (TP) has been determined from the frozen spin targets of the large ribosomal subunit, which has been deuterated in the TP and rRNA respectively. The results agree with those from neutron scattering in H2O/D2O mixtures obtained at room temperature. This is a necessary prerequisite for the planned determination of the in situ structure of individual ribosomal proteins and especially of that of ribosome bound mRNA and tRNAs. PMID:1720669

  20. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release.

    PubMed

    Arce, Guillermo

    2015-12-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  1. Frozen Chemistry Effects on Nozzle Performance Simulations

    NASA Technical Reports Server (NTRS)

    Yoder, Dennis A.; Georgiadis, Nicholas J.; O'Gara, Michael R.

    2009-01-01

    Simulations of exhaust nozzle flows are typically conducted assuming the gas is calorically perfect, and typically modeled as air. However the gas inside a real nozzle is generally composed of combustion products whose thermodynamic properties may differ. In this study, the effect of gas model assumption on exhaust nozzle simulations is examined. The three methods considered model the nozzle exhaust gas as calorically perfect air, a calorically perfect exhaust gas mixture, and a frozen exhaust gas mixture. In the latter case the individual non-reacting species are tracked and modeled as a gas which is only thermally perfect. Performance parameters such as mass flow rate, gross thrust, and thrust coefficient are compared as are mean flow and turbulence profiles in the jet plume region. Nozzles which operate at low temperatures or have low subsonic exit Mach numbers experience relatively minor temperature variations inside the nozzle, and may be modeled as a calorically perfect gas. In those which operate at the opposite extreme conditions, variations in the thermodynamic properties can lead to different expansion behavior within the nozzle. Modeling these cases as a perfect exhaust gas flow rather than air captures much of the flow features of the frozen chemistry simulations. Use of the exhaust gas reduces the nozzle mass flow rate, but has little effect on the gross thrust. When reporting nozzle thrust coefficient results, however, it is important to use the appropriate gas model assumptions to compute the ideal exit velocity. Otherwise the values obtained may be an overly optimistic estimate of nozzle performance.

  2. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

    PubMed Central

    Arce, Guillermo

    2015-01-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  3. Stability of Frozen Orbits Around Europa

    NASA Astrophysics Data System (ADS)

    Cardoso Dos Santos, Josué; Vilhena de Moraes, R.; Carvalho, J. S.

    2013-05-01

    Abstract (2,250 Maximum Characters): A planetary satellite of interest at the present moment for the scientific community is Europa, one of the four largest moons of Jupiter. There are some missions planned to visit Europa in the next years, for example, Jupiter Europa Orbiter (JEO, NASA) and Jupiter IcyMoon Explorer (JUICE, ESA). In this work we are formulating theories and constructing computer programs to be used in the design of aerospace tasks as regards the stability of artificial satellite orbits around planetary satellites. The studies are related to translational motion of orbits around planetary satellites considering polygenic perturbations due to forces, such as the nonspherical shape of the central body and the perturbation of the third body. The equations of motion will be developed in closed form to avoid expansions in eccentricity and inclination. For a description of canonical formalism are used the Delaunay canonical variables. The canonical set of equations, which are nonlinear differential equations, will be used to study the stability of orbits around Europa. We will use a simplified dynamic model, which considers the effects caused by non-uniform distribution of mass of Europa (J2, J3 and C22) and the gravitational attraction of Jupiter. Emphasis will be given to the case of frozen orbits, defined as having almost constant values of eccentricity, inclination, and argument of pericentre. An approach will be used to search for frozen orbits around planetary satellites and study their stability by applying a process of normalization of Hamiltonian. Acknowledges: FAPESP

  4. Application of manure to frozen ground in Ohio

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Six small watersheds (approximately 1 ha each) at the USDA-ARS North Appalachian Experimental Watershed research station near Coshocton, Ohio were used to evaluate the environmental impacts of applying manure to frozen ground. On frozen, snow-covered ground in February, two watersheds received turk...

  5. 129Xe spin relaxation in frozen xenon

    NASA Astrophysics Data System (ADS)

    Fitzgerald, R. J.; Gatzke, M.; Fox, David C.; Cates, G. D.; Happer, W.

    1999-04-01

    We discuss the longitudinal spin relaxation of 129Xe nuclei in frozen xenon. Over a large range of temperatures and magnetic fields, the dominant spin-lattice relaxation mechanism is shown to be nuclear spin-flip Raman scattering of lattice phonons. Two closely related interactions couple the lattice phonons to the spins of 129Xe nuclei: (1) the nuclear spin-rotation interaction between nearest-neighbor atoms, and (2) the paramagnetic antishielding of the externally applied field at the site of 129Xe nuclei by the electrons of neighboring Xe atoms. We show that relaxation rates can be predicted by using measured chemical shifts of gaseous and condensed xenon. The predicted relaxation rates are in good agreement with measurements. We outline a simple way to estimate the spin-rotation coupling and paramagnetic antishielding in terms of the small perturbations of the outermost electron orbitals of one xenon atom due to a neighboring atom.

  6. Modular self-dispensing frozen confectionary maker

    SciTech Connect

    Brown, L.

    1988-04-12

    A self-dispensing frozen confectionary maker is described comprising: (a) a container defining a mixing chamber with an open end, the container having a hollow chamber at least partially filled with a freezable solution; (b) a coupling means rotatably mounted in the container; (c) means for driving the coupling means to rotate in either of first and second directions, the second direction being opposite to the first direction; (d) means for displacing a fluid in the mixing chamber, the fluid-displacing means being arranged in the mixing chamber and rotatably coupled to the coupling means; (e) cover means for securely covering the open end, the cover means having outlet means incorporated therein; and (f) means for supporting the container in first and second positions, wherein the fluid-displacing means has an axis of rotation which is generally vertical when the container is in the first position and generally horizontal when the container is in the second position.

  7. Perioperative physiotherapy in patients undergoing lung cancer resection.

    PubMed

    Rodriguez-Larrad, Ana; Lascurain-Aguirrebena, Ion; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2014-08-01

    Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in

  8. Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting.

    PubMed

    Ghadimi, Kamrouz; Levy, Jerrold H; Welsby, Ian J

    2016-05-01

    Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagulants, the effect is balanced against thromboembolic risk. The latter is dependent on both the dose of PCCs and the individual patient prothrombotic predisposition. PCCs are approved by the US Food and Drug Administration for the reversal of vitamin K antagonists in the setting of coagulopathy or bleeding and, therefore, can be administered when urgent surgery is required in patients taking warfarin. However, there is growing experience with the off-label use of PCCs to treat patients with surgical coagulopathic bleeding. Despite their increasing use, there are limited prospective data related to the safety, efficacy, and dosing of PCCs for this indication. PCC administration in the perioperative setting may be tailored to the individual patient based on the laboratory and clinical variables, including point-of-care coagulation testing, to balance hemostatic benefits while minimizing the prothrombotic risk. Importantly, in patients with perioperative bleeding, other considerations should include treating additional sources of coagulopathy such as hypofibrinogenemia, thrombocytopenia, and platelet disorders or surgical sources of bleeding. Thromboembolic risk from excessive PCC dosing may be present well into the postoperative period after hemostasis is achieved owing to the relatively long half-life of prothrombin (factor II, 60-72 hours). The integration of PCCs into comprehensive perioperative coagulation treatment algorithms for refractory bleeding is increasingly reported, but further studies are needed to better evaluate the safe and effective administration of these factor concentrates. PMID:26983050

  9. Frozen Ground Controls on Hydrological Processes

    NASA Astrophysics Data System (ADS)

    Hinzman, L. D.; Kane, D. L.; Woo, M. K.

    2015-12-01

    Frozen ground establishes a unique discipline of hydrologic science where the hydrologic regime is intimately coupled with the thermal regime to the extent that one may not be completely understood without correct characterization of the other. In permafrost regions, material properties may change drastically on a scale of centimeters to meters, particularly in the vertical dimension due to distinct changes in soil and thermal characteristics. Properties may vary just as dramatically in the horizontal dimension across the boundary of discontinuous permafrost. Although the spatial extent of permafrost changes on relatively slow time scales in response to disturbance or a changing climate, this too introduces an added level of complexity. Permafrost may nearly eliminate the interactions between near-surface and sub-permafrost aquifers, which in essence defines the hydrologic response of every watershed that is directly influenced by permafrost. Even though the principles governing water movement in permafrost areas are the same as those in more temperate regions, interactions of extremes in climate and the land surface characteristics render permafrost hydrology different from the hydrology of temperate latitudes. Ice-rich permafrost prevents deep percolation of rainfall or snowmelt water, often maintaining a moist to saturated active layer above the permafrost table. Most hydrologic activities are confined above-ground or in the thin active layer, which supplies summer moisture for baseflow and/or plant transpiration. Limited storage capacity of the thawed active layer does not support extended baseflow in a stream, though the proportion of baseflow increases as the percentage of permafrost extent decreases. In areas where permafrost is discontinuous or where it has thawed substantially near the surface, local hydrology may display a markedly different character as there are stronger exchanges between the surface water and the ground water system, or water may drain

  10. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy

    PubMed Central

    Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-01-01

    Introduction Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. Material and methods One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. Results The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Conclusions Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy. PMID:26848296

  11. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology.

    PubMed

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre; Santullano, Cesar Aldecoa Alvarez; De Robertis, Edoardo; Filipescu, Daniela C; Fries, Dietmar; Görlinger, Klaus; Haas, Thorsten; Imberger, Georgina; Jacob, Matthias; Lancé, Marcus; Llau, Juan; Mallett, Sue; Meier, Jens; Rahe-Meyer, Niels; Samama, Charles Marc; Smith, Andrew; Solomon, Cristina; Van der Linden, Philippe; Wikkelsø, Anne Juul; Wouters, Patrick; Wyffels, Piet

    2013-06-01

    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and

  12. Perioperative management of pediatric patients on mechanical cardiac support.

    PubMed

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  13. Perioperative Smartphone Apps and Devices for Patient-Centered Care.

    PubMed

    Simpao, Allan F; Lingappan, Arul M; Ahumada, Luis M; Rehman, Mohamed A; Gálvez, Jorge A

    2015-09-01

    Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future. PMID:26265239

  14. Perioperative Anaphylactic Risk Score For Risk-Oriented Premedication

    PubMed Central

    Manfredi, Giacomo; Pezzuto, F.; Balestrini, A.; Lo Schiavo, M.; Montera, M.C.; Pio, A.; Iannelli, M.; Gargano, D.; Bianchi, M.J.; Casale, G.; Galimberti, M.; Triggiani, M.; Piazza, O.

    Basing on the current knowledge, this paper is aimed to review the core characteristics of the most relevant therapeutic agents (steroids and antihistamines), administered to prevent perioperative anaphylaxis. Moreover, the Authors propose the validation of a Global Anaphylactic Risk Score, built up by recording the individual scores related to the most relevant anaphylaxis parameters (i.e. medical history, symptoms and medication for asthma, rhinitis and urticaria etc) and by adding them on all together; the score could be used in the preoperative phase to evaluate the global anaphylactic risk and to prescribe risk-oriented premedication protocols. PMID:24251246

  15. Adult perioperative echocardiography: anatomy, mechanisms and effective communication.

    PubMed

    Michelena, Hector I; Suri, Rakesh M; Malouf, Joseph; Enriquez-Sarano, Maurice; Mankad, Sunil V

    2014-01-01

    Intra-operative transesophageal echocardiography (TEE) is a mature imaging technique which represents the premier surgical quality control instrument in the contemporary operating room. In adult cardiac surgery, management of valvular heart disease and related structural cardiac abnormalities derive the most benefit from perioperative echocardiography which includes pre-operative transthoracic echocardiography, intra-operative TEE and post-surgical echocardiographic surveillance. This review discusses the theoretical background upon which these imaging techniques are built-on, and offers a practical state-of-the-art guide on their application, emphasizing the importance of anatomic relationships, mechanisms of dysfunction and effective communication with our surgeons. PMID:25081403

  16. Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting.

    PubMed

    Viswanath, Omar; Simpao, Allan F; Santhosh, Sushmitha

    2015-08-15

    We present the case of an asymptomatic 82-year-old patient with no coronary artery disease and a negative cardiac workup who presented to the hospital for an elective total knee replacement. The patient had stable vital signs in the preanesthesia holding unit, yet the anesthesiologist recognized new-onset atrial fibrillation on the patient's monitor. The dysrhythmia was confirmed with a 12-lead electrocardiogram. The procedure was canceled, and the patient was sent for additional evaluation. An echocardiogram revealed a pulmonary embolism. This case report illustrates the need for a questioning attitude and diligent monitoring in all phases of perioperative care. PMID:26275306

  17. Hot Climate and Perioperative Outcome in Trauma Patients

    PubMed Central

    Gupta, Bhawna; Katyal, Sunil; Gautam, Nikhil

    2016-01-01

    Introduction Extreme hot climatic conditions constitute a major public health threat. Recent studies have shown higher rate of perioperative complications during hot weather. Although a lot of researches have been carried out to evaluate effect of hot climatic conditions and its correlation with other medical conditions, but very little has been studied in trauma patients. Aim To evaluate the impact of hot climatic conditions on perioperative morbidity in trauma patients. Materials and Methods We enrolled 100 trauma patients scheduled for surgery after approval by the Hospital and University Ethical Committee. Patients were grouped as Control Group (C) when outdoor temperature ranged in comfortable zone i.e., 20-290C and Study Group (S) when outdoor temperature ranged 400C or more. Patients living in regular air conditioned atmosphere (more than 18 hours per day) and with co-morbid conditions or on drugs interfering with temperature regulation were excluded. Student’s t-test, z-test and chi-square tests were used for statistical analysis. Results Both groups were comparable in terms of demographics, age (control group C=38.2±12.93 years and in group S= 40.14 ± 15.98 years), sex, socioeconomic status and type of surgery. Mean Trauma Index Score (TIS) were 6.20±1.56 and 5.80±1.31 respectively. All patients were of low risk as per Shoe Maker’s risk criteria. Post Anaesthesia Care Unit (PACU) stay was similar. Mean duration of hospital stay was 12.16 ± 8.50 days in group C and 10.98 ± 6.90 days in group S (p-value 0.21). 20% patients in group C whereas 54% in group S had complications (p= 0.009). There was a higher incidence of infections as well as respiratory distress in group S. On multiple logistic regression analysis peak environmental temperature was found to be the single independent risk factor for predicting perioperative morbidity. Conclusion High ambient temperature adversely affects the outcome of surgery even in low risk young trauma patients

  18. PERIOPERATIVE CARE OF A CHILD WITH CRISPONI SYNDROME.

    PubMed

    Rafiq, Mahmood; Almasry, Shadi; Abdulrahman, Anas; Al-Sohabani, Mazen; Tobias, Joseph D

    2016-06-01

    Crisponi syndrome is an autosomal recessive disorder characterized by intermittent episodes of muscular contraction of the facial muscles with trismus and excessive salivation simulating a tetanic spasm. These episodes occur in response to tactile stimulation or during crying. Associated physical and constitutional findings include characteristic facial anomalies, camptodactyly, intermittent hyperthermia, and feeding difficulties. We present a 15-month-old girl who required anesthetic care during laparoscopic fundoplication and gastric tube insertion. The perioperative implications of the disorder are reviewed and suggestions for anesthetic management provided. PMID:27487643

  19. Legal, professional and ethical considerations of advanced perioperative practice.

    PubMed

    Quick, Julie

    2010-05-01

    Advances within the NHS have recognised nurses in roles that go beyond the historical parameters of their initial training and role characteristics (DH 1999, DH 2000). Working within such a role creates added responsibilities of advancing practice and the continuing development of knowledge and skills. Nurses working at a higher level of practice will require an understanding of not only the professional and legal implications that new roles create, but also an awareness of the ethical dilemmas that will undoubtedly become increasingly complex (Bartter 2002). This article examines the professional, legal and ethical implications of advanced perioperative practice through the author's role as a surgical care practitioner (SCP). PMID:20521577

  20. Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma

    PubMed Central

    Erdoğan, Mehmet Ali; Uçar, Muharrem; Özkan, Ahmet Selim; Özgül, Ülkü; Durmuş, Mahmut

    2016-01-01

    Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma. PMID:27366556

  1. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    PubMed

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. PMID:25829458

  2. Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

    PubMed

    Harless, Megan; Depp, Caleb; Collins, Shawn; Hewer, Ian

    2015-06-01

    Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia. PMID:26137757

  3. Integrating Perioperative Content in Nursing Curricula: A Case Study Approach.

    PubMed

    Byrne, Michelle; Root, Susan; Culbertson, Laurie

    2016-06-01

    Perioperative nursing care requires unique specialty knowledge, skills, and abilities. National initiatives in nursing education and health care support integrating perioperative nursing content into curricular offerings in nursing schools and health care institutions. We provide an overview of the initiatives affecting nursing education, followed by a case study example and a guide to assist educators with incorporating perioperative case studies into their education plans. These resources may enhance the integration of perioperative nursing concepts in undergraduate curricula, internships, and continuing education offerings. The purpose of this article is to provide resources for nurse educators to systematically create case studies and to encourage increased exposure to perioperative concepts and competencies in a myriad of educational environments. PMID:27234794

  4. 78 FR 18958 - Certain Frozen Warmwater Shrimp From the People's Republic of China and Diamond Sawblades and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-28

    ...On March 22, 2013, the U.S. Trade Representative (``USTR'') instructed the Department of Commerce (``Department'') to implement its determinations under section 129 of the Uruguay Round Agreements Act (``URAA'') regarding the antidumping investigations of certain frozen warmwater shrimp (``shrimp'') from the People's Republic of China (`PRC'') and diamond sawblades and parts thereof......

  5. Clinical decision support for perioperative information management systems.

    PubMed

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered. PMID:23690340

  6. Perioperative management of patients with lung carcinoma and cerebral metastases

    PubMed Central

    Gheorghita, Eva; Pruna, Viorel Mihai; Neagoe, Luminita; Bucur, Cristina; Cristescu, Catioara; Gorgan, Mircea Radu

    2010-01-01

    ABSTRACT Objective: The present study proposes to present the importance of perioperative therapeutic management in survival prolongation and the quality of life for patients that have undergone surgery for cerebral metastases secondary to pulmonary tumors. Method: During 2001-2009, 40 patients with ages between 43-74 years have been diagnosed in our clinic with pulmonary tumor and cerebral metastases. The patients presented single cerebral lesion (excepting one patient with 2 cerebral metastases) and pulmonary tumor. Intracranial pressure (ICP) was high in all cases. All patients have undergone operation with general anesthesia. Results:For all patients the reduction of ICP and keeping an optimal CPP (cerebral perfusion pressure) was pursued. In 38 cases, general anesthesia was performed with Sevoflurane and opioids (fentanyl, remifentanyl, sufentanyl) and in 2 cases the TIVA (total intravenous anesthesia) technique was used with propofol and remifentanyl. 14 of the patients required intraoperative depletive treatment through administering mannitol 20%. 37 patients (92%) have been discharged with improved neurological condition without showing signs of intracranial hypertension, convulsive seizures and with partially or totally remitted hemiparesis and one patient had worse postoperative neurological status. Conclusion:Pulmonary tumor with cerebral metastases represent an important cause for death rate. To solve secondary cerebral lesions, the perioperative management must include assesment and choosing an anesthesia technique with a proper intraoperative management. PMID:21977115

  7. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D

    2016-08-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  8. Myocardial ischemia--association with perioperative cardiac morbidity.

    PubMed Central

    Cunningham, A. J.

    1993-01-01

    The development of ambulatory electrocardiographic recorders and analysers and the application of transesophageal echocardiography in the mid-1980's enabled investigators to quantify and describe the occurrence of silent as well as symptomatic ischemia in the perioperative period. Several technical advances which have recently occurred in ECG monitoring include the use of miniaturized digital computing equipment to store and analyze data. In addition, real time ST-segment analysis has become widely available on multicomponent monitors in both the operating room and intensive care units. The incidence of perioperative myocardial ischemia depends on the patient population, the surgical procedure, and the monitoring technique used. Several studies in the early 1990's have shown that cardiac morbidity in patients undergoing major, noncardiac surgery is best predicted by postoperative myocardial ischemia, rather than tradition preoperative clinical predictors. Long duration postoperative ischemia may be the factor most significantly associated with adverse cardiac outcome. Postoperative pain, physiological and emotional stress may all combine to cause tachycardia, hypertension, increase in cardiac output, and fluid shifts which, in high risk patients, might result in subendocardial ischemia and eventual myocardial infarction. If postoperative myocardial ischemia is the cause of late postoperative myocardial infarction in patients undergoing non-cardiac surgery, then treatment of postoperative myocardial ischemia should reduce morbidity. In addition, reducing pain and stress and avoiding postoperative hypoxemia might prevent postoperative myocardial ischemia and minimize the need for extensive preoperative cardiac evaluation. PMID:7825338

  9. Differences in Perioperative Outcomes Between Right and Left Hepatic Lobectomy.

    PubMed

    Douaiher, Jeffrey; Dhir, Mashaal; Smith, Lynette; Are, Chandrakanth

    2016-03-01

    The safety of hepatic resection is well documented, but outcome studies comparing right and left hepatic lobectomy are sparse, especially in the context of malignancy. This study analyzes the differences in outcomes between right and left hepatic lobectomy in patients with malignant diagnoses. All patients undergoing right and left hepatic lobectomies for malignancy were extracted from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). The data was analyzed to determine differences in perioperative mortality and morbidity between the two groups. A total of 1680 patients who underwent right or left hepatic lobectomy for malignant diagnoses were identified. Patients undergoing right hepatic lobectomy had a four-fold increase in perioperative mortality, compared to left lobectomy (p < 0.0001). Mortality in right lobectomy patients increased incrementally with age, with a 12-fold increase in patients > 81 years of age. Patients undergoing right lobectomy also experienced a statistically significant increase in morbidity involving several systems (infectious, pulmonary, cardiac and renal). The results of our study demonstrate that patients undergoing right hepatic lobectomy for malignancy experience a significantly higher incidence of mortality and multi-system morbidity when compared to left lobectomy. This information will be crucial for pre-operative risk-stratification of patients undergoing hepatic resection for malignancy. PMID:27065681

  10. An Overview of Perioperative Care for Pediatric Patients.

    PubMed

    Derieg, Sarah

    2016-07-01

    Care of pediatric surgical patients is not limited to pediatric facilities, and all perioperative RNs should have a basic understanding of the specialized care that children require. This knowledge set includes an understanding of the basic terminology used to describe this patient population as well as the developmental stages of pediatric patients. Preoperatively, the nurse should conduct a thorough assessment and evaluation and address the anxieties and questions of the patient and his or her parent or guardian. Intraoperatively, the nurse should be prepared to help manage difficult intubation, laryngospasm during induction and extubation, difficult IV access, positioning, skin care, surgical site preparation, and thermoregulation. Postoperative care considerations include addressing airway differences, vital signs, pain assessment and management, fluid management, and preparation for discharge. Awareness of the anatomic and physiologic differences, developmental stages, and surgical needs of children will allow the perioperative RN to provide high-quality, safe care to the pediatric surgical patient. PMID:27350350

  11. Peri-operative cardiac protection for non-cardiac surgery.

    PubMed

    Wong, S S C; Irwin, M G

    2016-01-01

    Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically. PMID:26620144

  12. [Perioperative management of adult patients with obstructive sleep apnea].

    PubMed

    Rösslein, Martin

    2015-03-01

    Obstructive sleep apnea (OSA) is a common sleep related breathing disorder with an increasing prevalence. Most surgical patients with OSA have not been diagnosed prior to surgery and are at an increased risk of developing perioperative complications. Preoperative identification of these patients is important in order to take appropriate measures concerning a safe perioperative management. While the level of scientific evidence for single measures is still low, several steps seem prudent: Preoperatively, sedating medications should only be applied with extreme caution. Anesthetic management should focus on regional anesthetic techniques and reduction of systemic opioids. In the case of general anesthesia, an increased risk of a patient presenting with a difficult airway should be appreciated. The extent and duration of postoperative continuous monitoring has to be determined on an individual basis. A preoperatively existing therapy with continuous positive airway pressure should be continued postoperatively as soon as possible. Patients with OSA may be managed on an outpatient basis if certain requirements are met. PMID:25850644

  13. Angioedema: Classification, management and emerging therapies for the perioperative physician.

    PubMed

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-08-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  14. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perioperative considerations.

    PubMed

    Yang, Weiping; Tao, Zongyuan; Chen, Hao; Li, Qinyu; Chu, Peiguo G; Yen, Yun; Qiu, Weihua

    2009-01-01

    The presence of a vermiform appendix in an inguinal hernia sac is termed as Amyand's hernia. Although rare, mistakes in diagnosis and treatment can cause catastrophic results. Charts of patients with inguinal hernia were reviewed, and four cases of Amyand's hernia were confirmed. The clinical presentation, anesthetic, and perioperative management of Amyand's hernia were further analyzed. The mean age of patients was over 70 years, and all were males. None of the patients were diagnosed preoperatively. All the patients had little abdominal complaint only with a right inguinal mass and dragging sensation for several hours. Due to the short time after incarceration and significant cardiovascular and pulmonary comorbidities, manual reduction was attempted first in three patients. With complete preoperative evaluation and careful perioperative support, all patients underwent appendectomy and Bassini's hernia repair through a groin incision. Based on age-related organ failure and associated chronic medical illnesses of geriatric patients, the difficulties in the diagnosis and treatment are also summarized and analyzed. PMID:20001812

  15. Angioedema: Classification, management and emerging therapies for the perioperative physician

    PubMed Central

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-01-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  16. Multimodal analgesia for perioperative pain in three cats.

    PubMed

    Steagall, Paulo V M; Monteiro-Steagall, Beatriz P

    2013-08-01

    Adequate pain relief is usually achieved with the simultaneous use of two or more different classes of analgesics, often called multimodal analgesia. The purpose of this article is to highlight the use of perioperative multimodal analgesia and the need to individualize the treatment plan based on the presenting condition, and to adjust it based on the response to analgesia for a given patient. This case series presents the alleviation of acute pain in three cats undergoing different major surgical procedures. These cases involved the administration of different classes of analgesic drugs, including opioids, non-steroidal anti-inflammatory drugs, tramadol, ketamine, gabapentin and local anesthetics. The rationale for the administration of analgesic drugs is discussed herein. Each case presented a particular challenge owing to the different cause, severity, duration and location of pain. Pain management is a challenging, but essential, component of feline practice: multimodal analgesia may minimize stress while controlling acute perioperative pain. Individual response to therapy is a key component of pain relief in cats. PMID:23382595

  17. Perioperative pain management in hip arthroscopy; what options are there?

    PubMed Central

    Bech, N. H.; Hulst, A. H.; Spuijbroek, J. A.; van Leuken, L. L. A.; Haverkamp, D.

    2016-01-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  18. Radiation inactivation of foodborne pathogens on frozen seafood products.

    PubMed

    Sommers, Christopher H; Rajkowski, Kathleen T

    2011-04-01

    Foodborne illness due to consumption of contaminated seafood is, unfortunately, a regular occurrence in the United States. Ionizing (gamma) radiation can effectively inactivate microorganisms and extend the shelf life of seafood. In this study, the ability of gamma irradiation to inactivate foodborne pathogens surface inoculated onto frozen seafood (scallops, lobster meat, blue crab, swordfish, octopus, and squid) was investigated. The radiation D(10)-values (the radiation dose needed to inactivate 1 log unit of a microorganism) for Listeria monocytogenes, Staphylococcus aureus, and Salmonella inoculated onto seafood samples that were then frozen and irradiated in the frozen state (-20°C) were 0.43 to 0.66, 0.48 to 0.71, and 0.47 to 0.70 kGy, respectively. In contrast, the radiation D(10)-value for the same pathogens suspended on frozen pork were 1.26, 0.98, and 1.18 kGy for L. monocytogenes, S. aureus, and Salmonella, respectively. The radiation dose needed to inactivate these foodborne pathogens on frozen seafood is significantly lower than that for frozen meat or frozen vegetables. PMID:21477481

  19. [Adaptability of sweet corn ears to a frozen process].

    PubMed

    Ramírez Matheus, Alejandra O; Martínez, Norelkys Maribel; de Bertorelli, Ligia O; De Venanzi, Frank

    2004-12-01

    The effects of frozen condition on the quality of three sweet corn ears (2038, 2010, 2004) and the pattern (Bonanza), were evaluated. Biometrics characteristics like ear size, ear diameter, row and kernel deep were measured as well as chemical and physical measurement in fresh and frozen states. The corn ears were frozen at -95 degrees C by 7 minutes. The yield and stability of the frozen ears were evaluated at 45 and 90 days of frozen storage (-18 degrees C). The average commercial yield as frozen corn ear for all the hybrids was 54.2%. The industry has a similar value range of 48% to 54%. The ear size average was 21.57 cm, row number was 15, ear diameter 45.54 mm and the kernel corn deep was 8.57 mm. All these measurements were found not different from commercial values found for the industry. All corn samples evaluated showed good stability despites the frozen processing and storage. Hybrid 2038 ranked higher in quality. PMID:15969270

  20. Cool-down and frozen start-up behavior of a grooved water heat pipe

    SciTech Connect

    Jang, J.H.

    1990-12-01

    A grooved water heat pipe was tested to study its characteristics during the cool-down and start-up periods. The water heat pipe was cooled down from the ambient temperature to below the freezing temperature of water. During the cool-down, isothermal conditions were maintained at the evaporator and adiabatic sections until the working fluid was frozen. When water was frozen along the entire heat pipe, the heat pipe was rendered inactive. The start-up of the heat pipe from this state was investigated under several different operating conditions. The results show the existence of large temperature gradients between the evaporator and the condenser, and the moving of the melting front of the working fluid along the heat pipe. Successful start-up was achieved for some test cases using partial gravity assist. The start-up behavior depended largely on the operating conditions.

  1. Cool-down and frozen start-up behavior of a grooved water heat pipe

    NASA Technical Reports Server (NTRS)

    Jang, Jong Hoon

    1990-01-01

    A grooved water heat pipe was tested to study its characteristics during the cool-down and start-up periods. The water heat pipe was cooled down from the ambient temperature to below the freezing temperature of water. During the cool-down, isothermal conditions were maintained at the evaporator and adiabatic sections until the working fluid was frozen. When water was frozen along the entire heat pipe, the heat pipe was rendered inactive. The start-up of the heat pipe from this state was studied under several different operating conditions. The results show the existence of large temperature gradients between the evaporator and the condenser, and the moving of the melting front of the working fluid along the heat pipe. Successful start-up was achieved for some test cases using partial gravity assist. The start-up behavior depended largely on the operating conditions.

  2. A novel experiment for measuring infiltration into seasonal frozen soil

    NASA Astrophysics Data System (ADS)

    Demand, Dominic; Weiler, Markus

    2016-04-01

    Large parts of the northern hemisphere have at least seasonal frozen soils. Depending on the initial soil water content infiltration capacity can be reduced through pore blockage of ice. Many studies dealing with this topic used numerical modelling for estimating the effect of frozen soils on infiltration. Only a few studies investigated the influences of seasonal frozen soils on infiltration and runoff generation in field experiments. Some authors point out that preferential flow can be an important factor under frozen conditions, but only qualitative information are available so far. A missing methodology makes it hard to measure and quantify infiltration into frozen soils, especially the role of preferential flow. Therefore, a novel multi-method approach for measuring the influences of seasonal frozen soil on infiltration is presented. Sprinkling experiments with a rate of 50 mm/h were performed at frozen soil plots under wet and dry initial conditions in a grassland field site in the Black Forest, Germany. Additionally, two different water temperatures were used for the sprinkling experiments (~2°C and ~10°C). Thermal infrared imagery was tested for continuous, in-situ monitoring of the spatiotemporal soil thermal state during infiltration and the possibility to derive information on water flow. A dye tracer (Brilliant Blue FCF) was added to the infiltrating water and analyzed by image analysis for flow patterns and depth distribution. Thermal infrared imagery and dye tracer were used for the first time in field experiments in frozen soils and were tested for their potential to show the effect of preferential flow under frozen conditions. These information were related to observed soil moisture and temperature profiles measured with capacitance probes in five depths. Furthermore timing and amount of surface runoff was examined for all plots. Brilliant Blue flow patterns and surface runoff were compared against unfrozen soils with similar initial conditions

  3. Current capabilities of ``HPTAM'' for modeling high-temperature heat pipes' startup from a frozen state

    NASA Astrophysics Data System (ADS)

    Tournier, Jean-Michel; El-Genk, Mohamed

    2002-01-01

    The Heat Pipe Transient Analysis Model ``HPTAM'' has been developed at the University of New Mexico's Institute for Space and Nuclear Power Studies for simulating the transient and steady state operation as well as the startup of alkali-metal and low-temperature heat pipes from a frozen state. This model has been subject to continuous upgrade and verification since the early nineties using experimental data for water, sodium, and lithium heat pipes. Some of the current capabilities of HPTAM include tracking: (a) the progression of the 2-D thaw front in the wick and the transition fronts separating the successive flow regimes (free-molecular, transition, and continuum) in the vapor core; (b) the liquid circulation in the wick and in the annular space that may be incorporated by design between the wick and the heat pipe wall; (c) the formation of the wet point at the wick-vapor interface and its progression toward the condenser; (d) the excess liquid volume resulting from the decrease in density of the working fluid upon thaw and heating up to the operating temperature, and its accumulation at the end of the condenser section; (e) the change in the local radius of curvature of the liquid meniscus in the surface pores of the wick and incipient dryout; (f) the sublimation of the frozen working fluid in the evaporator and resolidification in the adiabatic and condenser sections early during the startup from a frozen state; and (g) the changes in the local vapor velocity and the liquid velocity and temperature distributions. The simulation capabilities of HPTAM are reviewed and examples of the code verification results using experimental data for the startup of sodium and lithium heat pipes from a frozen state are presented and discussed. HPTAM employs a very stable and efficient numerical technique and may run at twice the real time on a 700-MHz PC. .

  4. Generating attenuation-resistant frozen waves in absorbing fluid.

    PubMed

    Dorrah, Ahmed H; Zamboni-Rached, Michel; Mojahedi, Mo

    2016-08-15

    We demonstrate a class of nondiffracting beams, called frozen waves, with a central spot that can be made to maintain a predefined intensity profile while propagating in an absorbing fluid. Frozen waves are composed of Bessel beams with different transverse and longitudinal wavenumbers, and are generated using a programmable spatial light modulator. The attenuation-resistant frozen waves demonstrated here address the problem of propagation losses in absorbing media. This development can be beneficial for many applications in particle micro-manipulation, data communications, remote sensing, and imaging. PMID:27519067

  5. Experiences with frozen blood products in the Netherlands military.

    PubMed

    Lelkens, C C M; Koning, J G; de Kort, B; Floot, I B G; Noorman, F

    2006-06-01

    For peacekeeping and peace enforcing missions abroad the Netherlands Armed Forces decided to use universal donor frozen blood products in addition to liquid products. This article describes our experiences with the frozen blood inventory, with special attention to quality control. It is shown that all thawed (washed) blood products are in compliance with international regulations and guidelines. By means of the -80 degrees C frozen stock of red cells, plasma and platelets readily available after thaw (and wash), we can now safely reduce shipments and abandon the backup 'walking' blood bank, without compromising the availability of blood products in theatre. PMID:16815757

  6. A ray of light about frozen embryos.

    PubMed

    Clayton, Ellen Wright

    1992-12-01

    The Tennessee Supreme Court's decision in Davis v. Davis, a case that raises the question of how to allocate frozen embryos in the event of divorce, addresses many of the legal issues posed by in vitro fertilization. The decision considers the interests of the progenitors as well as of the children who may result. For example, the court held that gamete providers' discretion regarding the disposition of embryos can be limited only when their decisions would harm the children who might be born. The court also made clear that efforts to seek genetic parenthood are protected only when accompanied by a desire to raise the resulting children, a conclusion that also affects other reproductive technologies. In addition to elaborating an analytic framework, the court set guidelines for resolving disputes when the couples had made no prior agreements, including holding that while the embryos are ex-utero the desire to avoid genetic parenthood almost always trumps the wish to become a parent. The well-reasoned analysis in Davis v. Davis should help shape legal and ethical discussion regarding the use of in vitro fertilization for many years to come. PMID:11645754

  7. Therapeutic surfactant-stripped frozen micelles

    NASA Astrophysics Data System (ADS)

    Zhang, Yumiao; Song, Wentao; Geng, Jumin; Chitgupi, Upendra; Unsal, Hande; Federizon, Jasmin; Rzayev, Javid; Sukumaran, Dinesh K.; Alexandridis, Paschalis; Lovell, Jonathan F.

    2016-05-01

    Injectable hydrophobic drugs are typically dissolved in surfactants and non-aqueous solvents which can induce negative side-effects. Alternatives like `top-down' fine milling of excipient-free injectable drug suspensions are not yet clinically viable and `bottom-up' self-assembled delivery systems usually substitute one solubilizing excipient for another, bringing new issues to consider. Here, we show that Pluronic (Poloxamer) block copolymers are amenable to low-temperature processing to strip away all free and loosely bound surfactant, leaving behind concentrated, kinetically frozen drug micelles containing minimal solubilizing excipient. This approach was validated for phylloquinone, cyclosporine, testosterone undecanoate, cabazitaxel and seven other bioactive molecules, achieving sizes between 45 and 160 nm and drug to solubilizer molar ratios 2-3 orders of magnitude higher than current formulations. Hypertonic saline or co-loaded cargo was found to prevent aggregation in some cases. Use of surfactant-stripped micelles avoided potential risks associated with other injectable formulations. Mechanistic insights are elucidated and therapeutic dose responses are demonstrated.

  8. Therapeutic surfactant-stripped frozen micelles

    PubMed Central

    Zhang, Yumiao; Song, Wentao; Geng, Jumin; Chitgupi, Upendra; Unsal, Hande; Federizon, Jasmin; Rzayev, Javid; Sukumaran, Dinesh K.; Alexandridis, Paschalis; Lovell, Jonathan F.

    2016-01-01

    Injectable hydrophobic drugs are typically dissolved in surfactants and non-aqueous solvents which can induce negative side-effects. Alternatives like ‘top-down' fine milling of excipient-free injectable drug suspensions are not yet clinically viable and ‘bottom-up' self-assembled delivery systems usually substitute one solubilizing excipient for another, bringing new issues to consider. Here, we show that Pluronic (Poloxamer) block copolymers are amenable to low-temperature processing to strip away all free and loosely bound surfactant, leaving behind concentrated, kinetically frozen drug micelles containing minimal solubilizing excipient. This approach was validated for phylloquinone, cyclosporine, testosterone undecanoate, cabazitaxel and seven other bioactive molecules, achieving sizes between 45 and 160 nm and drug to solubilizer molar ratios 2–3 orders of magnitude higher than current formulations. Hypertonic saline or co-loaded cargo was found to prevent aggregation in some cases. Use of surfactant-stripped micelles avoided potential risks associated with other injectable formulations. Mechanistic insights are elucidated and therapeutic dose responses are demonstrated. PMID:27193558

  9. Therapeutic surfactant-stripped frozen micelles.

    PubMed

    Zhang, Yumiao; Song, Wentao; Geng, Jumin; Chitgupi, Upendra; Unsal, Hande; Federizon, Jasmin; Rzayev, Javid; Sukumaran, Dinesh K; Alexandridis, Paschalis; Lovell, Jonathan F

    2016-01-01

    Injectable hydrophobic drugs are typically dissolved in surfactants and non-aqueous solvents which can induce negative side-effects. Alternatives like 'top-down' fine milling of excipient-free injectable drug suspensions are not yet clinically viable and 'bottom-up' self-assembled delivery systems usually substitute one solubilizing excipient for another, bringing new issues to consider. Here, we show that Pluronic (Poloxamer) block copolymers are amenable to low-temperature processing to strip away all free and loosely bound surfactant, leaving behind concentrated, kinetically frozen drug micelles containing minimal solubilizing excipient. This approach was validated for phylloquinone, cyclosporine, testosterone undecanoate, cabazitaxel and seven other bioactive molecules, achieving sizes between 45 and 160 nm and drug to solubilizer molar ratios 2-3 orders of magnitude higher than current formulations. Hypertonic saline or co-loaded cargo was found to prevent aggregation in some cases. Use of surfactant-stripped micelles avoided potential risks associated with other injectable formulations. Mechanistic insights are elucidated and therapeutic dose responses are demonstrated. PMID:27193558

  10. Effects of Guided Undergraduate Perioperative Education on Recruiting Novice RNs and Retaining Experienced RNs.

    PubMed

    Foran, Paula

    2015-09-01

    This qualitative research describes undergraduate nurses' perceptions of their perioperative placement experiences and how they may affect their future perioperative employment. It also describes experienced perioperative nurses' perceptions of the effect of student placement experiences on retention. The author asked undergraduate nurses about their experiences in the OR, if any, and whether they would consider perioperative nursing as a career; the author also asked experienced perioperative educators to comment on whether there are correlations between types of perioperative student experiences that affect stress levels for supervising staff members. The author used reporting of disconfirming data, and expert peers performed an external examination of data to guarantee the rigor of qualitative data analysis. The findings indicate that undergraduate nurses who are provided with guided practical experiences (as opposed to non-guided experiences or no OR experiences) are more likely to consider perioperative nursing as a career. In addition, the findings show that the arrival of students in the OR with no preparation for the experience is a major stressor for staff members. PMID:26323223

  11. A Primer on Population Health Management and Its Perioperative Application.

    PubMed

    Boudreaux, Arthur M; Vetter, Thomas R

    2016-07-01

    The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in

  12. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

    PubMed Central

    Douketis, James D.; Spyropoulos, Alex C.; Kaatz, Scott; Becker, Richard C.; Caprini, Joseph A.; Dunn, Andrew S.; Garcia, David A.; Jacobson, Alan; Jaffer, Amir K.; Kong, David F.; Schulman, Sam; Turpie, Alexander G.G.; Hasselblad, Vic; Ortel, Thomas L.

    2016-01-01

    BACKGROUND It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. RESULTS In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], −0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). CONCLUSIONS In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to

  13. View of the highway, approach to the Frozen Lake switchback ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, approach to the Frozen Lake switchback curve, looking east. Proposed realignment will shift the road slightly to the south (right) - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  14. View of the highway, from above the switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from above the switchbacks between Frozen Lake and Bar Drift, looking northeast, showing the retained alignment across the Beartooth Plateau - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  15. View of the highway, at the Frozen Lake switchback curve, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, at the Frozen Lake switchback curve, looking northwest. The proposed realignment would be just to the southeast (right) of the existing alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  16. View of the highway, from above the switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from above the switchbacks between Frozen Lake and Bar Drift, looking south, showing the setting and retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  17. View of the highway, lower west summit switchbacks between Frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, lower west summit switchbacks between Frozen Lake and Bar Drift, looking northwest, showing retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  18. View of the highway, from the switchbacks above Frozen Lake ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from the switchbacks above Frozen Lake (in midground), looking southwest, showing the general setting and retained switchback alignments - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  19. View of the highway, from just north of the frozen ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the highway, from just north of the frozen Lake switchback, looking northwest, showing the retained alignment - Beartooth Highway, Red Lodge, Montana to Cooke City, Montana, Cody, Park County, WY

  20. Herellea (Acinetobacter) and Pseudomonas ovalis (P. putida) from Frozen Foods

    PubMed Central

    Eller, Charles

    1969-01-01

    Seventeen strains of Herellea vaginicola (Acinetobacter antitratus) and 8 of Pseudomonas ovalis (P. putida), isolated from 23 (6.3%) of 364 samples of frozen, foil-pack foods, were identified and characterized morphologically and biochemically. Herellea was isolated from 17 foods (4.7%), P. ovalis from 6 (1.6%). No Mima were found. The food samples included precooked frozen meats, precooked and uncooked frozen vegetables, and uncooked frozen desserts. The bacteria were detected in the food with a procedure used generally for the detection of salmonellae. The pseudomonad simulated the characteristics of Herellea on Sellers differential agar, except for the fact that it fluoresced. From consideration of the habitat and pathogenicity of Herellea and Mima, it is concluded that, although the presence of these bacteria may not be desirable, their significance in food remains unanswered. PMID:4886860