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Sample records for abdominal surgical procedures

  1. Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes

    PubMed Central

    Cooper, Zara; Scott, John W.; Rosenthal, Ronnie A.; Mitchell, Susan L.

    2016-01-01

    OBJECTIVES To systematically review the current literature on mortality and functional outcomes after emergency major abdominal surgery in older adults. DESIGN Systematic literature search and standardized data collection of primary research publications from January 1994 through December 2013 on mortality or functional outcome in adults aged 65 and older after emergency major abdominal surgery using PubMed, EMBASE, Web of Science, Cochrane, and CINAHL. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies. SETTING Systematic review of retrospective and cohort studies using Preferred Reporting Items for Systematic reviews and Meta-Analyses, Meta-analysis Of Observational Studies in Epidemiology, Strengthening the Reporting of Observational Studies in Epidemiology, and A Measurement Tool to Assess Systematic Reviews guidelines. PARTICIPANTS Older adults. MEASUREMENTS Articles were assessed using a standardized quality scoring system based on study design, measurement of exposures, measurement of outcomes, and control for confounding. RESULTS Of 1,459 articles screened, 93 underwent full-text review, and 20 were systematically reviewed. In-hospital and 30-day mortality of all older adults exceeded 15% in 14 of 16 studies, where reported. Older adults undergoing emergency major abdominal surgery consistently had higher mortality across study settings and procedure types than younger individuals undergoing emergency procedures and older adults undergoing elective procedures. In studies that stratified older adults, odds of death increased with age. None of these studies examined postoperative functional status, which precluded including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using metaanalysis. CONCLUSION Age independently predicts mortality after emergency major abdominal surgery. Data on changes in

  2. Abdominal surgical emergencies in the puerperium.

    PubMed Central

    Munro, A; Jones, P F

    1975-01-01

    Since surgical emergencies in the puerperium are rare, surgeons and obstetricians amass little experience of them. There may be considerable delay in making a diagnosis, firstly, because the abdominal symptoms are thought to be related to the pregnancy, and, secondly, because the signs are rarely convincing in contrast to the symptoms. Any of the common surgical emergencies may occur in pregnancy and the puerperium and there are some others that appear to be a particullar problem of the puerperium. PMID:1203726

  3. [Surgical correction of infrarenal abdominal aorta aneurysms].

    PubMed

    Khamitov, F F; Matochkin, E A; Vertkina, N V; Kizyma, A G; Lisitskiĭ, D A

    2008-01-01

    The authors compare various surgical strategies of infrarenal abdominal aorta aneurysm (IAAA) repair based on the experience of the Department of Cardiovascular Surgery, Urban Clinical Hospital No.81. Total 198 patients underwent aneurysm resection and grafting through conventional (90) or minilaparotomy (108) approaches. Mini-approach was shown to improve significantly both perioperative course and outcomes of IAAA correction. The main advantage of this approach comprised limited invasiveness together with sufficient exposure of abdominal aorta and its branches. Abandoning small bowel evisceration helps to preserve ther-moregulation and achieve volemic homeostasis with less fluid volume. Postoperative period after surgical mini-approach was characterized by shorter period of mechanical ventilation and ICU stay, earlier restoration of bowel motility, conversion to usual nutrition, patient mobilization and discharge. Minimally invasive technology significantly broadens feasibility of radical aortic reconstructions for patients with serious cardio-vascular comorbidities.

  4. Abdominal wall closure after a stomal reversal procedure.

    PubMed

    López-Cano, Manuel; Pereira, José Antonio; Villanueva, Borja; Vallribera, Francesc; Espin, Eloy; Armengol Carrasco, Manuel; Arbós Vía, María Antonia; Feliu, Xavier; Morales-Conde, Salvador

    2014-01-01

    The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

  5. [Abdominal artery aneurysm and associated surgical abdominal diseases: towards optimal timing].

    PubMed

    Stilo, Francesco; Mirenda, Francesco; Mandolfino, Tommaso; La Spada, Michele; D'Alfonso, Mario; Carmignani, Amedeo; De Caridi, Giovanni; Benedetto, Filippo; Spinelli, Francesco

    2003-01-01

    The purpose of this study was to assess which modalities offered the best timing in the treatment of abdominal aortic aneurysms associated with other abdominal surgical diseases. From January 1984 to December 2002, 372 patients underwent surgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age 72 years. Of these 10% were operated on urgently. The traditional open technique was used in 307 patients, and the endovascular method in the remaining 65 cases. In 40 patients (11%) we observed other associated abdominal diseases which were treated during the same operation in 34 cases (85%). We had three deaths in the 34 cases treated in the same operation (9%). In the remaining cases no perioperative mortality was registered. There were no cases of prosthesis infection. The mean hospital stay was 9 days. Simultaneous treatment appears, on the one hand, to carry an increased operative risk and increased mortality and, on the other, to present the advantage of having to perform only one surgical procedure. The advent of the endovascular method allows us to postpone the treatment of the associated disease without increasing the technical difficulty of the second operation.

  6. Surgical procedures in pinniped and cetacean species.

    PubMed

    Higgins, Jennifer L; Hendrickson, Dean A

    2013-12-01

    Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment

  7. Aesthetic Surgical Crown Lengthening Procedure

    PubMed Central

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  8. Surgical management of abdominal compartment syndrome; indications and techniques

    PubMed Central

    Leppäniemi, Ari

    2009-01-01

    The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention. PMID:19366442

  9. Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)☆

    PubMed Central

    Mueller, E.R.; Kenton, K.; Tarney, C.; Brubaker, L.; Rosenman, A.; Smith, B.; Stroupe, K.; Bresee, C.; Pantuck, A.; Schulam, P.; Anger, J.T.

    2014-01-01

    Introduction Robotic assistance during laparoscopic surgery for pelvic organ prolapse rapidly disseminated across the United States without level I data to support its benefit over traditional open and laparoscopic approaches. This manuscript describes design and methodology of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS) Trial [1]. Methods ACCESS is a randomized comparative effectiveness trial enrolling patients at two academic teaching facilities, UCLA (Los Angeles, CA) and Loyola University (Chicago, IL). The primary aim is to compare costs of robotic assisted versus pure laparoscopic abdominal sacrocolpopexy (RASC vs LASC). Following a clinical decision for minimally-invasive abdominal sacrocolpopexy (ASC) and research consent, participants with symptomatic stage≥II pelvic organ prolapse are randomized to LASC or RASC on the day of surgery. Costs of care are based on each patient’s billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot and initial hospitalization and any re-hospitalization in the first 6 weeks are compared between groups. Secondary outcomes include post-operative pain, anatomic outcomes, symptom severity and quality of life, and adverse events. Power calculation determined that 32 women in each arm would provide 95% power to detect a $2500 difference in total charges, using a two-sided two sample t-test with a significance level of 0.05. Results Enrollment was completed in May 2011. The 12-month follow-up will end in May 2012. Conclusions This is a multi-center study to assess cost as a primary outcome in a comparative effectiveness trial of LASC versus RASC. PMID:22643040

  10. [Normal abdominal ultrasound anatomy. Examination procedure].

    PubMed

    Salcedo Joven, I; Segura Grau, A; Rodríguez Lorenzo, A; Segura Cabral, J M

    2014-01-01

    To carry out an abdominal ultrasound examination with the highest degree of accuracy and thoroughness, it is essential to have a good knowledge of the anatomy and the normal measurements of the different organs. In this way, we can determine their normal condition and identify the pathology and its location more easily. It is very important to adopt a correct examination procedure, systematically sweeping the scan in the same direction and not leaving any organ unexamined. We suggest a procedure consisting of longitudinal, cross-sectional and oblique scans to view all the abdominal organs, starting the examination in the epigastric region, scanning first the right upper quadrant, then the left upper quadrant, both iliac fossa, and lastly the hypogastric region.

  11. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.

    PubMed

    Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V

    2016-04-01

    Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.

  12. Augmented reality in surgical procedures

    NASA Astrophysics Data System (ADS)

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

    2008-02-01

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

  13. Surgical Procedures. Second Edition. Teacher Edition.

    ERIC Educational Resources Information Center

    Baker, Beverly; And Others

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

  14. [EXPERIENCE OF RELAPAROTOMY APPLICATION IN SURGICAL TREATMENT OF THE ABDOMINAL CAVITY ORGANS DISEASES].

    PubMed

    Malyk, S V; Podlesnyi, V I; Lavrenko, D O; Ksyonz, I V

    2015-10-01

    During 2011 - 2014 yrs in Surgical Clinic of The First City Clinic (Poltava) a relaparotomy was performed in 127 patients. There was established, that relaparotomy constitutes the only one procedure for such life threatening states, as intraabdominal bleeding, ileus in a decompensation stage, eventration, progressing peritonitis, abdominal compartment syndrome stages III - IV. The rate of relaparotomy application after performance of urgent operative interventions is bigger than after planned operations (ratio 4:1). Individual estimation of a state and choice of optimal surgical tactics during primary and secondary operative interventions are needed to improve the results of treatment.

  15. Surgical management of abdominal and retroperitoneal Castleman's disease

    PubMed Central

    Bucher, Pascal; Chassot, Gilles; Zufferey, Guillaume; Ris, Frederic; Huber, Olivier; Morel, Philippe

    2005-01-01

    Background Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form. Methods The authors report two cases of localized Castleman's disease in the retroperitoneal space and review the current and recent progress in the knowledge of this atypical disease. Cases presentation The two patients were young healthy women presenting with a hyper vascular peri-renal mass suggestive of malignant tumor. Both have been resected in-toto. One of them had an extensive resection with nephrectomy, while the second had a kidney preserving surgery. Pathological examination revealed localized Castleman's disease and surgical margins were free of disease. Postoperative course was uneventful, and after more than 5-years of follow-up no recurrences have been observed. Conclusion Localized Castleman's disease should be considered when facing a solid hypervascular abdominal or retroperitoneal mass. A better knowledge of this disorder and its characteristic would help surgeon to avoid unnecessarily extensive resection for this benign disorder when dealing with abdominal or retroperitoneal tumors. Surgical resection is curative for the localized form, when complete, while splenectomy could be indicated for the systemic form. PMID:15941478

  16. Small Mammals: Common Surgical Procedures of Rodents, Ferrets, Hedgehogs, and Sugar Gliders.

    PubMed

    Miwa, Yasutsugu; Sladky, Kurt K

    2016-01-01

    Small mammal surgical procedures are a part of clinical veterinary practice and are performed with regularity. Anesthetic and analgesic techniques are important components of any successful small mammal surgical procedure. Many basic surgical principles used in dogs and cats can be directly applied to small mammals, but tissues tend to be smaller and thinner, and hemostasis is critical with small patients due to risk of death with minimal blood loss. Common surgical procedures in small mammals include integumentary mass and abscess excision, reproductive procedures, gastrointestinal foreign body removal, urolith removal, prolapsed tissues associated with the gastrointestinal tract, intra-abdominal mass excision, and hepatic surgery.

  17. Abdominal trauma at the Southern Surgical Association, 1888-1987.

    PubMed Central

    Nance, F C

    1988-01-01

    Since 1888 98 papers have been presented to the Southern Surgical Association (SSA) dealing directly or indirectly with abdominal trauma. The papers reflect the progress over the century in the management of this injury. Almost two-thirds of the papers have originated from the major city hospitals of the south. An interest in abdominal trauma has been manifest among the officers of SSA. Twenty-two presidents have presented papers or taken part in discussions. Four 25-year eras were identified. In the earliest, exploration of abdominal wounds was firmly established as a principle. The second period was characterized by consolidation of principles and strengthening of supportive care. The third era encompassing World War II marked a nadir in productivity. In the last 25 years a reawakened interest has resulted in a marked increase in the number and quality of presentations, which have increasingly focused on specific organ injuries. Images Fig. 1. Fig. 2. Fig. 5. Fig. 6. Fig. 7. Fig. 8. PMID:3291795

  18. [Prevention of surgical site infection in abdominal surgery. A critical review of the evidence].

    PubMed

    Ruiz Tovar, Jaime; Badia, Josep M

    2014-04-01

    Surgical site infection (SSI) is associated with prolonged hospital stay, increased morbidity, mortality and sanitary costs, and reduced patients quality of life. Many hospitals have adopted guidelines of scientifically-validated processes for prevention of surgical site and central-line catheter infections and sepsis. Most of these guidelines have resulted in an improvement in postoperative results. A review of the best available evidence on these measures in abdominal surgery is presented. The best measures are: avoidance of hair removal from the surgical field, skin decontamination with alcoholic antiseptic, correct use of antibiotic prophylaxis (administration within 30-60 min before incision, use of 1(st) or 2(nd) generation cephalosporins, single preoperative dosis, dosage adjustments based on body weight and renal function, intraoperative re-dosing if the duration of the procedure exceeds 2 half-lives of the drug or there is excessive blood loss), prevention of hypothermia, control of perioperative glucose levels, avoid blood transfusion and restrict intraoperative liquid infusion.

  19. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

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

  20. Guidelines for surgical procedures after liver transplantation.

    PubMed Central

    Testa, G; Goldstein, R M; Toughanipour, A; Abbasoglu, O; Jeyarajah, R; Levy, M F; Husberg, B S; Gonwa, T A; Klintmalm, G B

    1998-01-01

    OBJECTIVE: The first purpose of this study is to identify the types and incidences of surgical procedures in patients who have previously undergone liver transplantation, with particular focus on the complication rates and the lengths of hospital stay. The second purpose is to present the management guidelines for patients with liver transplants at the preoperative, intraoperative, and postoperative stages of surgical procedure. SUMMARY BACKGROUND DATA: The surgical literature on this issue is scant, and with the growing liver transplant patient population it is not unlikey for any surgery specialist to have to operate on a patient who has undergone liver transplantation. METHODS: A sample of 409 patients with available hospital records, with a minimum of a 2-year follow-up, and with telephone access for interviews was chosen. Type of surgery, time from the liver transplant, hospital stay, immunosuppressive regimen, and complications were recorded. RESULTS: A large proportion of patients (24.2%) underwent some type of surgical procedure 2 to 10 years after liver transplantation. The authors demonstrate that most of the elective procedures can be safely carried out without an increased incidence of complication and without longer hospital stay than the general population. Conversely, emergent procedures are plagued by a greater incidence of complications that not only affect the function of the liver graft but may risk the life of the patient. PMID:9563551

  1. Peritoneal lavage and other diagnostic procedures in blunt abdominal trauma

    SciTech Connect

    Burney, R.E.

    1986-08-01

    Diagnostic procedures such as peritoneal lavage, computed tomography, emergency angiography, nuclear scintigraphy, and contrast studies of the gastrointestinal and urinary tracts can assist in the identification, quantification, and localization of injury after blunt abdominal trauma. Use of these procedures should be determined by careful clinically assessment as part of an aggressive approach to the diagnosis of the injured patient. 22 references.

  2. Immersive Learning Experiences for Surgical Procedures.

    PubMed

    Cha, Young-Woon; Dou, Mingsong; Chabra, Rohan; Menozzi, Federico; State, Andrei; Wallen, Eric; Fuchs, Henry

    2016-01-01

    This paper introduces a computer-based system that is designed to record a surgical procedure with multiple depth cameras and reconstruct in three dimensions the dynamic geometry of the actions and events that occur during the procedure. The resulting 3D-plus-time data takes the form of dynamic, textured geometry and can be immersively examined at a later time; equipped with a Virtual Reality headset such as Oculus Rift DK2, a user can walk around the reconstruction of the procedure room while controlling playback of the recorded surgical procedure with simple VCR-like controls (play, pause, rewind, fast forward). The reconstruction can be annotated in space and time to provide more information of the scene to users. We expect such a system to be useful in applications such as training of medical students and nurses.

  3. Surgical Procedures in Predoctoral Periodontics Programs.

    ERIC Educational Resources Information Center

    Radentz, William H.; Caffesse, Raul G.

    1991-01-01

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

  4. Major surgical complications from minor urological procedures.

    PubMed Central

    Eke, N.

    2000-01-01

    Some urological procedures are regarded as minor or simple. As a result, these may be delegated to trainee surgeons to do. Occasionally nonmedical persons embark on some of the procedures such as male circumcision. Published serious complications from urological procedures considered minor or simple were identified from a Medline search (1966 through 1999) and reference lists of relevant publications. The operations regarded as minor were carried out by medical personnel of all grades as well as by nonmedical persons. The complications can be classified as mutilatory, infective, hemorrhagic, or obstructive. Although the mutilatory complications affect mainly procedures on the penis, infective and hemorrhagic complications affect almost all the procedures. Tumor implantation has occurred along needle biopsy tracts. Although many of the complications are not related to technique or competence, a plea is made for the awareness of their occurrence to encourage preventive strategies. Adequate training of surgical personnel remains essential worldwide. PMID:10976176

  5. [Skeletal discrepancies: could we avoid surgical procedures?].

    PubMed

    Bouletreau, Pierre; Raberin, Monique; Mayeux, Jean-François

    2014-12-01

    Orthodontic-surgical protocols are nowadays considered as the state-of-the-art in cases of skeletal dentomaxillary dysmorphosis. However, for some reasons, it may happen that unquestionable indications for orthodontic-surgical procedures are not respected, patients being treated by orthodontics alone. This kind of mistake in the treatment planning lay the patient open to various potential complications such as: abnormal duration of the orthodontic treatment, dental root resorptions, questionable tooth extraction, unfavorable facial aesthetics, treatment instability... The authors discuss these points illustrated by clinical cases. Although orthognathic surgery protocols became considerably simplified these last two decades, orthodontic-surgical protocols are still relevantly considered as heavy both by patients and practitioners. As a consequence, their indication must be carefully weighed by a multidisciplinary team, keeping in mind that these protocols represent the ultimate functional and aesthetic treatment for dento-skeletal dysmorphoses.

  6. Surgical Procedures for Renal Artery Aneurysms

    PubMed Central

    Inoue, Yoshinori; Kudo, Toshifumi; Toyofuku, Takahiro

    2012-01-01

    Objective: The aim of this study was to assess the strategy and surgical procedures for treating a renal artery aneurysm (RAA). Patients and Methods: We retrospectively reviewed the surgical strategy for 21 cases with RAA between 2001 and 2010 at this institution. Treatment was indicated for patients with an RAA larger than 2 cm and/or symptoms. Surgical treatment was the initial strategy, and coil embolization was indicated in the case of narrow-necked, saccular, extraparenchymal aneurysms. Results: Fifteen patients in 21 cases received an aneurysmectomy and renal artery reconstruction with an in-situ repair. One patient underwent an unplanned nephrectomy, and coil embolization was performed in 5 patients. Conclusion: In-situ repair was safe and minimally invasive. RAA, even in the second bifurcation, could be exposed by a subcostal incision, and the transperitoneal approach permitted the safe treatment of an RAA with acceptable results, in our simple preservation of renal function. PMID:23555504

  7. Alterations in respiratory mechanics after laparoscopic and open surgical procedures

    PubMed Central

    Kimberley, Nicholas A.; Kirkpatrick, Susan M.; Watters, James M.

    1996-01-01

    Objective To compare the effects of laparoscopic and open surgical procedures on postoperative strength and respiratory mechanics. Design Prospective cohort study. Setting Adult university hospital. Participants Fifty-one women aged 21 to 62 years scheduled to undergo elective cholecystectomy or hysterectomy (or related procedures), otherwise in good health. Intervention Open or laparoscopic cholecystectomy or hysterectomy (or related procedures). Main Outcome Measures Maximum voluntary handgrip strength (HGS), forced vital capacity (VC), forced expiratory volume in 1 second (FEV1), and maximal inspiratory pressure (MIP) were each measured preoperatively and on the first postoperative morning. A visual analogue pain scale score was evaluated in relation to performance of the postoperative strength and respiratory measurements. Results VC, FEV1 and MIP, but not HGS, were decreased after surgery. Postoperative VC, FEV1 and MIP were lower after open procedures than after laparoscopic procedures and after cholecystectomy than after hysterectomy (all p < 0.001). Pain scores were lower after laparoscopic than after open procedures (p < 0.005) and could account in part for differences in postoperative respiratory mechanics. Conclusions Cholecystectomy and hysterectomy do not result in generalized muscle weakness, unlike more major abdominal procedures. Postoperative alterations in respiratory mechanics are related to the site of the surgery, the use of an open versus a laparoscopic approach and postoperative pain. PMID:8697322

  8. Fundamental Ethical Issues in Unnecessary Surgical Procedures.

    PubMed

    Tayade, Motilal Chandu; Dalvi, Shashank D

    2016-04-01

    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don't really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient's lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario.

  9. Wound infection after arterial surgical procedures.

    PubMed

    van Himbeeck, F J; van Knippenberg, L A; Niessen, M C; van Griethuysen, A J

    1992-09-01

    During the period October 1983 to March 1987, 603 patients who underwent arterial surgical procedures were studied to determine the incidence and treatment of wound infections. Bypass procedures were performed in 395 patients (65.5%), in which autogenous vein was used for 158 grafts (26%), synthetic Dacron for 216 grafts (36%), and umbilical vein for 21 grafts (3.5%). Thrombo-endarterectomies, embolectomies and patch-grafts were performed in 208 patients (34.5%). An Infection Control Nurse examined and registered the wounds. The definition of wound infection used in our study is equivalent to Szilagyi grade II infection. Vascular surgery is classified as clean surgery, the clean wound infection rate being a useful measurement to evaluate preventative measures and surgical technique. Thirty-one patients (5.1%) developed a wound infection as a postoperative complication. The overall incidence of wound complications including haematoma and seroma following arterial reconstruction was 13%. The site of wound infection was predominantly the groin. The most common pathogen was Staphylococcus aureus which was found in 17 patients (2.8%). All infections resolved without further surgical intervention. The influence of possible aetiological factors is considered and the importance of prophylactic antibiotics and good surgical technique is stressed.

  10. The challenge of evaluating surgical procedures.

    PubMed Central

    Stirrat, G. M.; Farrow, S. C.; Farndon, J.; Dwyer, N.

    1992-01-01

    All new interventions and procedures must be properly assessed in comparison to the currently accepted method(s). It is unethical not to do so. The optimum method is by Randomised Controlled Trial (RCT). This is ideally suited to the testing of drugs because the trial can usually be double blind and placebo controlled. RCTs are less commonly used for the evaluation of new surgical techniques. There are valid and invalid reasons for this and these are discussed. PMID:1567147

  11. Skin simulation for minor surgical procedures.

    PubMed

    Munro, A; Park, K G; Atkinson, D; Day, R P; Capperauld, I

    1994-06-01

    A simulated skin preparation is described which is made by bonding siliconized rubber to a latex foam base. This composite material, which simulates both the dermis/epidermis and subcutaneous fat, provides a realistic model which can be used to teach excision of skin lesions and a variety of suturing methods. We believe that this simulator is of value not only for surgeons in-training but also will allow general practitioners to improve their technical skills in performing minor surgical procedures.

  12. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.

    PubMed

    Sartelli, Massimo; Abu-Zidan, Fikri M; Ansaloni, Luca; Bala, Miklosh; Beltrán, Marcelo A; Biffl, Walter L; Catena, Fausto; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Demetrashvili, Zaza; Demetriades, Demetrios; Diaz, Jose J; Di Saverio, Salomone; Fraga, Gustavo P; Ghnnam, Wagih; Griffiths, Ewen A; Gupta, Sanjay; Hecker, Andreas; Karamarkovic, Aleksandar; Kong, Victor Y; Kafka-Ritsch, Reinhold; Kluger, Yoram; Latifi, Rifat; Leppaniemi, Ari; Lee, Jae Gil; McFarlane, Michael; Marwah, Sanjay; Moore, Frederick A; Ordonez, Carlos A; Pereira, Gerson Alves; Plaudis, Haralds; Shelat, Vishal G; Ulrych, Jan; Zachariah, Sanoop K; Zielinski, Martin D; Garcia, Maria Paula; Moore, Ernest E

    2015-01-01

    The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

  13. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a...

  14. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a...

  15. Two stage surgical procedure for root coverage.

    PubMed

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

    2012-07-01

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

  16. Fundamental Ethical Issues in Unnecessary Surgical Procedures

    PubMed Central

    Dalvi, Shashank D.

    2016-01-01

    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don’t really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient’s lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario. PMID:27190833

  17. Abdominal surgical site infections: a prospective study of determinant factors in Harare, Zimbabwe.

    PubMed

    Muchuweti, David; Jönsson, Kent U G

    2015-10-01

    Surgical site infections (SSIs) are reported in lower frequencies in the developed countries than in the developing world. A prospective evaluation of risk factors in 285 patients undergoing abdominal surgery procedures in Zimbabwe was therefore undertaken. Overall infection rate was 26%. The age group 30-39 years had the highest number of dirty wounds and the highest rate of human immunodeficiency virus (HIV) infection. Multivariate regression analysis showed a correlation between wound class and SSI (P < 0·05). This was also noted for American Society of Anesthesiologists (ASA) score (P < 0·05). HIV-infected patients had 52% SSIs and non-infected patients had 26% (P < 0·05). Patients receiving blood transfusion had 51% SSIs and those not transfused had 17% (P < 0·01). Patients receiving pre- and intra-operative prophylactic antibiotics had 18% SSIs and those receiving postoperative administration had 37% (P < 0·01). Treatment ranged from dressings only in 11% to surgical intervention in 30% resulting in prolongation of median hospital stay from 8 to 18 days (P < 0·001). Mortality was 7%. High wound class, high ASA score, blood transfusion, HIV infection and delayed use of prophylactic antibiotics were risk factors for SSIs, resulting in surgical interventions, prolonged hospital stay and mortality.

  18. Heart rate variability during abdominal surgical manipulation under general and epidural anesthesia.

    PubMed

    Hirata, Naoyuki; Miyashita, Ryo; Maruyama, Daisuke; Kawaguchi, Ryoichi; Shimizu, Hitoshi; Yamakage, Michiaki

    2012-12-01

    Anesthesiologists occasionally encounter bradycardia during abdominal surgery and recognize the phenomenon as a vagal reflex. The presence of bradycardia implies efferent vagal dominance in the autonomic nervous system during this vagal reflex. In this study, we investigated the effect of abdominal surgical manipulation on autonomic nervous activity, using heart rate variability analysis. Abdominal surgical manipulation decreased the heart rate and enhanced not only the high-frequency power (0.15-0.4 Hz) but also the low-frequency power (0.04-0.15 Hz) calculated from the power spectral density of heart rate variability. Our results suggest that both vagal tone and sympathetic tone could be activated during the vagal reflex caused by abdominal surgical manipulation.

  19. Costs of surgical procedures in Indian hospitals

    PubMed Central

    Chatterjee, Susmita; Laxminarayan, Ramanan

    2013-01-01

    Objective Despite a growing volume of surgical procedures in low-income and middle-income countries, the costs of these procedures are not well understood. We estimated the costs of 12 surgical procedures commonly conducted in five different types of hospitals in India from the provider perspective, using a microcosting method. Design Cost and utilisation data were collected retrospectively from April 2010 to March 2011 to avoid seasonal variability. Setting For this study, we chose five hospitals of different types: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed district hospital, a 655-bed private teaching hospital and a 778-bed tertiary care teaching hospital based on their willingness to cooperate and data accessibility. The hospitals were from four states in India. The private, charitable and tertiary care hospitals serve urban populations, the district hospital serves a semiurban area and the private teaching hospital serves a rural population. Results Costs of conducting lower section caesarean section ranged from rupees 2469 to 41 087; hysterectomy rupees 4124 to 57 622 and appendectomy rupees 2421 to 3616 (US$1=rupees 52). We computed the costs of conducting lap and open cholecystectomy (rupees 27 732 and 44 142, respectively); hernia repair (rupees 13 204); external fixation (rupees 8406); intestinal obstruction (rupees 6406); amputation (rupees 5158); coronary artery bypass graft (rupees 177 141); craniotomy (rupees 75 982) and functional endoscopic sinus surgery (rupees 53 398). Conclusions Estimated costs are roughly comparable with rates of reimbursement provided by the Rashtriya Swasthya Bima Yojana (RSBY)—India's government-financed health insurance scheme that covers 32.4 million poor families. Results from this type of study can be used to set and revise the reimbursement rates. PMID:23794591

  20. Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation.

    PubMed

    Taghavi, Sharven; Jayarajan, Senthil N; Mangi, Abeel A; Hollenbach, Kathryn; Dauer, Elizabeth; Sjoholm, Lars O; Pathak, Abhijit; Santora, Thomas A; Goldberg, Amy J; Rappold, Joseph F

    2015-01-01

    As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

  1. [Results of surgical treatment of postoperative abdominal hernia].

    PubMed

    Belokonev, V I; Pushkin, S Iu

    2000-09-01

    There were examined 525 patients with postoperative abdominal hernia, in 47.3% of them big, vast and giant hernia was revealed. There were operated 436 patients using local tissues with duplicature formation--according to Mayo, Sapezhko, Napalkov and Yanov method.

  2. [The symptoms and surgical tactics for complicated forms of the abdominal cavity tuberculosis].

    PubMed

    Kosul'nikov, S O; Kravchenko, K V; Tarnopol'skiĭ, S A; Besedin, A M

    2012-01-01

    The results of treatment of 12 patients, suffering complicated forms of abdominal tuberculosis and external intestinal fistulas, were presented. Late diagnosis of abdominal tuberculosis in the patients, suffering the complications phase of the disease, is caused by unclear symptoms presence in early stages of the disease. Clinical and laboratory indices in peritonitis of a phthisis origin are nonspeciphic. In 91% of patients, admitted to the hospital for complicated forms of abdominal tuberculosis and external intestinal fistulas, the operative treatment was indicated. Surgical intervention (more frequently right-sided hemicolectomy, enterostomy, the abscesses opening, the caseously-changed lymph nodes excision, formation of anastomosis) was performed in 11 patients for peritonitis and external intestinal fistulas. The method of a secure invagination anastomoses formation was elaborated, permitting to perform primary restoration operations. An early diagnosis, early effective therapy and radical surgical intervention conduction for complicated abdominal tuberculosis promote the patients to survive.

  3. Finishing procedures in orthodontic-surgical cases.

    PubMed

    Brunel, Jean-Michel

    2015-09-01

    To ensure optimal results, we must do our utmost to achieve targets based on order, symmetry and precision, our ultimate aim being to strive towards the desired harmony, planned contrast and exact proportions. Orthodontic-surgical treatments require specific finishing procedures, which most often call for multidisciplinary, or even transdisciplinary, collaboration. Finishing will involve the dental arches just as much as the orofacial environment. Above all, treatment of this kind demands a highly targeted approach in combination with well-defined and perfectly executed techniques. To finish a case satisfactorily, reasonable targets should be aimed for to ensure they are achieved. One must be ambitious and yet wise. A tight alliance of surgeon and orthodontist will nurture convincing and achievable projects and good, lifelong outcomes. Following the consolidation phase, roughly 4 to 6 weeks post-surgery, we can initiate the final orthodontic treatment, which, in effect, constitutes a mini-treatment in its own right. "Details make perfection, but perfection is not a detail" (Leonardo Da Vinci). "A lucid mind is the ante-chamber of intelligence" (Léo Ferré). In the order of life, every form of unity is always unique, and if each of us is unique, it is because everyone else is too. Ambition, wisdom, lucidity and efficiency will guarantee a successful result, the successful result. We must not be mere observers of our treatments, but the architect, project manager and site foreman at one and the same time. One could talk ad infinitum about finishing orthodontic-surgical cases because everything else leads up to the case-finishing and even the fullest description could never be exhaustive.

  4. [Mathematical analysis of complicated course of acute surgical diseases of abdominal cavity organs].

    PubMed

    Vozniuk, S M; Pol'ovyĭ, V P; Sydorchuk, R I; Palianytsia, A S

    2013-03-01

    In this paper we analyze the results of diagnosis and treatment of 130 patients with acute surgical diseases of the abdominal cavity, complicated by peritonitis. We proposed the method of estimating the severity of the patients using a coefficient of status severity (C(SS)), developed a scale for prediction of complicated outcomes of acute surgical pathology of the abdominal cavity and abdominal sepsis, which is adapted to the working conditions of local clinics. Using the C(SS) and the scale prediction, allowed timely identification of patients' risk group with possible complicated course, assign adequate treatment, reduce postoperative complications by 5%, relaparotomies by 4.4%, decrease postoperative mortality by 3.9%.

  5. Women's sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery.

    PubMed

    Gütl, P; Greimel, E R; Roth, R; Winter, R

    2002-03-01

    The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

  6. Surgical management of an abdominal abscess in a Malayan tapir.

    PubMed

    Lambeth, R R; Dart, A J; Vogelnest, L; Dart, C M; Hodgson, D R

    1998-10-01

    A captive Malayan tapir was observed to have inappetence, weight loss, signs of depression, mild dehydration and diarrhoea. Haematological and serum biochemical tests showed anaemia, hypoproteinaemia, hyperfibrinogenaemia and neutrophilia with a left shift. Ultrasonic examination of the abdomen under anaesthesia revealed a well-encapsulated abscess. The abscess was marsupialised to the ventral body wall. Culture of the pus produced a mixed bacterial growth. Antimicrobial therapy was based on bacterial sensitivity results. Follow-up ultrasonic examinations showed resolution of the abscess. Ninety-one days after surgery the tapir began regurgitating food and water. An abscess originating from the stomach and occluding the lumen of the duodenum was identified at surgery. The abscess ruptured during surgical manipulations and the tapir was euthanased.

  7. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

    PubMed Central

    Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. PMID:26730260

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

    PubMed

    Shapiro, A; Cooper, D L

    2012-05-01

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

  9. Historical perspectives on the evolution of surgical procedures in endodontics.

    PubMed

    Gutmann, James L; Gutmann, Marylou S

    2010-01-01

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

  10. Modeling surgical procedures to assist in understanding surgical approach

    NASA Astrophysics Data System (ADS)

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

    2007-03-01

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

  11. Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

    PubMed Central

    Dong, Ding-Hui; Liu, Wen-Yan; Feng, Hai-Bo; Fu, Yi-Li; Huang, Shi; Xiang, Jun-Xi; Lyu, Yi

    2015-01-01

    Background: Magnetic anchored surgical instruments (MASI), relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT) deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI. Methods: For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT. Results: Abdominal wall at C point in the middle third lumbar vertebra plane (L3) is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. “BMI-ICAWT” curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x) = P1 × x2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056), P2 = 1.098 (0.03197, 2.164), P3 = −18.52 (−31.64, −5.412), R-square: 0.99. Conclusions: Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of “BMI-ICAWT” curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI. PMID:26228215

  12. Is any surgical procedure ideal for chronic pancreatitis?

    PubMed

    Wani, Nazir A; Parray, Fazl Q; Wani, Mehmood A

    2007-02-01

    Chronic pancreatitis continues to be a major therapeutic challenge for all pancreatic surgeons. This article is written with a purpose to review various surgical procedures developed from time to time for the relief of pain in these patients. Since no single procedure can be labeled as "ideal" because of the problems of the inability to address the whole pathology at the initial procedure, failure or recurrence of the pain; most of the pancreatic and practicing surgeons may benefit from knowledge of the various procedures being performed, even though the personal experience of the surgeon most of the time ultimately dictates the final choice of the procedure for the patient.

  13. The medical antigravity suit for management of surgically uncontrollable bleeding associated with abdominal pregnancy.

    PubMed

    Sandberg, E C; Pelligra, R

    1983-07-01

    Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented.

  14. [Surgical procedures improvements thanks to navigators and robots].

    PubMed

    Chouard, Claude-Henri; Dubois, François

    2002-01-01

    Navigator is a three-dimensional C-T scan image localization device, which supplies the surgeon with a real time relationship of surgical instruments with pathological lesion and vital organs. Robot controls surgical devices movements according to a various sophisticated programming, in order to palliate the imperfection of their manual use. Navigators and robots, frequently connected, allow a precise control of the instruments course, improving accuracy and efficiency of most surgical procedures. It is necessary to contribute to their improvement and development, taking in count the economic, ethic and legal problems which may be encountered.

  15. Surgical Site Infiltration for Abdominal Surgery: A Novel Neuroanatomical-based Approach

    PubMed Central

    Janis, Jeffrey E.; Haas, Eric M.; Ramshaw, Bruce J.; Nihira, Mikio A.; Dunkin, Brian J.

    2016-01-01

    Background: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. Methods: Literature searches were conducted for studies reporting the neuroanatomical sources of pain after abdominal surgery. Also, studies identified by preceding search were reviewed for relevant publications and manually retrieved. Results: Based on neuroanatomy, an optimal surgical site infiltration technique would consist of systematic, extensive, meticulous administration of local anesthetic into the peritoneum (or preperitoneum), subfascial, and subdermal tissue planes. The volume of local anesthetic would depend on the size of the incision such that 1 to 1.5 mL is injected every 1 to 2 cm of surgical incision per layer. It is best to infiltrate with a 22-gauge, 1.5-inch needle. The needle is inserted approximately 0.5 to 1 cm into the tissue plane, and local anesthetic solution is injected while slowly withdrawing the needle, which should reduce the risk of intravascular injection. Conclusions: Meticulous, systematic, and extensive surgical site local anesthetic infiltration in the various tissue planes including the peritoneal, musculofascial, and subdermal tissues, where pain foci originate, provides excellent postoperative pain relief. This approach should be combined with use of other nonopioid analgesics with opioids reserved for rescue. Further well-designed studies are necessary to assess the analgesic efficacy of the proposed infiltration technique. PMID:28293525

  16. Radius surgical system and conventional laparoscopic instruments in abdominal surgery: application, learning curve and ergonomy.

    PubMed

    Di Lorenzo, N; Camperchioli, I; Gaspari, A L

    2007-12-01

    We illustrate our experience with a new class of instruments, the mechanical manipulators (MM), whose main features are an improved mobility, and ergonomy and a modular structure. A specific MM, the Radius Surgical System (RADIUS), has been used both for educational purposes as well as in clinical studies, demonstrating that it can represent an efficient tool to support surgeons performing surgical complex procedures, with a short learning curve for the postural attitude.

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

    PubMed

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

    2001-08-01

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

  18. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... performed in an ASC; (2) Are not of a type that are commonly performed, or that may be safely performed, in... minutes or less duration. (3) Covered surgical procedures may not be of a type that— (i) Generally result in extensive blood loss; (ii) Require major or prolonged invasion of body cavities; (iii)...

  19. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., but may be safely performed in an ASC; (2) Are not of a type that are commonly performed, or that may...) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a type that— (i) Generally result in extensive blood loss; (ii) Require major or prolonged invasion of...

  20. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... performed in an ASC; (2) Are not of a type that are commonly performed, or that may be safely performed, in... minutes or less duration. (3) Covered surgical procedures may not be of a type that— (i) Generally result in extensive blood loss; (ii) Require major or prolonged invasion of body cavities; (iii)...

  1. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    PubMed

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR.

  2. Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

    PubMed Central

    Joy, Praisy; Prithishkumar, Ivan James; Isaac, Bina

    2017-01-01

    INTRODUCTION: Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. MATERIALS AND METHODS: Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus. RESULTS: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels. CONCLUSION: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains. PMID:27251822

  3. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

    PubMed Central

    Goodney, Philip P.; Tavris, Dale; Lucas, F. Lee; Gross, Thomas; Fisher, Elliott S.; Finlayson, Samuel R. G.

    2017-01-01

    Introduction Several reports suggest unexpectedly high rates of late abdominal aortic aneurysm (AAA) rupture occur after endovascular AAA repair (EVAR). However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed. Methods We performed a retrospective cohort study of patients undergoing infrarenal AAA repair using information from the Medicare inpatient hospital discharge records (MedPAR files), physician claim files (Part B files, 20% sample), and Medicare Denominator Files for the years 2001 to 2004. Using the Social Security Death Index, we identified all “late” deaths, defined as deaths occurring >30 days and after hospital discharge. We used the National Death Index to identify cause of death information; in particular, those deaths that were likely caused by late rupture. We compared causes of late death and survival between EVAR and open repair using Wilcoxon log-rank and rank-sum tests. Results Between 2001 and 2004, 13,971 patients underwent AAA repair (6119 EVAR, 7852 open repair). After a mean follow-up of 1.6 years in the EVAR cohort and 1.9 years in the open cohort, mortality rates were similar across repair type (15.4% EVAR, 15.9% open repair), with an adjusted odds ratio for death after open repair of 0.98 (95% confidence interval, 0.90–1.07). Of the 2194 documented deaths, 523 occurred before discharge or ≤30 days, and 1671 occurred >30 days and after hospital discharge. Cause of death information for the 1671 late deaths was available from the National Death Index for 1515 (91%). The 15 most common codes for causes of late death were dominated by cardiac disease (atherosclerotic heart disease, acute myocardial infarction) and pulmonary disease (lung cancer, respiratory failure). Causes of late death with specific mention of aneurysm were identified in 37 patients (2.4% of all deaths), but this event was not more common in EVAR or open repair (15 [0.3%] in the EVAR group, 22 [0

  4. Surgical treatment of inflammatory abdominal aortic aneurysms: Outcome and predictors analysis

    PubMed Central

    Nuellari, Edmond; Esposito, Giampiero; Kuci, Saimir; Kapedani, Edmond

    2014-01-01

    Objectives The aim of this study is to report our experience on the postoperative outcome of surgical treatment of inflammatory abdominal aortic aneurysm (IAAA). Materials and Methods Between 1997–2014, 35 patients with IAAA underwent surgery. The mean age was 63 ± 18 years. Chronic renal failure was identified in 11 (31.4%) patients and confirmed ischemic heart disease in 15 (43%) patients. The mean aortic aneurysm diameter was 68 ± 25 mm. The abdominal aorta was clamped above the renal arteries in 6 (17%) patients. Results The hospital mortality was 5.7% (2 patients). Three patients developed an aortic pseudoaneurysm and underwent a redo operation. Another patient developed a femoral anastomotic pseudoaneurysm 7 years after operation and he was treated surgically. The actuarial free-reoperation actuarial survival at 1, 5 and 7 years was 94%, 62% and 50%, respectively. The Cox model revealed the delta erythrocyte sedimentation rate (p = 0.002), ischemic heart disease (p = 0.006) and renal failure (p = 0.036) as strong predictors for poor overall outcome. Conclusion Early postoperative outcome in terms of mortality and morbidity seems acceptable, however, patients with IAAA have an increased risk for reoperation due to pseudonaneurysm formation. Strong predictors for poor overall outcome seem to be the elevated erythrocyte sedimentation rate, ischemic heart disease and chronic renal failure. PMID:25243075

  5. Surgical Treatment of Inflammatory Abdominal Aortic Aneurysms: Outcome and Predictors Analysis

    PubMed Central

    Nuellari, Edmond; Prifti, Edvin; Esposito, Giampiero; Kapedani, Edmond

    2014-01-01

    Objectives: The aim of this study is to report our experience on the postoperative outcome of surgical treatment of inflammatory abdominal aortic aneurysm (IAAA). Materials and Methods: Between 1997-2014, 35 patients with IAAA underwent surgery. The mean age was 63+/-18years. Chronic renal failure was identified in 11(31.4%)patients and confirmed ischemic heart disease in 15(43%)patients. The mean aortic aneurysm diameter was 68+/-25mm. The abdominal aorta was clamped above the renal arteries in 6 (17%) patients. Results: The hospital mortality was 5.7% (2 patients). Three patients developed an aortic pseudoaneurysm and underwent a redo operation. Another patient developed a femoral anastomotic pseudoaneurysm 7 years after operation and he was treated surgically. The actuarial free-reoperation actuarial survival at 1, 5 and 7 years was 94%, 62% and 50% respectively. The Cox model revealed the delta ESR (p=0.002), ischemic heart disease (p=0.006) and renal failure (p=0.036) as strong predictors for poor overall outcome. Conclusion: Early postoperative outcome in terms of mortality and morbidity seems acceptable, however patients with IAAA have an increased risk for reoperation due to pseudonaneurysm formation. Strong predictors for poor overall outcome seems to be the elevated erythrocyte sedimentation rate, ischemic heart disease and chronic renal failure. PMID:25568545

  6. Radiation exposure from fluoroscopy during orthopedic surgical procedures

    SciTech Connect

    Riley, S.A. )

    1989-11-01

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

  7. Surgical Procedures Needed to Eradicate Infection in Knee Septic Arthritis.

    PubMed

    Dave, Omkar H; Patel, Karan A; Andersen, Clark R; Carmichael, Kelly D

    2016-01-01

    Septic arthritis of the knee is encountered on a regular basis by orthopedists and nonorthopedists. No established therapeutic algorithm exists for septic arthritis of the knee, and there is much variability in management. This study assessed the number of surgical procedures, arthroscopic or open, required to eradicate infection. The study was a retrospective analysis of 79 patients who were treated for septic knee arthritis from 1995 to 2011. Patients who were included in the study had native septic knee arthritis that had resolved with treatment consisting of irrigation and debridement, either open or arthroscopic. Logistic regression analysis was used to explore the relation between the interval between onset of symptoms and index surgery and the use of arthroscopy and the need for multiple procedures. Fifty-two patients met the inclusion criteria, and 53% were male, with average follow-up of 7.2 years (range, 1-16.2 years). Arthroscopic irrigation and debridement was performed in 70% of cases. On average, successful treatment required 1.3 procedures (SD, 0.6; range, 1-4 procedures). A significant relation (P=.012) was found between time from presentation to surgery and the need for multiple procedures. With arthroscopic irrigation and debridement, most patients with septic knee arthritis require only 1 surgical procedure to eradicate infection. The need for multiple procedures increases with time from onset of symptoms to surgery.

  8. Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury

    PubMed Central

    Abdel-Aal, Ahmed Kamel; Ezzeldin, Islam B.; Moustafa, Amr Soliman; Ertel, Nathan; Oser, Rachel

    2015-01-01

    We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple’s pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure. PMID:27200175

  9. Suppression of Surgeons' Bacterial Hand Flora during Surgical Procedures with a New Antimicrobial Surgical Glove

    PubMed Central

    Kramer, Axel; Ouriel, Kenneth; Suchomel, Miranda; McLaws, Mary-Louise; Rottman, Martin; Leaper, David; Assadian, Afshin

    2014-01-01

    Abstract Background: Perforations of surgical gloves are common and increase with the duration of glove wear. Skin flora, re-grown after pre-operative disinfection of the hands, may contaminate a surgical site. An antimicrobial surgical glove with chlorhexidine on its inner surface has been developed. We hypothesized that by suppressing the re-growth of skin flora during the complete course of a surgical procedure, antimicrobial gloves may reduce the risk of surgical site contamination in the event of an intra-operative glove breach. Methods: We conducted a randomized, double-blind, single-center trial, to measure any differences in the bacterial skin populations of surgeons' hands during surgical procedures done with antimicrobial and non-antimicrobial surgical gloves [ISRCTN71391952]. In this study, 25 pairs of gloves were retrieved from 14 surgeons who donned them randomly on their dominant or non-dominant hand. The number of bacteria retrieved from glove fluid was measured and expressed as colony forming units (CFU)/mL. Results: The median cfu/mL of antimicrobial gloves was 0.00 (LQ: 0.00 CFU/mL; UQ: 0.00 cfu/mL), with a mean log10 cfu/mL=0.02 (range: 0.00–0.30). The median CFU/mL of non-antimicrobial gloves was 54.00 (LQ: 3.00 cfu/mL; UQ: 100.00 cfu/mL) with a mean log10 CFU/mL=1.32 (range: 0.00–2.39). After a mean operating time of 112 min, the difference in the log10 CFU/mL was 1.30 (p<0.001). Conclusions: A new antimicrobial surgical glove suppressed surgeons' hand flora during operative procedures. In the event of a glove breach, the use of such a glove may have the potential to prevent bacterial contamination of a sterile surgical site, thereby decreasing the risk of surgical site infection (SSI) and increasing patient safety. Further clinical studies are needed to confirm this concept. PMID:24116857

  10. The reverse abdominal reduction and the 'waistcoating' procedure for the correction of the fixated Pfannenstiel incision.

    PubMed

    Harrison, Douglas H

    2016-05-01

    The principles of a standard abdominal reduction are well understood; this technique has been used for many years. However, a reverse abdominal reduction may be considered in some cases, for example, continued weight loss, and thus skin redundancy on the upper abdomen in patients who have already undergone abdominal reduction and upper abdomen improvement in patients requiring a mastopexy or breast reduction simultaneously. Reverse abdominal reduction is rarely mentioned in the medical literature, but it can prove successful; although the scar across the lower sternum has often been considered to be unsatisfactory, often it does not prove to be so. Thus, this procedure can be proven to be successful in suitable cases. Secondly, the Pfannenstiel incision, if not satisfactorily repaired in the first instance, can become fixated to the abdominal wall; this fixation along with the inevitable migration of skin and fat at its cephalic edge causes a rather displeasing contour defect when wearing tight-fitting swimwear. The principle of the waistcoating procedure is essentially to chamfer the fat cephalically; this procedure is employed for removing the Pfannenstiel scar from the abdominal wall. The principle is simple and effective and can be applied in cases with fixated scars. These two aforementioned principles are not commonly used, but they can prove particularly effective in suitable cases. We illustrate the principles.

  11. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    SciTech Connect

    Wu, Ziheng; Xu, Liang; Qu, Lefeng; Raithel, Dieter

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  12. SPRENGEL'S DEFORMITY: SURGICAL CORRECTION BY A MODIFIED GREEN PROCEDURE

    PubMed Central

    da Silva Reginaldo, Sandro; de Macedo, Ruy Rocha; de Andrade Amaral, Rogério; Cardoso, André Luiz Passos; Araújo, Helder Rocha Silva; Daher, Sergio

    2015-01-01

    Objective: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity) using modified Green's Procedure, as well as patients' satisfaction and complications. Methods: Nine patients submitted to surgical treatment from September 1993 to April 2008 have been assessed. The modification from original technique was: subperiosteal muscle detachment, resection of superomedial scapular portion and fixation of medial portion of scapular spine to contralateral posterior iliac crest instead of skeletal traction, with subcutaneous wire. The mean age was 7 years and 3 months. The mean follow-up time was 3 years and 7 months. Results: The mean improvement in forward elevation was 39o (range 0 to 80o). According to the Cavendish Classification, cosmetic improvement of two degrees was achieved in eight cases, and three degrees in one. All patients were satisfied with results. Conclusions: Surgical correction of Sprengel's Deformity by a modified Green's procedure with contralateral posterior iliac crest fixation instead of skeletal traction, showed both cosmetic and functional improvements; all patients and/or family members were satisfied with the results, and the complications associated to the surgical technique did not interfere on end results. PMID:27004174

  13. Acute skin lesions after surgical procedures: a clinical approach.

    PubMed

    Borrego, L

    2013-11-01

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

  14. [Incidence of primary malignant lesions in clinically benign teratoma: on the problem of adequate surgical procedure].

    PubMed

    Kindermann, G; Jung, E M; Maassen, V; Bise, K

    1996-08-01

    The Problem of an Adequate Surgical Approach: Frequency of malignant teratomas is, according to the literature, 2%-10%. Examining 194 own cases (1983-1993) it was 1.5%. We found one squamous cell carcinoma (0.5%). Additionally we found 2 immature teratomas (1%). We point out the different biological behaviour of malignant mature teratomas and immature teratomas. We agree with the majority of authors that the method of choice is the intact removal of all teratomas without iatrogen rupture or contamination of the abdominal cavity by contents of the teratoma. This adequate surgical procedure can and should be performed by laparotomy or laparoscopy with endobag. The often practised method of cutting open the cyst during laparoscopy, sucking off the contents or cutting the teratoma into pieces, has been proven to lead to implantation and worsening the prognosis in case of a malignant teratoma. Even the rinsing of the abdominal cavity, usually carried out with this method, could not compensate always for the disadvantage of this "dirty" endoscopical method compared with usual oncological standards. This is pointed out by case reports in the literature and the first analysis of a German survey with early-follow-up of 192 laparoscopically managed ovarian malignancies [11a]. The principle of intact removal of every teratoma should again be kept in mind.

  15. Abdominal Angina Treated by Urgent Percutaneous Angioplasty: An Excellent Alternative to Surgical Revascularisation

    PubMed Central

    Shetty, Ranjan; Krishnan, Anand M; Rao, M Sudhakar; Malpe, Umesh Pai

    2016-01-01

    Chronic Mesenteric Ischemia (CMI) presenting as acute abdomen can be treated percutaneously. An endovascular intervention has surpassed surgical revascularization over the past decade due to its lesser perioperative complication rate. Trans-femoral approach of revascularising is limited by its difficulty in coaxial alignment of the guiding catheter and hence, brachial artery and recently the radial approach have been utilized for mesenteric artery revascularisation for over a decade. Here by we report a case of chronic mesenteric ischemia having total occlusion of two and 70% occlusion of one of the three mesenteric vessels. The patient had presented with acute abdomen which in turn was percutaneously revascularised via the left brachial artery for the two major abdominal visceral vessels being superior mesenteric artery and inferior mesenteric artery. PMID:28050424

  16. [The particularities of acute surgical diseases treatment of abdominal cavity organs in patients with haemophilia].

    PubMed

    Shutov, S A; Karagiulia, S R; Danishian, K I; Zorenko, V Iu; Grzhimolovskiĭ, A V; Polianskaia, T Iu; Shulutko, E M; Galstian, G M

    2014-01-01

    The experience of treatment of 366 patients with haemophilia who were urgently hospitalized in hеmatological Scientific Center over the last 10 years is presented in the article. There were 114 (31.1%) patients with acute diseases of abdominal cavity organs, 150 (41%) patients with bleeding from upper gastrointestinal tract, 102 (27.9%) patients with acute hematomas of retroperitoneal space. Urgent operations were performed in 48 (22.2%) patients who were hospitalized with clinical symptoms of acute abdomen syndrome. It was developed the criteria of diagnosis and choice of treatment tactic on the basis of the received results. Application of presented algorithms led to improve the quality of urgent surgical care to patients with haemophilia.

  17. [Role of heat flow generated by an abdominal cavity in monitoring of acute surgical pathology of abdominal organs].

    PubMed

    Bodiaka, V Iu

    2013-01-01

    Despite of significant development of modern surgery results of treatment of acute diffused peritonitis and acute intestinal obstruction are still unsatisfactory. Successful treatment of these conditions depends considerably on timely and adequate diagnosing as it gives a choice of optimal treatment tactics. Measuring of a human body heat flow in areas of organs affected by pathology in cases of acute diffused peritonitis and acute intestinal obstruction provides a possibility to improve the principles of early differential diagnosing, to form new approaches to treatment tactics and monitoring of general health status of a patient during early postoperative treatment. 47 patient suffering from acute diffused peritonitis and 42 patients suffering from acute intestinal obstruction have been examined; the patients were divided into groups based on abdominal cavity exudates character, intestinal obstruction type and intra-abdominal hypertension grade. Measurement of abdominal cavity heat flow was performed by a contact method with use of thermoelectric medical thermometer. Intra-abdominal hypertension was measured by generally used transvesical method. It has been established that abdominal cavity heat flow correlates with character of abdominal cavity exudates; this is also confirmed by reliable difference between serous peritonitis and fibrinopurulent peritonitis indices. Indices in case of acute intestinal obstruction are lower than ones in case of acute diffused peritonitis as there are no inflammatory changes of peritoneum. Development of intra-abdominal hypertension of grades 3-4 directly influences the heat flow extent; this is explained by accelerated and aggravated pathological changes of inner organs cased by the main disease. Thus, abdominal cavity heat flow fully reflects degree of purulent and inflammatory processes of abdominal cavity organs and can be used for additional diagnosing and clinical course monitoring.

  18. Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

    PubMed Central

    Cota, Luís Otávio Miranda; Cyrino, Renata Magalhães; Lages, Eugênio José Pereira

    2015-01-01

    Background and Objective Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. Materials and Methods A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. Results Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. Conclusions Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures. PMID:26496187

  19. [The surgical treatment of inflammatory aneurysms of the abdominal aorta. The usefulness of nuclear magnetic resonance (MR) in the preoperative diagnosis].

    PubMed

    Chiesa, R; Esposito, G; Melissano, G; Jannello, A; Mellone, R; Castrucci, M; Radice, F; Del Maschio, A

    1993-09-15

    Inflammatory abdominal aortic aneurysms (IAAA) represent a peculiar variant compared with the common atherosclerotic origin of aortic aneurysms. Between January 1988 and March 1992, 111 aneurysmectomies were performed at our institution: 98 elective and 13 emergency procedures. In 10 cases (all males, mean age 68.5) an IAAA was found. 8/10 of those patients operated upon electively were studied preoperatively with MRI. All the IAAA but one were correctly identified preoperatively. Identification of IAAA with MRI in these cases improved the surgical approach. In conclusion, patients with IAAA can be operated upon safely especially if a preoperative diagnosis is present. MRI greatly improves our ability to characterize non invasively IAAA.

  20. Laparoscopic tube-preserving surgical procedures for ectopic tubal pregnancy

    PubMed Central

    Lee, Dong Hee; Kim, Hwa Cheung; Seong, Seok Ju

    2016-01-01

    Objective To present our experience with laparoscopic tube-preserving surgery for ectopic tubal pregnancy and evaluate its feasibility and efficacy. Methods This was a prospective study of 57 consecutive patients with ectopic tubal pregnancies undergoing laparoscopic tube-preserving procedures including salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking. The outcome measures were treatment success rates and homolateral patency rates. Results Of the 57 surgical procedures, 55 (96.4%) were performed successfully without any additional intervention. The number of patients receiving salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking were 24 (42.1%), 25 (43.9%), 4 (7.0%), and 2 (3.5%), respectively. Two case was switched to salpingectomy because excessive bipolar coagulation was required to obtain hemostasis at the tubal bleeding bed. Over a mean β-human chorionic gonadotropin resolution time of 18.3±5.9 days, no persistent trophoblast or postoperative complications occurred. A tubal patency test using hysterosalpingography was performed in 15 cases at 3 months postoperatively. Among these, the homolateral tubal patency rate was 75% (11 of 15) and the contralateral patency rate was 80% (12 of 15). Conclusion Tube-preserving surgery is a feasible and safe treatment option for ectopic tubal pregnancy. However, considering that the optimal goal of tube-preserving surgical procedures is not the treatment success, some caution is warranted in interpreting results of this study. PMID:27896254

  1. [Abdominal catastrophe--surgeon's view].

    PubMed

    Vyhnánek, F

    2010-07-01

    Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates.

  2. Nitrousoxide as a conscious sedative in minor oral surgical procedure

    PubMed Central

    Mohan, Rakesh; Asir, Vigil Dev; Shanmugapriyan; Ebenezr, Vijay; Dakir, Abu; Balakrishnan; Jacob, Jeffin

    2015-01-01

    Nitrous oxide (N2O) is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably. However, as a single agent, it has an impressive safety and is excellent for providing minimal and moderate sedation for apprehensive minor oral surgical procedure. In this article, action of N2O in overcoming the anxiety and pain of the patient during the minor oral surgery and its advantages and disadvantages, have been reviewed. PMID:26015724

  3. [Mammary prosthesis: considerations about a choreography of the surgical procedure].

    PubMed

    Grolleau, J-L; Gangloff, D; Garrido, I; Chavoin, J-P

    2005-10-01

    Breast augmentation offers a high rate of satisfaction but the local complications remain frequent. These are mainly capsular contracture, malpositions of implant, acute or infraclinical infections. The causes of these complications are multifactorials. The goal of this chapter is to determine the effect of the surgical technique on the result. We think that if no routine procedure can be proposed, a reflexion on the objectives of the breast augmentation and the adaptation of the surgical technique is necessary for each surgeon. We identify twelve aims and discuss them: rigorous preoperative planning, determination of the position of the implant, creation of an adapted implant pocket, as much atraumatic as possible dissection, no bacterial contamination, no foreign particles, respect of the implant, drainage or not, efficient suture, pain and discomfort control, need for contension and clear postoperative advices. These objectives being precised, we integrate them in a chronological surgical process under the form of questions. Each surgeon can then choose his answers by evaluating the arguments, which led to his choices.

  4. Pressure ulcer prevalence and risk factors during prolonged surgical procedures.

    PubMed

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2011-12-01

    Pressure ulcer formation related to positioning while in the OR increases the length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify the prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admission patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ(2) = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ(2) = 15.848, P = .000), skin assessment in the postanesthesia care unit (χ(2) = 41.652, P = .000), and male gender (χ(2) = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that the use of a foam pad (β = 2.691, P = .024) and a lower day-one Braden score (β = .244, P = .003) were predictive of pressure ulcers.

  5. Early Palma procedure after iliac vein injury in abdominal penetrating trauma.

    PubMed

    Alcocer, Francisco; Aguilar, Jesus; Agraz, Salvador; Jordan, William D

    2008-09-01

    Ligation for penetrating abdominal vein trauma may have better outcome than a vascular reconstruction in an unstable patient. However, symptoms of chronic venous insufficiency may appear over time. We describe our surgical experience with 4 patients who underwent iliac vein ligation followed by venous bypass with a modified Palma derivation between 48 and 240 hours after sustaining penetrating abdominal trauma with concomitant iliac vein injury. Patients were assessed for venous symptoms and conduit patency with continuous wave Doppler and duplex scanning. One graft occluded acutely and the remaining three remain patent with functioning valves. In order to preserve venous outflow after severe iliac vein injury, we think that venous ligation as a part of damage control surgery followed by a modified Palma operation may prevent chronic symptoms of venous outflow obstruction without compromising an already injured patient.

  6. Development of a new illumination procedure for photodynamic therapy of the abdominal cavity.

    PubMed

    Guyon, Laurie; Lesage, Jean Claude; Betrouni, Nacim; Mordon, Serge

    2012-03-01

    A homogeneous illumination of intra-abdominal organs is essential for successful photodynamic therapy of the abdominal cavity. Considering the current lack of outstanding light-delivery systems, a new illumination procedure was assessed. A rat model of peritoneal carcinomatosis was used. Four hours after intraperitoneal injection of hexaminolevulinate, a square illuminating panel connected to a 635-nm laser source was inserted vertically into the abdominal cavity. The abdominal incision was sutured and a pneumoperitoneum created prior to illumination. Light dosimetry was based on the calculation of the peritoneal surface by MRI. The rats were treated with a light dose of 20, 10, 5 or 2.5 J/cm(2) administered continuously with an irradiance of 7 mW/cm(2). The homogeneity of the cavity illumination was assessed by quantification of the photobleaching of the tumor lesions according to their localization and by scoring of that of the liver and of the bowel immediately after treatment. Photobleaching quantification for tumor lesions relied on the calculation of the fluorescence intensity ratio (after/before treatment) after recording of the lesions during blue-light laparoscopy and determination of their fluorescence intensity with Sigmascan Pro software. The procedure led to a homogeneous treatment of the abdominal cavity. No statistical difference was observed for the photobleaching values according to the localization of the lesions on the peritoneum (p=0.59) and photobleaching of the liver and of the intestine was homogeneous. We conclude that this procedure can successfully treat the major sites involved in peritoneal carcinomatosis.

  7. Development of a new illumination procedure for photodynamic therapy of the abdominal cavity

    NASA Astrophysics Data System (ADS)

    Guyon, Laurie; Claude Lesage, Jean; Betrouni, Nacim; Mordon, Serge

    2012-03-01

    A homogeneous illumination of intra-abdominal organs is essential for successful photodynamic therapy of the abdominal cavity. Considering the current lack of outstanding light-delivery systems, a new illumination procedure was assessed. A rat model of peritoneal carcinomatosis was used. Four hours after intraperitoneal injection of hexaminolevulinate, a square illuminating panel connected to a 635-nm laser source was inserted vertically into the abdominal cavity. The abdominal incision was sutured and a pneumoperitoneum created prior to illumination. Light dosimetry was based on the calculation of the peritoneal surface by MRI. The rats were treated with a light dose of 20, 10, 5 or 2.5 J/cm2 administered continuously with an irradiance of 7 mW/cm2. The homogeneity of the cavity illumination was assessed by quantification of the photobleaching of the tumor lesions according to their localization and by scoring of that of the liver and of the bowel immediately after treatment. Photobleaching quantification for tumor lesions relied on the calculation of the fluorescence intensity ratio (after/before treatment) after recording of the lesions during blue-light laparoscopy and determination of their fluorescence intensity with Sigmascan Pro software. The procedure led to a homogeneous treatment of the abdominal cavity. No statistical difference was observed for the photobleaching values according to the localization of the lesions on the peritoneum (p=0.59) and photobleaching of the liver and of the intestine was homogeneous. We conclude that this procedure can successfully treat the major sites involved in peritoneal carcinomatosis.

  8. TextWithSurgeryPatients - A Research Hypothesis in Enhancing Education and Physical Assessment for Abdominal Surgical Patients.

    PubMed

    Hansen, Margaret

    2016-01-01

    Medical surgical nurses may not have the time or resources to provide effective pre- and post-operative instructions for patients in today's healthcare system. And, making timely physical assessments following discharge from the hospital is not always straightforward. Therefore, the risk for readmission associated with post-surgical complications is a concern. At present, mobile healthcare technologies and patient care are precipitously evolving and may serve as a resource to enhance communication between the healthcare provider and patient. A mobile telephone text message (short message service [SMS]) intervention for abdominal surgical patients may foster effective education (communication) and timely self-reported physical assessment in the home environment hence preventing deleterious outcomes. The aim of this research proposal is to identify the feasibility of using a SMS intervention via smart phones to improve health outcomes via timely communication, reach large numbers of at-risk surgical patients and, establish and sustain uniform protocols in a cost-efficient manner.

  9. [Clinical diagnosis of HIV infection in patients with acute surgical diseases of the abdominal cavity organs and pulmonary tuberculosis].

    PubMed

    Nguen, V Kh; Stroganov, P V; Geshelin, S A

    2011-09-01

    The results of treatment of 81 patients, suffering tuberculosis and operated in emergency for an acute surgical diseases of the abdominal cavity organs, are adduced, in 29 of them--nonspecific diseases of nontuberculosis genesis were diagnosed. In 52 patients the indication for emergency operation performance were complications of abdominal tuberculosis (perforation of the tuberculosis ulcers of small intestine--in 37, the tuberculosis mesadenitis--in 15), of them in 34--pulmonary tuberculosis was in inactive phase, that's why the HIV presence was supposed. In 26 patients the diagnosis was confirmed, basing on serologic analysis data. The presence of intraabdominal catastrophe, caused by abdominal tuberculosis complications on inactive pulmonary tuberculosis background witnesses with 85.3% probability the HIV-infectioning of the patient.

  10. Surgically placed abdominal wall catheters on postoperative analgesia and outcomes after living liver donation.

    PubMed

    Khan, James; Katz, Joel; Montbriand, Janice; Ladak, Salima; McCluskey, Stuart; Srinivas, Coimbatore; Ko, Raynauld; Grant, David; Bradbury, Ashleene; LeManach, Yannick; Clarke, Hance

    2015-04-01

    Living donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for postoperative pain management, although it is often refused or contraindicated. Surgically placed abdominal wall catheters (AWCs) are a novel pain modality that can potentially provide pain relief for those patients who are unable to receive an epidural. A retrospective review was performed at a single center. Patients were categorized according to their postoperative pain modality: intravenous (IV) patient-controlled analgesia (PCA), AWCs with IV PCA, or patient-controlled epidural analgesia (PCEA). Pain scores, opioid consumption, and outcomes were compared for the first 3 postoperative days. Propensity score matches (PSMs) were performed to adjust for covariates and to confirm the primary analysis. The AWC group had significantly lower mean morphine-equivalent consumption on postoperative day 3 [18.1 mg, standard error (SE)=3.1 versus 28.2 mg, SE=3.0; P=0.02] and mean cumulative morphine-equivalent consumption (97.2 mg, SE=7.2 versus 121.0 mg, SE=9.1; P=0.04) in comparison with the IV PCA group; the difference in cumulative-morphine equivalent remained significant in the PSMs. AWC pain scores were higher than those in the PCEA group and were similar to the those in the IV PCA group. The AWC group had a lower incidence of pruritus and a shorter hospital stay in comparison with the PCEA group and had a lower incidence of sedation in comparison with both groups. Time to ambulation, nausea, and vomiting were comparable among all 3 groups. The PSMs confirmed all results except for a decrease in the length of stay in comparison with PCEA. AWCs may be an alternative to epidural analgesia after living donor liver resections. Randomized trials are needed to verify the benefits of AWCs, including the safety and adverse effects.

  11. Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

    PubMed

    Hernández-Gascón, B; Peña, E; Pascual, G; Rodríguez, M; Bellón, J M; Calvo, B

    2012-01-01

    Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue.

  12. Increased mid-abdominal circumference is a predictor for surgical wound complications in kidney transplant recipients: A prospective cohort study.

    PubMed

    Taha, Mohamed; Davis, Niall F; Power, Richard; Mohan, Ponusamy; Forde, James; Smyth, Gordon; Little, Dilly M

    2017-03-15

    Kidney transplant recipients are at an increased risk of developing surgical site wound complications due to their immunosuppressed status. We aimed to determine whether increased mid-abdominal circumference (MAC) is predictive for wound complications in transplant recipients. A prospective study was performed on all kidney transplant recipients from October 2014 to October 2015. "Controls" consisted of kidney transplant recipients without a surgical site wound complication and "cases" consisted of recipients that developed a wound complication. In total, 144 patients underwent kidney transplantation and 107 patients met inclusion criteria. Postoperative wound complications were documented in 28 (26%) patients. Patients that developed a wound complication had a significantly greater MAC, body mass index (BMI), and body weight upon renal transplantation (P<.001, P=.011, and P=.011, respectively). On single and multiple logistic regression analyses, MAC was a significant predictor for developing a surgical wound complication (P=.02). Delayed graft function and a history of preformed anti-HLA antibodies were also predictive for surgical wound complications (P=.003 and P=.014, respectively). Increased MAC is a significant predictor for surgical wound complications in kidney transplant recipients. Integrating clinical methods for measuring visceral adiposity may be useful for stratifying kidney transplant recipients with an increased risk of a surgical wound complication.

  13. Lymph node dissection for Siewert II esophagogastric junction adenocarcinoma: A retrospective study of 3 surgical procedures.

    PubMed

    Duan, Xiao-Feng; Yue, Jie; Tang, Peng; Shang, Xiao-Bin; Jiang, Hong-Jing; Yu, Zhen-Tao

    2017-02-01

    the perioperative mortality and complication rates in Siewert type II AEG, but obtained satisfactory length of the proximal surgical margin, and was better than the left transthoracic approach in thoracic and abdominal lymph node dissection. However, the advantages of Ivor-Lewis procedure requires further follow-up and validation through prospective randomized controlled trials.

  14. Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics

    PubMed Central

    Ioannou, Andreas L.; Kotsakis, Georgios A.; McHale, Michelle G.; Lareau, Donald E.; Hinrichs, James E.; Romanos, Georgios E.

    2015-01-01

    Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth. PMID:26124837

  15. Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy.

    PubMed

    Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico

    2016-08-03

    Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach.

  16. Spectrophotometer properties of vein blood plasma in UF-region patients with sharp surgical pathology of abdominal region organs

    NASA Astrophysics Data System (ADS)

    Guminestskij, S. G.; Polianski, I. J.; Motrich, A. V.; Grunchuk, F. W.

    2006-05-01

    It is set that there are two maximums in UF- region absorption of vein blood plasma of a man: at λ = 235 nm and at λ = 280 nm. It is shown that there are the substantial changes of values of the optical density D comparative with controls (for donors) exactly in a maximum at development of sharp surgical diseases of organs of abdominal region λ = 280 nm, in that time as maximum at λ = 235 nm in this plan is not informing. Resulted results of researches of dynamics of changes of optical properties of vein blood plasma in UF- region of patients with pathology of abdominal region organs in after operating period (sharp appendicitis, sharp pancreatitis, intestinal impassability and others like that), which can have the diagnostic value.

  17. Thoraco-abdominal wall reconstruction after surgical debulking of a giant retroperitoneal liposarcoma: a case report.

    PubMed

    Colebunders, B; Colpaert, S D M; Mertens, M; Willemsen, P

    2011-01-01

    A case of a patient with a recurrent dedifferentiated retroperitoneal liposarcoma with extensive invasion of the thoraco-abdominal wall including the skin, requiring reconstructive surgery after debulking of the tumor is reported.

  18. Spectrally selective UV bactericidal effect for curative treatment of post-surgical intra-abdominal abscesses and other infections

    NASA Astrophysics Data System (ADS)

    Dudelzak, Alexander E.; Miller, Mark A.; Babichenko, Sergey M.

    2004-07-01

    Results of in-vitro studies of bactericidal effects of ultraviolet (UV) irradiation on strains causing drug-resistant endo-cavital infections (Enterococcus, Staphylococcus aureus, Pseudomonas aeruginosa, and others) are presented. An original technique to measure effects of UV-irradiation on bacterial growth at different wavelengths has been developed. Spectral dependences of the bactericidal effect have been observed, and spectral maxima of bactericidal efficiency have been found. Applications to curative treatments of wounds, post-surgical intra-abdominal abscesses and other diseases are discussed.

  19. A study on total intravenous anesthesia in orthognathic surgical procedures

    PubMed Central

    Vasundhar, P. L.; Sadhasivam, Gokkulakrishnan; Bhushan, Satya; Kalyan, Siva; Chiang, Kho Chai

    2016-01-01

    Aims and Objective: To assess the use of propofol for induction and maintenance of anaesthesia among patients undergoing various combinations of orthognathic surgical procedures. Materials and Methods: Following Preoperative evaluation, patients were given Fentanyl (2 micrograms/kg) intravenously. Induction (2 mg/kg) and maintenance (10 mg/kg/hr) of anaesthesia was achieved by Propofol infusion. Blood Pressure and heart rate were maintained at >70 or 80 mm Hg and >50 respectively and were monitored continuously. Infusion was stopped approximately 30 to 40 minutes before the end of surgery. Immediate recovery recorded and was assessed. Results: The average duration of anaesthesia and surgery were found to be 4 hrs 28 min (SD= 1 hr. 35 min) and 4 hrs 3 min (SD=1 hr 38 min). None of the patients experienced pain on injection of induction agent. No significant change was observed in the mean heart rate and mean BP at different time intervals from baseline value to 30 minutes after the recovery. The average time taken to obey simple commands after stopping Propofol infusion was 42.60 ± 9.09 min. Time taken for spontaneous eye opening, full orientation and to count backwards was 43.45 ± 9.11, 47.85 ± 8.18 and 50.9 ± 9.14 respectively. Face-Hand test performed at 15 min after extubation was positive in all the patients. The mean Aldrete score at 15 min after extubation was 11.65 ± 0.75. The mean value of unaided sitting time for at least 2 min was after 119.00 ± 20.56 min. The average score of picture card test, time taken in “picking up matches” test, Ball bearing test, time taken to walk and to void urine were 5.80 ± 1.47, 67.95 ± 5.72, 9.80 ± 2.57, 172.75 ± 39.25 and 163.75 ± 55.96 respectively. Ninety percent of the patients were amenable for a repeat of this anaesthetic using the same regime but 10% of them did not answer anything. Seven patients (35%) had chills post-operatively. Conclusion: Propofol is an excellent anaesthetic for day care procedures

  20. Economics of abdominal wall reconstruction.

    PubMed

    Bower, Curtis; Roth, J Scott

    2013-10-01

    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

  1. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  2. Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

    PubMed Central

    Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg

    2015-01-01

    Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of

  3. Negative pressure wound therapy aids recovery following surgical debridement due to severe bacterial cellulitis with abdominal abscess post-cesarean

    PubMed Central

    Young, Christopher N.J.; Ng, Ka Ying Bonnie; Webb, Vanessa; Vidow, Sarah; Parasuraman, Rajeswari; Umranikar, Sameer

    2016-01-01

    Abstract Introduction: Bacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate—used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and “ad-hoc” solutions to improve efficacy and patient experience. A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community. NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm2 per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully

  4. [Abdominal approaches and drainages of the abdominal cavity].

    PubMed

    Hagel, C; Schilling, M

    2006-04-01

    Appropriate access to the abdominal cavity is the first and crucial step for successful abdominal surgical intervention. In planning the incision, several variables have to be considered, such as anatomy of the abdominal wall, localization of the target organ, and individual conditions (previous incisions, minimal access surgery, etc). Medial laparotomy is the preferred incision for emergency cases and ill-defined pathologies, allowing access and hence exploration to all quadrants. Transverse laparotomies give superior access to the dorsal and right aspects of the liver and cause less pain in patients unfit for regional anesthetic procedures. Draining of the abdominal cavity is used after various resective and reconstructive procedures, but there is little evidence for its use in a number of operations such as gastric, hepatic, and colorectal resections. Advantages and disadvantages of different abdominal wall incisions and drainages are discussed.

  5. A standard operating procedure for the surgical implantation of transmitters in juvenile salmonids

    USGS Publications Warehouse

    Liedtke, T.L.; Beeman, J.W.; Gee, L.P.

    2012-01-01

    Biotelemetry is a useful tool to monitor the movements of animals and is widely applied in fisheries research. Radio or acoustic technology can be used, depending on the study design and the environmental conditions in the study area. A broad definition of telemetry also includes the use of Passive Integrated Transponder (PIT) tags, either separately or with a radio or acoustic transmitter. To use telemetry, fish must be equipped with a transmitter. Although there are several attachment procedures available, surgical implantation of transmitters in the abdominal cavity is recognized as the best technique for long-term telemetry studies in general (Stasko and Pincock, 1977; Winter, 1996; Jepsen, 2003), and specifically for juvenile salmonids, Oncorhynchus spp. (Adams and others, 1998a, 1998b; Martinelli and others, 1998; Hall and others, 2009). Studies that use telemetry assume that the processes by which the animals are captured, handled, and tagged, as well as the act of carrying the transmitter, will have minimal effect on their behavior and performance. This assumption, commonly stated as a lack of transmitter effects, must be valid if telemetry studies are to describe accurately the movements and behavior of an entire population of interest, rather than the subset of that population that carries transmitters. This document describes a standard operating procedure (SOP) for surgical implantation of radio or acoustic transmitters in juvenile salmonids. The procedures were developed from a broad base of published information, laboratory experiments, and practical experience in tagging thousands of fish for numerous studies of juvenile salmon movements near Columbia River and Snake River hydroelectric dams. Staff from the Western Fisheries Research Center's Columbia River Research Laboratory (CRRL) frequently have used telemetry studies to evaluate new structures or operations at hydroelectric dams in the Columbia River Basin, and these evaluations typically

  6. [Differential surgical treatment of victims with damage to the small and large intestines in a closed abdominal injury combined, depending on the prediction of traumatic disease course and morphological changes of the intestinal wall].

    PubMed

    Zaruts'kyĭ, Ia L; Denysenko, V M; Khomenko, I P; Levkivskyĭ, R H

    2013-08-01

    Use of differentiated surgical approach to the management of surgical treatment, depending on the degree of violation of systemic hemodynamics, the timing and volume of surgical procedures, depending on the prognosis of traumatic disease course of cardiac index, interventions in the small and large intestine depending on morphological changes of the intestinal wall by cardiac and stroke indexes, put method extra-enteric anastomosis in patients with damage to the small intestine and colon combined with closed abdominal injury permitted to reduce the rate of postoperative complications from 22.2 to 10.1%, mortality at 2.1 times in shock period (from 19.3 to 9.2%) and the overall mortality from 33.3 to 21.1%.

  7. 42 CFR 416.166 - Covered surgical procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....166 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Prospective Payment System for ASC Services Furnished on or After January 1, 2008 § 416.166 Covered surgical... prolonged invasion of body cavities; (3) Directly involve major blood vessels; (4) Are generally emergent...

  8. 42 CFR 416.166 - Covered surgical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....166 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Payment System for ASC Services Furnished on or After January 1, 2008 § 416.166 Covered surgical...) Generally result in extensive blood loss; (2) Require major or prolonged invasion of body cavities;...

  9. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments.

    PubMed

    Hatipoglu, Sinan; Akbulut, Sami; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-12-28

    With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.

  10. Catheter for Cleaning Surgical Optics During Surgical Procedures: A Possible Solution for Residue Buildup and Fogging in Video Surgery.

    PubMed

    de Abreu, Igor Renato Louro Bruno; Abrão, Fernando Conrado; Silva, Alessandra Rodrigues; Corrêa, Larissa Teresa Cirera; Younes, Riad Nain

    2015-05-01

    Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.

  11. [Approaches to the abdominal cavity and closure of the abdominal wall].

    PubMed

    Dittmar, Y; Rauchfuss, F; Ardelt, M; Settmacher, U

    2011-12-01

    Although minimally invasive approaches to the abdominal cavity are becoming increasingly more important, open surgical techniques are still of essential interest and must be mastered by general and visceral surgeons. The choice of the particular approach depends on the specificity and location of the scheduled procedure. The following article is intended to give an overview on the current literature as well as experiences in the field of open surgical approaches to the abdominal cavity.

  12. Risk Factors for Survival following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysms: A 13-Year Experience

    PubMed Central

    Ozen, Anil; Hanedan, Muhammet Onur; Songur, Çetin Murat; Boysan, Emre; Unal, Ertekin Utku; Mola, Serkan; Erkengel, Halil Ibrahim; Kubat, Emre; Iscan, Zafer; Tutun, Ufuk; Sarıtas, Ahmet; Birincioglu, Cemal Levent

    2015-01-01

    Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs. PMID:26697083

  13. Improved surgical mesh integration into the rat abdominal wall with arginine administration.

    PubMed

    Arbos, M A; Ferrando, J M; Quiles, M T; Vidal, J; López-Cano, M; Gil, J; Manero, J M; Peña, J; Huguet, P; Schwartz-Riera, S; Reventós, J; Armengol, M

    2006-02-01

    Prosthetic meshes are used as the standard of care in abdominal wall hernia repair. However, hernia recurrences and side effects remain unsolved problems. The demand by health care providers for increasingly efficient and cost-effective surgery encourages the development of newer strategies to improve devices and outcomes. Here, we evaluated whether l-arginine administration was able to ameliorate long-term polypropylene prostheses incorporation into the abdominal wall of Sprague-Dawley rats. Meshes were placed on-lay and continuous l-arginine was administered. In vivo biocompatibility was studied at 7, 25 and 30 days post-implantation. Effectively, l-arginine administration in combination with mesh triggered subtle changes in ECM composition that impinged on critical biochemical and structural features. Lastly, tensile strength augmented and stiffness decreased over the control condition. This could help to restructure the mechanical load transfer from the implant to the brittle surrounding tissues, i.e., impact load and fatigue load associated with mechanical tensions could be distributed between the mesh and the restored tissue in a more balanced manner, and ultimately help to reduce the incidence of loosening, recurrences, and local wound complications. Since the newly formed tissue is more mechanically stable, this approach could eventually be introduced to human hernia repair.

  14. Surgical Treatment of Canine Glaucoma: Filtering and End-Stage Glaucoma Procedures.

    PubMed

    Maggio, Federica; Bras, Dineli

    2015-11-01

    Canine glaucoma is a common cause of vision loss associated with raised intraocular pressure, and leads to damage of the retina and optic nerve head. In most cases, medical treatment alone cannot provide long-term management of intraocular pressure control and preservation of vision. Surgical intervention is usually recommended to either decrease aqueous humor production, or increase its outflow. Among the current available procedures, filtering techniques are aimed at increasing aqueous humor outflow. Proper surgical timing and a combination of cyclodestructive and filtering procedures have been recently suggested to improve the long-term success of surgical treatment in dogs. Bleb fibrosis and surgical failure are still common occurrences in filtration surgery with relapse of glaucoma and vision loss. End stage procedures, such as enucleation, evisceration with intrascleral prosthesis, and chemical ablation of the ciliary bodies are then recommended to address chronic discomfort in buphthalmic and blind eyes.

  15. IMMEDIATE DISCONTINUATION OF INTRAVENOUS FLUIDS AFTER COMMON SURGICAL PROCEDURES

    PubMed Central

    Al-Awad, Naif I.; Wosomu, Lade; Al Hassanin, Emad A.W.; Al-Mulhim, Abdulmohsen A.; Adu-Gyamfi, Yaw; Shawan, Saad M.; Abdulhadi, Maha S.

    2000-01-01

    Background: Intravenous (IV) fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community. Setting: A University teaching hospital in Eastern Saudi Arabia. Aims: To determine the feasibility of the practice in our setting and increase clinicians’ awareness of it and encourage its general adoption. Method: A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations. End Points: The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of IV line. Results: The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients’ mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids. Conclusions: In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults. PMID:23008615

  16. Surgical procedure logging with use of a hand-held computer

    PubMed Central

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

    2002-01-01

    Objective To evaluate the feasibility of incorporating hand-held computing technology in a surgical residency program, by means of hand-held devices for surgical procedure logging linked through the Internet to a central database. Setting Division of General Surgery, University of Toronto. Design A survey of general surgery residents. Methods The 69 residents in the general surgery training program received hand-held computers with preinstalled medical programs and a program designed for surgical procedure logging. Procedural data were uploaded via the Internet to a central database. Survey data were collected regarding previous computer use as well as previous procedure logging methods. Main outcome measure Utilization of the procedure logging system. Results After a 5-month pilot period, 38% of surgical residents were using the procedure-logging program successfully and on a regular basis. Program use was higher among more junior trainees. Analysis of the database provided valuable information on individual trainees, hospital programs and supervising surgeons, data that would assist in program development. Conclusions Hand-held devices can be implemented in a large division of general surgery to provide a reference database and a procedure-logging platform. However, user acceptance is not uniform and continued training and support are necessary to increase acceptance. The procedure database provides important information for optimizing trainees’ educational experience. PMID:12387537

  17. The Sauvé-Kapandji procedure: indications and tips for surgical success.

    PubMed

    Lluch, Alberto

    2010-11-01

    Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, with the main disadvantage of loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji procedure. This procedure is not void of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these can be prevented if a careful surgical technique is used.

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

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Jindal, Ravi

    2012-01-01

    The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures. PMID:23225921

  19. [Bladder drainage in patients undergoing the Pereyra surgical procedure].

    PubMed

    Rodríguez-Colorado, S; Villagrán, R; Escobar-Del Barco, L; Villalobos-Acosta, S; Kunhardt-Rasch, J; Delgado-Urdapilleta, J

    1996-07-01

    Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter.

  20. [Laparoscopic cholecystectomy--1,000 procedures in a surgical department].

    PubMed

    Freund, U; Mayo, A; Schwartz, I; Neufeld, D; Paran, H

    2000-11-01

    The first 1,000 laparoscopic cholecystectomies performed in our department were reviewed. There was no operative mortality; conversion to open cholecystectomy was necessary in 2%. In the last 600 cases the rate of conversion had decreased to 0.5%. There was common bile duct injury in 0.3%, with the injuries identified during primary surgery. This clinical experience is consistent with previous studies, which proved that laparoscopic cholecystectomy is safe and should replace open operation as the procedure of choice.

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

    PubMed

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

    2012-01-01

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

  2. Spontaneous Cholecysto-Cutaneous Fistula Draining Through an Old Abdominal Surgical Scar

    PubMed Central

    Surya, Mukesh; Soni, Pawan; Nimkar, Kshama

    2016-01-01

    Summary Background Though cholelithiasis and cholecystitis are common clinical problems, spontaneous cholecysto-cutaneous fistula is a rare complication of cholelithiasis in present-day practice. Very few cases have been reported in literature after 1950s. Case Report A 60-year-old male presented with pain and discharging sinus in the upper abdomen. Ultrasonography and computed tomography confirmed the presence of perforation of the gall bladder and cholecysto-cutaneous fistula. External opening of the fistula was overlying an old surgical scar. Less than five cases of spontaneous cholecysto-cutaneous fistula draining through an old surgical scar have been reported in literature. Initially, the patient was managed conservatively, followed by elective open cholecystectomy and excision of the fistula tract. Conclusions Though very rare in the present era of advanced medical care, cholecysto-cutaneous fistula as a potential diagnosis should be kept in mind in patients presenting with acute upper abdomen pain and discharging sinus. High degree of suspicion is required for early diagnosis and treatment of this condition. PMID:27822325

  3. [Safety and accuracy of surgical procedures: case law evolution].

    PubMed

    Rougé-Maillart, C; Gaudin, A; Lermite, E; Arnaud, J-P; Penneau, M

    2008-01-01

    Surgeons, like other doctors, practice their profession within a framework of contractual liability defined by statute in 1936. This established that the doctor was subject to a contractual obligation to provide appropriate and diligent care. Care and technical acts should conform to those which would have been provided by a prudent doctor within the standards of knowledge and practice of his field; care which deviates from this standard would be considered medical error or fault. This standard of care is referred to as "sound professional conduct". However, while not calling this basic principle into question, civil jurisdictions have progressively held surgeons liable whenever injury has occurred following surgical acts, without considering whether care deviates from sound professional conduct. Since 2000, judges have begun to attribute a requirement for absolute safety of results in cases where the surgeon had injured an organ unrelated to the planned operation. However it seems that the rare judgments given on this topic in the last 2-3 years have become less frequent. The creation of a compensation regime for medical accidents, via the law dated March 4, 2002, has contributed to this evolution. It is to be hoped that the flaws described in this system do not encourage jurisdictions to reconsider previous case law decisions.

  4. Surgical and immediate postrelease mortality of harlequin ducks (Histrionicus histrionicus) implanted with abdominal radio transmitters with percutaneous antennae

    USGS Publications Warehouse

    Mulcahy, Daniel M.; Esler, Daniel

    1999-01-01

    Radiotelemetry is an essential tool in the study of free-ranging bird populations, and a variety of transmitter-attachment methods have been developed. A promising new method is abdominal implantation of a transmitter with a percutaneous antenna. Researchers using this technique should be concerned about and aware of mortality during surgery and during the immediate postrelease period (the 14-day period following surgery). Of 307 radio-implant surgeries performed between 1995 and 1997 in harlequin ducks (Histrionicus histrionicus), 7 (2.3%) deaths were documented during surgery or anesthetic recovery. Of 295 birds released with implanted radios, 10 (3.4%) died during the immediate postrelease period. Modifications to anesthetic procedures used in the 204 surgeries performed in 1996 and 1997 reduced mortality to 1.5% during surgery and 1.5% during the immediate postrelease period. Anesthetic modifications included intubation of all birds, placement of birds on an elevated platform that allowed the head to rest at a level lower than the body during surgery, placement of a heated water blanket under the birds during surgery, monitoring of body temperature, and use of electrocardiogram and Doppler ultrasound to monitor heart rates and arrhythmias. Low levels of mortality associated with abdominal implantation of radio transmitters may be unavoidable, but mortality can be minimized with adjustments to anesthetic technique.

  5. [Web-based education: learning surgical procedures step-by-step with 3D visualization].

    PubMed

    van der Velde, Susanne; Maljers, Jaap; Wiggers, Theo

    2014-01-01

    There is a need for more uniform, structured education focused on surgical procedures. We offer a standardized, step-by-step, web-based procedural training method with which surgeons can train more interns efficiently. The basis of this learning method is formed by 3D films in which surgical procedures are performed in clearly defined steps and the anatomic structures behind the surgical operating planes are further dissected. This basis is supported by online modules in which, aside from the operation, preparation and postoperative care are also addressed. Registrars can test their knowledge with exams. Trainers can see what the registrars studied, how they scored and how they progressed with their clinical skills. With the online portfolio we offer building blocks for certification and accreditation. With this clearly structured research method of constant quality, registrars are less dependent on the local trainer. In addition, through better preparation, the operation capacity can be used more efficiently for the training.

  6. Prevalence of Neoplastic Diseases in Pet Birds Referred for Surgical Procedures

    PubMed Central

    Castro, Patrícia F.; Fantoni, Denise T.; Miranda, Bruna C.; Matera, Julia M.

    2016-01-01

    Neoplastic disease is common in pet birds, particularly in psittacines, and treatment should be primarily aimed at tumor eradication. Nineteen cases of pet birds submitted to diagnostic and/or therapeutic surgical procedures due to neoplastic disease characterized by the presence of visible masses were retrospectively analyzed; affected species, types of neoplasms and respective locations, and outcomes of surgical procedures were determined. All birds undergoing surgery belonged to the order Psittaciformes; the Blue-fronted parrot (Amazona aestiva) was the prevalent species. Lipoma was the most frequent neoplasm in the sample studied. Most neoplasms affected the integumentary system, particularly the pericloacal area. Tumor resection was the most common surgical procedure performed, with high resolution and low recurrence rates. PMID:26981315

  7. Recession Vs Myotomy–Comparative Analysis of Two Surgical Procedures of Weakening Inferior Oblique Muscle Overaction

    PubMed Central

    Alajbegovic-Halimic, Jasmina; Zvizdic, Denisa; Sahbegovic-Holcner, Amra; Kulanic-Kuduzovic, Amira

    2015-01-01

    Introduction: Inferior oblique overaction (IOOA) can be primary or secondary, isolated or combined to other types of horizontal deviation, mostly with esotropias. Surgical weakening of IOOA means several techniques like; recession, myotomy, myectomy, anteroposition etc. Goals: we analyzed the effect of inferior oblique muscle surgical weakening comparing two groups of patients with primary hypertropia. Material and methods: In 5-years retrospective study, we observed 33 patients on which we did the surgical procedure of weakening inferior muscle overaction by two methods; recession and myotomy. Results: In total number of 33 patients, there were 57,6% male and 42,4% female patients with average age of 10,6±7,5 (in range of 4–36). There was 33,3% of isolated primary hypertropias, and 66,7% combined with esotropias. At 23 (69,9%) patients the recession surgical procedure was done, and with 10 (30,1%) myotomy. Better effect and binocularity was in 65,2% of patients in recession group which was statistically significant with significance level of p<0,0, χ2=5,705; p=0,021. Conclusion: Comparing of two surgical procedures of weakening inferior oblique muscles overaction, recession is better procedure than myotomy. PMID:26261384

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

    PubMed

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

    2011-01-01

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

  9. “Reality Surgery” — A Research Ethics Perspective on the Live Broadcast of Surgical Procedures

    PubMed Central

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

    2013-01-01

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

  10. Towards robotic heart surgery: introduction of autonomous procedures into an experimental surgical telemanipulator system.

    PubMed

    Bauernschmitt, R; Schirmbeck, E U; Knoll, A; Mayer, H; Nagy, I; Wessel, N; Wildhirt, S M; Lange, R

    2005-09-01

    The introduction of telemanipulator systems into cardiac surgery enabled the heart surgeon to perform minimally invasive procedures with high precision and stereoscopic view. For further improvement and especially for inclusion of autonomous action sequences, implementation of force-feedback is necessary. The aim of our study was to provide a robotic scenario giving the surgeon an impression very similar to open procedures (high immersion) and to enable autonomous surgical knot tying with delicate suture material. In this experimental set-up the feasibility of autonomous surgical knot tying is demonstrated for the first time using stereoscopic view and force feedback.

  11. Surgical care burden in orbito-temporal neurofibromatosis: Multiple procedures and surgical care duration analysis in 47 consecutive adult patients.

    PubMed

    Pessis, Rachel; Lantieri, Laurent; Britto, Jonathan A; Leguerinel, Caroline; Wolkenstein, Pierre; Hivelin, Mikaël

    2015-10-01

    Patients with orbito-temporal neurofibromatosis (OTNF) bear a heavy burden of surgical care. We studied 47 consecutive patients with OTNF from the French Neurofibromatosis 1 Referral Center cohort (n > 900), over a 15-year period to determine the clinical features most likely to predict repeat surgery and longer duration of surgical care. Forty-seven patients (5.2% of the NF1 patients' cohort) underwent 79 procedures with a 4.8 years average follow-up. Soft-tissue surgery had a high revision rate (19/45 patients), skeletal surgery did not (2/13 patients). Transosseous wire canthopexy and facial aesthetic unit remodeling were associated with stable outcome. Ptosis repair carried an unfavorable outcome, particularly in the presence of sphenoid dysplasia. Stable skeletal remodeling was achieved with polyethylene implants and/or cementoplasty. Multiple procedures were undertaken in 70% of patients and were predicted by the NF volume, canthopexy, skeletal dysplasia, or a Jackson's classification 2 and/or 3; but not by declining visual acuity. A classification based upon predictive risk of repeated procedures is proposed: Group 1: Isolated soft tissue infiltration not requiring levator palpebrae or canthal surgery; Group 2: Soft tissue involvement requiring ptosis repair or canthopexy, or NF great axis over 4.5 cm; Group 3: Presence of sphenoid dysplasia with pulsatile proptosis, regardless of visual acuity.

  12. Endoscopic goniotomy: a potential surgical procedure for primary infantile glaucoma

    NASA Astrophysics Data System (ADS)

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

    1993-06-01

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

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

    PubMed Central

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

    2014-01-01

    ABSTRACT Aim: This paper reports two clinical cases in which the application of low-level laser therapy (LLLT) enhanced the postoperative symptoms after pediatric surgical procedures. Background: The uses of novel technologies allow more comfort to the patients and ensure a rapid procedure, and LLLT application has shown a positive effect in the prevention of discomfort after invasive procedures. Case description: Low-level laser therapy protocol was applied after surgical removal of supernumerary tooth and frenectomy resulting in less swallow and pain with no need of medication intake. Conclusion: The laser application was well accepted by both children and parents and showed a clinical efficiency in the follow-up examinations beyond the satisfactory quality of wound healing. Clinical significance: The LLLT approach is an excellent adjuvant therapy resource for delivery an optimal postoperative after surgical procedures in children. How to cite this article: Paschoal M, Souza J, Santos-Pinto L, Pansani C. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures. Int J Clin Pediatr Dent 2014;7(2):125-129. PMID:25356012

  14. Surgical treatment of inflammatory abdominal aortic aneurysms: a long-term follow-up of 19 patients.

    PubMed

    Railo, Mikael; Isoluoma, Martti; Keto, Pekka; Salo, Jarmo A

    2005-05-01

    The prevalence of inflammatory abdominal aortic aneurysms (IAAA) in autopsy material ranges between 2.5 and 10% of all aneurysms. Clinical findings, the distinction between inflammatory and degenerative aneurysms, and epidemiological data are uncertain, and only a few long-term follow-up studies of patients after surgical treatment of IAAAs exist. In this study, 19 patients underwent either emergency or elective surgery for IAAA during the 10-year period between 1983 and 1993 at Helsinki University Central Hospital. Demographics, symptoms, and operative and follow-up data were collected retrospectively with emphasis on the long-term outcome of IAAA. Causes of late death were available from hospital records and the central statistical office of Finland. For survival analysis we compared ruptured versus nonruptured and emergency versus elective cases of IAAAs. Mean follow-up for the 18 surviving patients (1 hospital death) was 7.4 years. One patient (5%) died of a long-term complication of the aneurysmal disease. There was no statistically significant difference in survival rates for emergency versus elective surgery cases or ruptured versus nonruptured aneurysms. The most common cause of late death was myocardial infarction. The hospital stay mortality (5%) and morbidity (31%), and the survival rate of 26% at 5 years for ruptured and 65% and 43% for nonruptured IAAAs at 5 years and 10 years, respectively, are comparable to normal AAA survival rates. These findings show that surgery is recommended, especially as ruptures also occur in this subgroup of aneurysms.

  15. [A case of surgical treatment for solitary lymph node recurrence of hepatocellular carcinoma simultaneously developed in the mediastinum and abdominal cavity].

    PubMed

    Uchinami, Hiroshi; Abe, Yuki; Kikuchi, Isao; Yoshioka, Masato; Kume, Makoto; Sato, Tsutomu; Yamamoto, Yuzo

    2009-07-01

    We report a surgically treated case of lymph node recurrence from hepatocellular carcinoma (HCC) that occurred simultaneously but individually in the mediastinum and abdominal cavity with no metastasis. A 52-year-old man had undergone left lateral segmentectomy for poorly differentiated HCC. Three months after surgery, abdominal computed tomography revealed an enlarged solitary lymph node along the common hepatic artery. Another isolated mediastinal lymph node was also positive on whole body 18F-fluorodeoxyglucose positron emission tomography. Because no other metastatic lesions were identified, we resected these two lymph nodes under a diagnosis of lymph node metastases from HCC. Histopathologically, both of them were classified as poorly differentiated HCC with solid growth. No further recurrence has been found during 20-month follow-up period. Our experience suggested that even though metastatic lymph nodes of HCC were present in the mediastinum and abdominal cavity, resection may provide survival benefit if each metastasis is individually solitary.

  16. Hemopatch Application for Ventricular Wall Laceration in Redo Cardiac Surgical Procedures.

    PubMed

    Sandrio, Stany; Purbojo, Ariawan; Cesnjevar, Robert A; Rüffer, André

    2016-02-01

    As survival among patients with complex congenital heart disease continues to improve, long-term survivors frequently require redo surgical procedures, with potentially escalating technical difficulty and bleeding risk. This report describes our experience with a new hemostatic pad, Hemopatch (Baxter Deutschland GmbH, Unterschleissheim, Germany) in redo cardiac surgery.

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

    PubMed

    Uygur, Safak; Tuncer, Serhan

    2014-12-01

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

  18. [Perioperative pain management for abdominal and thoracic surgery].

    PubMed

    Englbrecht, J S; Pogatzki-Zahn, E M

    2014-06-01

    Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures.

  19. [Abdominal paracentesis].

    PubMed

    Glauser, Frédéric; Barras, Anne-Catherine; Pache, Isabelle; Monti, Matteo

    2008-10-29

    Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill.

  20. Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy

    PubMed Central

    Nath, Rahul K; Somasundaram, Chandra

    2016-01-01

    AIM To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy (OBPP) patients to results of conventional operative procedures at other institutions. METHODS We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years (average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us. We analyzed the anatomical improvements and functional modified Mallet statistically before and after a year post-revision operations. RESULTS Pre-revision surgery average modified Mallet score was 12.0 ± 1.5. This functional score was greatly improved to 18 ± 2.3 (P < 0.0001) at least one-year after revision surgical procedures. Radiological scores (PHHA and glenoid version) were also improved significantly to 31.9 ± 13.6 (P < 0.001), -16.3 ± 11 (P < 0.0002), at least one-year after triangle tilt procedure. Their mean pre-triangle tilt (yet after other surgeon’s surgeries) PHHA, glenoid version and SHEAR were 14.6 ± 21.7, -31.6 ± 19.3 and 16.1 ± 14.7 respectively. CONCLUSION We demonstrate here, mod Quad and triangle tilt as successful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment. PMID:27900273

  1. Prevalence and Characteristics of Surgical Site Infections Caused by Gram-negative Rod-shaped Bacteria from the Family Enterobacteriacae and Gram-positive Cocci from the Genus Staphylococcus in Patients who Underwent Surgical Procedures on Selected Surgical Wards.

    PubMed

    Tomaszewska-Kowalska, Małgorzata; Kołomecki, Krzysztof; Wieloch-Torzecka, Maria

    2016-10-01

    Surgical site infections on surgical wards are the most common cause of postoperative complications. Prevalence of surgical site infections depends on the surgical specialization. Analysis of the causes of surgical site infections allows to conclude that microorganisms from the patient's own microbiota - Gram-negative rod-shaped bacteria from the family Enterobacteriacae and from the patient's skin microbiota - Gram-positive cocci - Staphylococcus are the most common agents inducing surgical site infections. The aim of the study was to assess prevalence and characteristics of surgical site infections caused by Gram-negative rod-shaped bacteria from the family Eneterobacteriacae and Gram-positive cocci from the genus Staphylococcus in patients who underwent surgical procedures at the Regional Specialist Hospital named after M. Copernika in Łódź on selected surgical wards.

  2. Surgical Resection for Hepatocellular Carcinoma with Cardiac Cirrhosis after the Fontan Procedure

    PubMed Central

    Takuma, Yoshitaka; Fukada, Yuji; Iwadou, Shota; Miyatake, Hirokazu; Uematsu, Shuji; Okamoto, Ryoichi; Sato, Daisuke; Matsukawa, Hiroyoshi; Shiozaki, Shigehiro; Kamada, Masahiro; Morito, Toshiaki; Araki, Yasuyuki

    2016-01-01

    A 29-year-old woman who underwent the Fontan procedure at 10 years of age had an incidental finding of liver masses on abdominal ultrasonography. Subsequent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid magnetic resonance imaging showed a 15 mm hypervascular mass with washout in the hepatobiliary phase in liver segment 4 (S4), and an 18 mm hypervascular mass without washout in the hepatobiliary phase in liver segment 2 (S2). The S2 liver mass was pathologically diagnosed to be a regenerative nodule by an ultrasound-guided needle biopsy, and the S4 liver mass was pathologically diagnosed as a poorly differentiated hepatocellular carcinoma after partial hepatectomy. PMID:27853067

  3. [Surgical treatment for aortic arch aneurysm: newly developed procedures and their outcomes].

    PubMed

    Ogino, Hitoshi

    2011-01-01

    The surgical treatment of aortic arch aneurysm including newly developed procedures and their outcomes is reviewed. Major advances in aortic arch repair have been made by meticulous brain protection with antegrade-selective and retrograde cerebral perfusion in addition to hypothermia circulatory arrest and refinement of surgical techniques. Total arch replacement using a multibranched prosthetic graft with antegrade-selective cerebral perfusion (SCP) under hypothermia through a median sternotomy has been standardized, resulting in lower mortality and cerebral mortality rates. In particular, the impact of the use of the axillary artery for cardiopulmonary bypass and of the stepwise or elephant trunk technique for distal anastomosis has recently been assessed. In addition, arch repair under moderate hypothermia in conjunction with SCP has been attempted without any serious problems. The surgical strategy for extended aortic aneurysms is also of concern. A two-stage approach with an elephant trunk procedure is employed predominantly for high-risk patients, while one-stage repair is aggressively applied for relatively young, low-risk patients. In contrast, there has been great progress in stent graft therapy for aortic arch lesions. Arch stent graft repairs including hybrid procedures have been attempted in elderly, high-risk patients. Consequently, these comorbid procedures can be used satisfactorily.

  4. [The Significance of Resection of the Cricoid Cartilage as a Surgical Procedure in Laryngotracheal Surgery].

    PubMed

    Hirai, Tomohisa; Fukushima, Noriyuki; Kano, Makoto; Miyahara, Nobuyuki; Miyoshi, Ayako; Ariki, Masahiko; Masuda, Shin; Nagamine, Hisayo

    2015-10-01

    The cricoid cartilage has been regarded as an extremely important organ because it plays important role in both of phonation and breathing. We herein report on two different types of surgical procedure for laryngotracheal diseases with aggressive resection of the cricoid cartilage. The first procedure is a tracheostomaplasty by partial resection of the cricoid cartilage. A tracheostoma is made by resection of the cricoid cartilage in the range of approximately a one-third front. This method is effective for such cases having difficulty in tracheostomy owing their backgrounds with such condition as neck stiffness, obesity, higher displacement of the brachiocephalic artery, short neck, thyroid disease and so on. We applied this procedure for eight cases with such difficult backgrounds. In all cases, we were able to make a good tracheostoma and the postoperative courses were uneventful. The second procedure is a glottic closure with resection of the cricoid cartilage and thyroid cartilage. We applied this procedure for six cases with intractable dysphagia. One case had a postoperative bleeding. We were able to make good conditions in all cases with a large tracheostoma and no pharyngeal-tracheal leakage. In conclusion, the surgical procedure involving resection of the cricoid cartilage can be applied to some laryngotracheal diseases.

  5. Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis.

    PubMed

    Lam, Hwai-Ding; Schaapherder, Alexander F; Kopp, Wouter H; Putter, Hein; Braat, Andries E; Baranski, Andrzej G

    2017-02-01

    Professional abdominal organ recovery with certification has been mandatory in the Netherlands since 2010. This study analyses the effects of certification (January 2010-September 2015) on pancreas transplantation and compares it to an era before certification (February 2002-May 2008) for surgical injuries and the number of pancreases transplanted. A total of 264 cases were analysed. Eighty-four recovered pancreases (31.8%) with surgically injuries were encountered. Forty-six of those were surgically salvaged for transplantation, resulting in a total of 226 (85.6%) being transplanted. It was found that certified surgeons recovered grafts from older donors (36.8 vs. 33.3; P = 0.021), more often from donation after circulatory death (DCD) donors (18% vs. 0%; P < 0.001) and had less surgical injuries (21.6% vs. 41.0%; P < 0.001). Certification (OR: 0.285; P < 0.001) and surgeons from a pancreas transplant centre (OR: 0.420; P = 0.002) were independent risk factors for surgical organ injury. Predictors for proceeding to the actual pancreas transplantation were a recovering surgeon from a pancreas transplantation centre (OR: 3.230; P = 0.003), certification (OR: 3.750; P = 0.004), donation after brain death (DBD) (OR: 8.313; P = 0.002) and donor body mass index (BMI) (OR: 0.851; P = 0.023). It is concluded that certification in abdominal organ recovery will limit the number of surgical injuries in pancreas grafts which will translate in more pancreases available for transplantation.

  6. The Impact of Body Mass Index on Perioperative Outcomes of Open and Endovascular Abdominal Aortic Aneurysm Repair from the National Surgical Quality Improvement Program 2005–2007

    PubMed Central

    Giles, Kristina A; Wyers, Mark C; Pomposelli, Frank B; Hamdan, Allen D; Ching, Y Avery; Schermerhorn, Marc L

    2010-01-01

    OBJECTIVES Obesity and morbid obesity have been shown to increase wound infections and occasionally mortality after many surgical procedures. Little is known about the relative impact of body mass index on these outcomes after open (OAR) and endovascular abdominal aortic aneurysm repair (EVAR). METHODS The 2005–2007 National Surgical Quality Improvement Program (NSQIP), a multi-institutional risk-adjusted database, was retrospectively queried to compare perioperative mortality (in-hospital or 30-day) and postoperative wound infections after OAR and EVAR. Patient demographics, comorbidities, and operative details were analyzed. Body mass index (BMI) was calculated from height and weight variables and definitions of obesity and morbid obesity were defined as BMI > 30kg/m2 and BMI > 40kg/m2 respectively. Student's T-test, Wilcoxon Rank Sum, Chi-square, and multivariate logistic regression were used to compare outcomes. RESULTS There were 2,097 OAR and 3,358 EVAR. Compared to EVAR, OAR patients were younger, more likely to be female (26% vs. 17%, P < .001), and less obese (27% vs. 32%, P < .001). Mortality was 3.7% vs. 1.2% after OAR vs. EVAR respectively (RR 3.1, P < .001) and overall morbidity was 28% vs. 12% (RR 2.3, P < .001). Morbidly obese patients had a higher mortality for both OAR (7.3%) and EVAR (2.4%) than obese patients (3.9% OAR; 1.5% EVAR) or non-obese patients (3.7% OAR; 1.1% EVAR). Obese patients had a higher rate of wound infection vs. non-obese after open repair (6.3% vs. 2.4%, P < .001) and EVAR (3.3% vs. 1.5%, P < .001). Morbid obesity predicted mortality after OAR but not EVAR and obesity was an independent predictor of wound infection after OAR and EVAR. CONCLUSIONS Morbid obesity confers a worse outcome for mortality after AAA repair. Obesity is also a risk factor for infectious complications after OAR and EVAR. Obese patients and particularly morbidly obese patients should be treated with EVAR when anatomically feasible. PMID:20843627

  7. Abdominal Adhesions

    MedlinePlus

    ... Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. Seek Help for ... and how to participate, visit the NIH Clinical Research Trials and You website ... Foundation for Functional Gastrointestinal Disorders 700 West Virginia ...

  8. Laparoscopic repair of abdominal incisional hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Abdominal incisional hernia is a common complication after open abdominal operations. Laparoscopic procedures have obvious mini-invasive advantages for surgical treatment of abdominal incisional hernia, especially to cases with big hernia defect. Laparoscopic repair of incisional hernia has routine mode but the actual operations will be various according to the condition of every hernia. Key points of these operations include design of the position of trocars, closure of defects and fixation of meshes. The details of these issues and experiences of perioperative evaluation and treatment will be talked about in this article. PMID:27761446

  9. [The isolated perfused porcine kidney model for investigations concerning surgical therapy procedures].

    PubMed

    Peters, Kristina; Michel, Maurice Stephan; Matis, Ulrike; Häcker, Axel

    2006-01-01

    Experiments to develop innovative surgical therapy procedures are conventionally conducted on animals, as crucial aspects like tissue removal and bleeding disposition cannot be investigated in vitro. Extracorporeal organ models however reflect these aspects and could thus reduce the use of animals for this purpose fundamentally in the future. The aim of this work was to validate the isolated perfused porcine kidney model with regard to its use for surgical purposes on the basis of histological and radiological procedures. The results show that neither storage nor artificial perfusion led to any structural or functional damage which would affect the quality of the organ. The kidney model is highly suitable for simulating the main aspects of renal physiology and allows a constant calibration of perfusion pressure and tissue temperature. Thus, with only a moderate amount of work involved, the kidney model provides a cheap and readily available alternative to conventional animal experiments; it allows standardised experimental settings and provides valid results.

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

    PubMed

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

    1989-01-01

    Surgical results of paediatric patients with Moyamoya disease who were treated by indirect revascularization procedures are reported. Encephalo-duro-arterio-synangiosis (EDAS), encephalomyo-arterio-synangiosis (EMAS), and/or encephalo-myo-synangiosis (EMS) were performed on 47 sides of 29 children with Moyamoya disease. The results of those non-anastomotic EC-IC bypass procedures were evaluated clinically, angiographically, and by computed tomography (CT). Postoperative external carotid angiograms showed a good collateral formation through EDAS, EMAS, or EMS in about 70-80 percent of all surgically treated sides. The symptoms such as TIA, RIND, and/or involuntary movements disappeared in the cases with a good collateral formation but not in those with insufficient development of the collateral circulation. The indirect EC-IC bypass surgery seems effective for most of the children with Moyamoya disease who present with ischaemic signs.

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

    PubMed

    Rehork, B; Rüden, H

    1991-10-01

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

  12. The Perception of Aversiveness of Surgical Procedure Pictures Is Modulated by Personal/Occupational Relevance

    PubMed Central

    Paes, Juliana; de Oliveira, Leticia; Pereira, Mirtes Garcia; David, Isabel; Souza, Gabriela Guerra Leal; Sobral, Ana Paula; Machado-Pinheiro, Walter; Mocaiber, Izabela

    2016-01-01

    It is well established that emotions are organized around two motivational systems: the defensive and the appetitive. Individual differences are relevant factors in emotional reactions, making them more flexible and less stereotyped. There is evidence that health professionals have lower emotional reactivity when viewing scenes of situations involving pain. The objective of this study was to investigate whether the rating of pictures of surgical procedure depends on their personal/occupational relevance. Fifty-two female Nursing (health discipline) and forty-eight Social Work (social science discipline) students participated in the experiment, which consisted of the presentation of 105 images of different categories (e.g., neutral, food), including 25 images of surgical procedure. Volunteers judged each picture according to its valence (pleasantness) and arousal using the Self-Assessment Manikin scale (dimensional approach). Additionally, the participants chose the word that best described what they felt while viewing each image (discrete emotion perspective). The average valence score for surgical procedure pictures for the Nursing group (M = 4.57; SD = 1.02) was higher than the score for the Social Work group (M = 3.31; SD = 1.05), indicating that Nursing students classified those images as less unpleasant than the Social Work students did. Additionally, the majority of Nursing students (65.4%) chose “neutral” as the word that best described what they felt while viewing the pictures. In the Social Work group, disgust (54.2%) was the emotion that was most frequently chosen. The evaluation of emotional stimuli differed according to the groups' personal/occupational relevance: Nursing students judged pictures of surgical procedure as less unpleasant than the Social Work students did, possibly reflecting an emotional regulation skill or some type of habituation that is critically relevant to their future professional work. PMID:27518897

  13. The Perception of Aversiveness of Surgical Procedure Pictures Is Modulated by Personal/Occupational Relevance.

    PubMed

    Paes, Juliana; de Oliveira, Leticia; Pereira, Mirtes Garcia; David, Isabel; Souza, Gabriela Guerra Leal; Sobral, Ana Paula; Machado-Pinheiro, Walter; Mocaiber, Izabela

    2016-01-01

    It is well established that emotions are organized around two motivational systems: the defensive and the appetitive. Individual differences are relevant factors in emotional reactions, making them more flexible and less stereotyped. There is evidence that health professionals have lower emotional reactivity when viewing scenes of situations involving pain. The objective of this study was to investigate whether the rating of pictures of surgical procedure depends on their personal/occupational relevance. Fifty-two female Nursing (health discipline) and forty-eight Social Work (social science discipline) students participated in the experiment, which consisted of the presentation of 105 images of different categories (e.g., neutral, food), including 25 images of surgical procedure. Volunteers judged each picture according to its valence (pleasantness) and arousal using the Self-Assessment Manikin scale (dimensional approach). Additionally, the participants chose the word that best described what they felt while viewing each image (discrete emotion perspective). The average valence score for surgical procedure pictures for the Nursing group (M = 4.57; SD = 1.02) was higher than the score for the Social Work group (M = 3.31; SD = 1.05), indicating that Nursing students classified those images as less unpleasant than the Social Work students did. Additionally, the majority of Nursing students (65.4%) chose "neutral" as the word that best described what they felt while viewing the pictures. In the Social Work group, disgust (54.2%) was the emotion that was most frequently chosen. The evaluation of emotional stimuli differed according to the groups' personal/occupational relevance: Nursing students judged pictures of surgical procedure as less unpleasant than the Social Work students did, possibly reflecting an emotional regulation skill or some type of habituation that is critically relevant to their future professional work.

  14. Infrainguinal endovascular procedures should be reserved for patients who do not have good open surgical options.

    PubMed

    Rubin, Brian; Reddy, Daniel J; Kalman, Peter G

    2005-09-01

    This article is the result of a debate. The motion proposed was "Infrainguinal endovascular procedures should be reserved for patients who do not have good open surgical options.'' Arguments in favor of the motion were offered by Daniel J. Reddy of Henry Ford Hospital in Detroit, MI, and arguments against the motion were offered by Peter Kalman of Loyola University Medical Center in Maywood, IL.

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

    PubMed

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

    2014-01-01

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

  16. Identification of Cutaneous Mycobacterium massiliense Infections Associated with Repeated Surgical Procedures

    PubMed Central

    Cho, Ah Young; Kim, Yeon Sook; Kook, Yoon Hoh; Kim, Shin Ok; Back, Seung Ju; Seo, Young Joon; Lee, Jeung Hoon

    2010-01-01

    Mycobacterium massiliense, an emerging pathogen that is increasingly reported as a causative agent in infections occurring during medical procedures, is difficult to be identified using conventional methods. Here we report the case of a cutaneous M. massiliense infection that was associated with repeated surgical procedures and that was identified via a comparative sequence analysis of rpoB and hsp65. The patient showed a substantial response to treatment with a combination of antimicrobial therapies consisting of clarithromycin, amikacin, and cefoxitin for 6 months. PMID:20548899

  17. The bilateral bispectral and the composite variability indexes during anesthesia for unilateral surgical procedure

    PubMed Central

    Lopes-Pimentel, Pedro; Koo, Maylin; Bocos, Javier; Sabaté, Antoni

    2017-01-01

    Background: The composite variability index (CVI), derived from the bispectral analysis (BIS), has been designed to detect nociception; however, there is no evidence that bilateral BIS and CVI show intrapatient reproducibility or variability. Methods: We conducted an observational study in patients who underwent for total knee arthroplasty. A BIS Bilateral Sensor was applied and continuously recorded at different points of the anesthesia procedure. Bland–Altman limits of agreement and dispersion for BIS and for CVI were applied. Results: Forty-nine right-handed patients were studied. There were differences between the right and left BIS values after tracheal intubation (which was higher on the right side) and at surgical stimulus (higher on the left side). The maximum BIS and minimum, mean, and maximum CVI scores were higher on the left side for left-side procedures, but there were no differences in any indexes for the right-side procedures. Except for the baseline measurements, both CVI and BIS scores presented high interpatient variability. Although the right to left bias was < 3% for the BIS index, dispersion was large at different stages of the anesthesia. The right to left bias for the CVI was 3.8% at tracheal intubation and 5.7% during surgical stimulus. Conclusions: Our results indicate that the large interindividual variability of BIS and CVI limits their usefulness. We found differences between the left and right measurements in a right-handed series of patients during surgical stimuli though they were not clinically relevant. PMID:28217053

  18. [Postoperative evaluation of different surgical procedures in genuine stress urinary incontinence: a retrospective study].

    PubMed

    Rodríguez-Colorado, S; Pérez-Soriano, P; Alvarez-Mercado, R L; Herbert, A; Kunhardt-Rasch, J

    1996-06-01

    An evaluation of the surgical treatment for stress and mixed urinary incontinence and pelvic relaxation. One-year follow-up, was done. A retrospective study with 144 files from the surgeries performed between February 1993 and June 1994, at the Clínica de Urología Ginecológica del Instituto Nacional de Perinatología. We excluded 37 files because of incomplete information. The age, parity, hormonal stage, preoperative diagnosis by urodynamic studies, surgical treatments and one-year follow-up were analyzed. The mean age was 45.5 years. Pereyra procedure was performed in 53, Burch procedure in 47, anterior colporrhaphy in 5, and sling procedure in 2 patients. The incidence of complications was similar between the different groups. Resumption of spontaneous postsurgical voiding was delayed in the Pereyra group. The Burch urethropexy and Pereyra procedures were equally effective, with no statistical differences observed. Burch vaginal suspension was not more effective for the correction of urinary stress incontinence than Pereyra procedure.

  19. Reconstruction of the Lower Abdominal Region Using Bilateral Pedicled Anterolateral Thigh Flaps Combined With Poly-Surgical Mesh: A Case Report.

    PubMed

    Zhou, Bo; Zhou, Xiao; Li, Zan; Chen, Ju-Ying; Peng, Xiao-Wei; Yang, Li-Chang; Lv, Chun-Liu

    2015-12-01

    The en-bloc resection of neoplasms on the abdominal wall often causes extensive defects that are difficult to manage. The anterolateral thigh (ALT) flap is a widely used flap in reconstructive surgery of defects. In this article, we present a case using bilateral pedicle anterolateral thigh flaps combined with a surgical polymesh to repair a large defect (22 cm × 18 cm) caused by dissection of a recurrent fibromatosis with good functional and aesthetic effects. There were no obvious morbidities or complications during a 6-month follow-up period.We conclude that the bilateral pedicle anterolateral thigh flap is a good choice for reconstruction of large lower abdominal wall defects. It can afford sufficient soft tissue coverage without obvious donor site morbidity.

  20. Surgically-induced astigmatism in combined ECCE with filtering procedures compared to ECCE alone.

    PubMed

    Choplin, N T; Monroe, J F

    1992-02-01

    Extracapsular cataract extraction with implantation of a posterior chamber lens combined with filtering surgery (glaucoma triple procedure) is frequently employed in the co-management of cataract and glaucoma. Nineteen triple procedures with a minimum of six months follow up were compared to 19 cases of extracapsular cataract extraction with lens implant matched for age, sex, and surgeon with regard to surgically induced astigmatism as determined by vector analysis. Follow up averaged 10 months for the triple group and 14 months for the controls. There was no statistically significant difference in preoperative astigmatism between the two groups nor in the mean number of sutures cut. Postoperatively, the keratometric cylinder averaged 2.55 +/- 1.54 diopters for the cases and 1.20 +/- 1.11 D for the controls; the difference of 1.36 D was statistically significant (P = .004). The postoperative refractive cylinder was 2.34 +/- 1.54 D for the cases and 1.29 +/- 1.07 D for the controls; the difference of 1.05 D was statistically significant (P = .017). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 +/- 1.25 D and the controls 1.23 +/- 0.81 D; the difference of 0.95 D was statistically significant (P = .006). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 +/- 1.25 D and the controls 1.23 +/- 0.81 D; the difference of 0.95 D was statistically significant (P = .006). When analyzed for change along the vertical meridian, the cases averaged 1.12 +/- 1.57 D surgically-induced against-the-rule astigmatism, as compared with 0.30 +/- 1.16 D for the controls (difference, 0.83 D; P = .062). The glaucoma triple procedures induced approximately 1.00 D more cylinder than the controls.

  1. Development of a surgical procedure for implantation of a prototype suprachoroidal retinal prosthesis

    PubMed Central

    Saunders, Alexia L; Williams, Chris E; Heriot, Wilson; Briggs, Robert; Yeoh, Jonthan; Nayagam, David AX; McCombe, Mark; Villalobos, Joel; Burns, Owen; Luu, Chi D; Ayton, Lauren N; McPhedran, Michelle; Opie, Nicholas L; McGowan, Ceara; Shepherd, Robert K; Guymer, Robyn; Allen, Penelope J

    2014-01-01

    Background Current surgical techniques for retinal prosthetic implantation require long and complicated surgery, which can increase the risk of complications and adverse outcomes. Method The suprachoroidal position is known to be an easier location to access surgically, and so this study aimed to develop a surgical procedure for implanting a prototype suprachoroidal retinal prosthesis. The array implantation procedure was developed in 14 enucleated eyes. A full-thickness scleral incision was made parallel to the intermuscular septum and superotemporal to the lateral rectus muscle. A pocket was created in the suprachoroidal space, and the moulded electrode array was inserted. The scleral incision was closed and scleral anchor point sutured. In 9 of the 14 eyes examined, the device insertion was obstructed by the posterior ciliary neurovascular bundle. Subsequently, the position of this neurovascular bundle in 10 eyes was characterized. Implantation and lead routing procedure was then developed in six human cadavers. The array was tunnelled forward from behind the pinna to the orbit. Next, a lateral canthotomy was made. Lead fixation was established by creating an orbitotomy drilled in the frontal process of the zygomatic bone. The lateral rectus muscle was detached, and implantation was carried out. Finally, pinna to lateral canthus measurements were taken on 61 patients in order to determine optimal lead length. Results These results identified potential anatomical obstructions and informed the anatomical fitting of the suprachoroidal retinal prosthesis. Conclusion As a result of this work, a straightforward surgical approach for accurate anatomical suprachoroidal array and lead placement was developed for clinical application. PMID:24330322

  2. Does menopausal status impact urinary continence outcomes following abdominal sacrocolpopexy without anti-incontinence procedures in continent women?

    PubMed Central

    Inan, Abdurrahman Hamdi; Toz, Emrah; Beyan, Emrah; Gurbuz, Tutku; Ozcan, Aykut; Oner, Oznur

    2016-01-01

    Objective: We investigated the impact of menopausal status on urinary continence following abdominal sacrocolpopexy (ASC) without an anti-incontinence procedure in continent women. Methods: We conducted a clinical follow-up study of 137 patients diagnosed with stage 3 or higher pelvic organ prolapse (POP) without urinary incontinence between January 2012 and December 2014. Patients were provided with detailed a priori information pertaining to the abdominal sacrocolpopexy procedure and were invited to attend follow-up visits at 1, 3, 12, and 24 months. Follow-up visits included a gynecological examination, cough test, and validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. Results: The mean follow-up time for the cohort was 16.5±3.45 months. The study group was divided according to menopausal status: premenopausal (Group-1) and postmenopausal women (Group-II). Anatomical recurrence was not detected during the follow-up period in either group, but de novo stress urinary incontinence was seen in 15 of 53 (28.3%) Group-I patients and in 6 of 84 (7.1%; p < 0.01) Group-II patients. Conclusions: The risk of de novo stress urinary incontinence in postmenopausal women after ASC is low. However, premenopausal patients have a higher incidence of de novo stress incontinence which affect quality of life. PMID:27648027

  3. Elbow denervation in dogs: development of an in vivo surgical procedure and pilot testing.

    PubMed

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

    2011-11-01

    The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

  4. Android application for determining surgical variables in brain-tumor resection procedures.

    PubMed

    Vijayan, Rohan C; Thompson, Reid C; Chambless, Lola B; Morone, Peter J; He, Le; Clements, Logan W; Griesenauer, Rebekah H; Kang, Hakmook; Miga, Michael I

    2017-01-01

    The fidelity of image-guided neurosurgical procedures is often compromised due to the mechanical deformations that occur during surgery. In recent work, a framework was developed to predict the extent of this brain shift in brain-tumor resection procedures. The approach uses preoperatively determined surgical variables to predict brain shift and then subsequently corrects the patient's preoperative image volume to more closely match the intraoperative state of the patient's brain. However, a clinical workflow difficulty with the execution of this framework is the preoperative acquisition of surgical variables. To simplify and expedite this process, an Android, Java-based application was developed for tablets to provide neurosurgeons with the ability to manipulate three-dimensional models of the patient's neuroanatomy and determine an expected head orientation, craniotomy size and location, and trajectory to be taken into the tumor. These variables can then be exported for use as inputs to the biomechanical model associated with the correction framework. A multisurgeon, multicase mock trial was conducted to compare the accuracy of the virtual plan to that of a mock physical surgery. It was concluded that the Android application was an accurate, efficient, and timely method for planning surgical variables.

  5. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

    PubMed Central

    da Silva, Katia Regina; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; de Carvalho, Eduardo Infante Januzzi; Fiorelli, Alfredo Inácio; Martinelli Filho, Martino; Costa, Roberto

    2016-01-01

    Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. PMID:27579544

  6. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat)

    PubMed Central

    Lewis, Kevin Michael; Kuntze, Carl Erik; Gulle, Heinz

    2016-01-01

    The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat) is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG). NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. PMID:26730213

  7. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat).

    PubMed

    Lewis, Kevin Michael; Kuntze, Carl Erik; Gulle, Heinz

    2016-01-01

    The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat) is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG). NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies.

  8. Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures.

    PubMed

    Alparslan, Leyla; Chiodo, Christopher P

    2008-12-01

    Chronic ankle instability has been defined as the development of recurrent ankle sprains and persistent symptoms after initial lateral ankle sprain. The diagnosis of ankle instability is usually established on the patient's history, physical examination, and radiographic assessment. Patients have signs of both functional and mechanical instability, and the repetitive, chronic nature of the injury may lead to intra-articular and periarticular pathologies. This article discusses the incidence, etiology, and magnetic resonance (MR) imaging of these pathologies, reviews the surgical treatment procedures for lateral ankle instability, and presents the postoperative MR imaging findings.

  9. Severe retroperitoneal and intra-abdominal bleeding after stapling procedure for prolapsed haemorrhoids (PPH); diagnosis, treatment and 6-year follow-up of the case.

    PubMed

    Safadi, Wajdi; Altshuler, Alexander; Kiv, Sakal; Waksman, Igor

    2014-10-30

    Procedure for prolapsed haemorrhoids (PPH) is a popular treatment of haemorrhoids. PPH has the advantages of a shorter operation time, minor degree of postoperative pain, shorter hospital stay and quicker recovery but may be followed by several postoperative complications. Rectal bleeding, acute pain, chronic pain, rectovaginal fistula, complete rectal obliteration, rectal stenosis, rectal pocket, tenesmus, faecal urgency, faecal incontinence, rectal perforation, pelvic sepsis and rectal haematoma have all been reported as postoperative complications of PPH. Additionally, one rare complication of the procedure is intra-abdominal bleeding. There are a few case reports describing intra-abdominal bleeding after the procedure. We report a case of a 26-year-old man who developed severe intra-abdominal and retroperitoneal haemorrhage after PPH. The diagnosis was made on the second postoperative day by CT of the abdomen and pelvis. The patient was treated conservatively and had an uneventful recovery.

  10. Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

    PubMed

    Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E

    2017-03-01

    OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas

  11. Evaluation of surgical anti-adhesion products to reduce postsurgical intra-abdominal adhesion formation in a rat model

    PubMed Central

    Zhang, Hui-Hui; Liao, Ni-Na; Luo, Jing-Wan; Sun, Yu-Long

    2017-01-01

    Background Adhesions frequently occur after abdominal surgery. Many anti-adhesion products have been used in clinic. However, the evidences are short for surgeons to reasonably choose the suitable anti-adhesion produces in clinical practice. This study provided such evidence by comparing the efficiency of five products to prevent abdominal adhesion formation in a rat model. Methods Fifty-six Sprague-Dawley rats were randomly divided into seven groups: sham-operation group, adhesion group, and five product groups (n = 8). The abdomens of rats were opened. The injuries were created on abdominal wall and cecum in the adhesion and product groups. The wounds on abdominal wall and cecum of rats in the adhesion group were not treated before the abdomens were closed. The wounds on abdominal wall and cecum of rats in the product groups were covered with anti-adhesion product: polylactic acid (PLA) film, Seprafilm®, medical polyethylene glycol berberine liquid (PEG), medical sodium hyaluronate gel (HA), or medical chitosan (Chitosan). Fourteen days after surgery, the adhesions were evaluated by incidence, severity, adhesion area on abdominal wall and adhesion breaking strength. Results The application of PLA film and Seprafilm® significantly reduced the incidence, severity, adhesion area and breaking strength of cecum-abdomen adhesion (P<0.05). HA, PEG and Chitosan failed to significantly reduce the cecum-abdomen adhesion (P>0.05). The statistical significances in the incidence and severity of abdomen-adipose adhesion between adhesion group and the product groups were not achieved. However, Seprafilm® was more effective to reduce abdomen-adipose adhesion than PLA film. Furthermore, it was found that the products tested in this study did not effectively reduce cecum-adipose adhesion. The application of PEG could result in abdomen-small intestine adhesion. Conclusion Based on the results of this study, the preference order of anti-adhesion products used to reduce

  12. Lingual frenectomy: a comparison between the conventional surgical and laser procedure.

    PubMed

    De Santis, D; Gerosa, R; Graziani, P F; Zanotti, G; Rossini, N; Castellani, R; Bissolotti, G; Chiarini, L; Nocini, P F; Bertossi, D

    2013-08-01

    Aim: Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum that may contribute to feeding, speech and mechanical problems. The purpose of this study is to compare the advantages of laser vis-à-vis conventional frenectomy in both intra- and post-surgical phases. Methods: This study took into consideration two patients, who were respectively 9 and 10-year-old. The first one underwent a common surgical procedure. A Nd:Yap laser device with a micropulsed wavelength of 1340 nm and power of 8 watts was used for the second. The postsurgical discomfort and healing characteristics were evaluated. Results: The results indicated that the Nd:Yap laser has the following advantages when compared to the conventional frenectomy: 1) soft tissue cutting was efficient, with no bleeding, giving a clear operative field; 2) there was no need to use sutures; 3) the surgery was less time-consuming; 4) there was no postsurgical infection and no need for analgesics or antibiotics; 5) wound contraction and scarring were decreased or eliminated; 6) despite the initial slowness of the healing process, the complete and final recovery was faster. Conclusion: Considering the above elements, it is possible to assert that the laser frenectomy has a series of unquestionable advantages if compared to the conventional surgical technique.

  13. Surgical treatment of moyamoya disease in children: which is more effective procedure, EDAS or EMS?

    PubMed

    Fujita, K; Tamaki, N; Matsumoto, S

    1986-01-01

    At present, encephaloduroarteriosynangiosis (EDAS) and encephalomyosynangiosis (EMS) are the treatments of choice for moyamoya disease in children, but no attempts have been made to determine which is the more effective procedure, for the ischemic lesions in moyamoya disease. Ten patients (seven children and three adults) underwent EDAS and/or EMS: three patients EDAS on both sides; seven patients EDAS on one side and EMS on the other. These ten patients were followed up with a neurological examination and r-CBF and angiographic studies. Postoperative angiograms and r-CBF studies demonstrated more revascularization from the external carotid artery in sides treated with EDAS than with sides treated with EMS. From these results, it is concluded that the EDAS surgical procedure is superior to that of EMS for moyamoya disease.

  14. Leveraging Lexical Matching and Ontological Alignment to Map SNOMED CT Surgical Procedures to ICD-10-PCS

    PubMed Central

    Fung, Kin Wah; Xu, Julia; Ameye, Filip; Gutiérrez, Arturo Romero; D'Havé, Arabella

    2016-01-01

    In 2015 ICD-10-PCS replaced ICD-9-CM for coding medical procedures in the U.S. We explored two methods to automatically map SNOMED CT surgical procedures to ICD-10-PCS. First, we used MetaMap to lexically map ICD-10-PCS index terms to SNOMED CT. Second, we made use of the axial structure of ICD-10-PCS and aligned them to defining attributes in SNOMED CT. Lexical mapping produced 45% of correct maps and 44% of broader maps. Ontological mappings were 40% correct and 5% broader. Both correct and broader maps will be useful in assisting mappers to create the map. When the two mapping methods agreed, the accuracy increased to 93%. Reviewing the MetaMap generated body part mappings and using additional information in the SNOMED CT names and definitions can lead to better results for the ontological map. PMID:28269853

  15. Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery.

    PubMed

    Bonardelli, Stefano; Cervi, Edoardo; Nodari, Franco; Guadrini, Cristina; Zanotti, Camilla; Giulini, Stefano Maria

    2012-06-01

    Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.

  16. Surgical removal of multiple mesenteric fibroids (Kg 4,500) by abdominal spread of previous laparoscopic uterine myomectomy

    PubMed Central

    LEANZA, V.; GULINO, F.A.; LEANZA, G.; ZARBO, G.

    2015-01-01

    Introduction Huge and multiple mesenteric fibroids (4,500 Kg weight) are very unusual. In many cases they are mistaken for subserosal fibroids of the womb due to the proximity with uterine walls. When they have a rapid growth, the risk of becoming malignant (sarcoma) has not to be underestimated. Surgery is challenging to remove abdominal nodes. Case report A case of a 40-year old woman, admitted to the hospital with abdominal masses occupying the entire cavity was reported. Both computerized tomography (CT) and ultrasounds (US) were not diriment for belonging of tumours. Clinical history of patient reports a laparoscopic removal of uterine fibroids, using the morcellator. Laparoscopy was performed four years before. Open surgery by means of a large transversal suprapubic laparotomy according to Pfannestiel was carried out. Multiple and huge mesenteric, peritoneal and intestinal tumours spread in the whole abdominal cavity were found, removed and examined by frozen section histology; in addition a series of small conglomerated myomas in the site of previous laparoscopic transumbilical route was taken away as well (the largest fibroid weighed Kg 3.500 and the all tumors removed 4,500 Kg); the result was benign (fibroids) and genital apparatus was preserved. Operation was challenging. Postoperative course was uneventful; after five days patient was discharged. Conclusions This case is very interesting for many factors: A) many extra-uterine fibroids spread throughout abdominal cavity; B) considerable weight of the masses C) intraoperative and postoperative danger. Finally, due to involvement of previous laparoscopic transumbilical incision together with other findings, the hypothesis of post laparoscopic dissemination has to be considered. A case of so large extragenital abdominal fibroids following laparoscopic uterine myomectomy has never been published so far. PMID:25827668

  17. Cone-Beam CT with Flat-Panel-Detector Digital Angiography System: Early Experience in Abdominal Interventional Procedures

    SciTech Connect

    Hirota, Shozo Nakao, Norio; Yamamoto, Satoshi; Kobayashi, Kaoru; Maeda, Hiroaki; Ishikura, Reiichi; Miura, Koui; Sakamoto, Kiyoshi; Ueda, Ken; Baba, Rika

    2006-12-15

    We developed a cone-beam computed tomography (CBCT) system equipped with a large flat-panel detector. Data obtained by 200{sup o} rotation imaging are reconstructed by means of CBCT to generate three-dimensional images. We report the use of CBCT angiography using CBCT in 10 patients with 8 liver malignancies and 2 hypersplenisms during abdominal interventional procedures. CBCT was very useful for interventional radiologists to confirm a perfusion area of the artery catheter wedged on CT by injection of contrast media through the catheter tip, although the image quality was slightly degraded, scoring as 2.60 on average by streak artifacts. CBCT is space-saving because it does not require a CT system with a gantry, and it is also time-saving because it does not require the transfer of patients.

  18. Effect of the Prolonged Inspiratory to Expiratory Ratio on Oxygenation and Respiratory Mechanics During Surgical Procedures.

    PubMed

    Park, Jin Ha; Lee, Jong Seok; Lee, Jae Hoon; Shin, Seokyung; Min, Nar Hyun; Kim, Min-Soo

    2016-03-01

    Prolonged inspiratory to expiratory (I:E) ratio ventilation has been researched to reduce lung injury and improve oxygenation in surgical patients with one-lung ventilation (OLV) or carbon dioxide (CO2) pneumoperitoneum. We aimed to confirm the efficacy of the 1:1 equal ratio ventilation (ERV) compared with the 1:2 conventional ratio ventilation (CRV) during surgical procedures. Electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched.Prospective interventional trials that assessed the effects of prolonged I:E ratio of 1:1 during surgical procedures. Adult patients undergoing OLV or CO2 pneumoperitoneum as specific interventions depending on surgical procedures. The included studies were examined with the Cochrane Collaboration's tool. The data regarding intraoperative oxygenation and respiratory mechanics were extracted, and then pooled with standardized mean difference (SMD) using the method of Hedges. Seven trials (498 total patients, 274 with ERV) were included. From overall analysis, ERV did not improve oxygenation at 20 or 30 minutes after specific interventions (SMD 0.193, 95% confidence interval (CI): -0.094 to 0.481, P = 0.188). From subgroup analyses, ERV provided significantly improved oxygenation only with laparoscopy (SMD 0.425, 95% CI: 0.167-0.682, P = 0.001). At 60 minutes after the specific interventions, ERV improved oxygenation significantly in the overall analysis (SMD 0.447, 95% CI: 0.209-0.685, P < 0.001) as well as in the subgroup analyses with OLV (SMD 0.328, 95% CI: 0.011-0.644, P = 0.042) and laparoscopy (SMD 0.668, 95% CI: 0.052-1.285, P = 0.034). ERV provided lower peak airway pressure (Ppeak) and plateau airway pressure (Pplat) than CRV, regardless of the type of intervention. The relatively small number of the included articles and their heterogeneity could be the main limitations. ERV improved oxygenation at all of the

  19. Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures.

    PubMed

    Grady, Philip; Clark, Nathaniel; Lenahan, John; Oudekerk, Christopher; Hawkins, Robert; Nezat, Greg; Pellegrini, Joseph E

    2012-08-01

    Abdominal surgery has a high incidence of postoperative pain and dysfunctional gastrointestinal motility. This study investigated the effect of a continuous intraoperative infusion of lidocaine on patients undergoing laparoscopic gynecologic surgery. In this double-blind, placebo-controlled investigation, 50 subjects were randomly assigned to control and experimental groups. Both groups received an intravenous lidocaine bolus of 1 mg/kg on induction. The experimental group received a continuous lidocaine infusion of 2 mg/kg/h, initiated following induction and discontinued 15 to 30 minutes before skin closure. Controls received a placebo infusion. Patients in the experimental group had lower postoperative day 3 pain scores using a verbal analog scale (P = .02). Morphine equivalent dose at second request for pain treatment in the postoperative anesthesia care unit was lower in the experimental group (P = .02). There was a statistically significant difference in time interval from surgical start to return of first flatus between the groups (P = .02). Data were analyzed using descriptive and inferential statistics. A P value less than .05 was considered significant. These study results are consistent with previous research suggesting that intraoperative lidocaine infusion may improve postoperative pain levels and may shorten the time to return of bowel function.

  20. Hyperplasia of gastric mucosa in donor rats orally infected with Taenia taeniaeformis eggs and in recipient rats surgically implanted with the larvae in the abdominal cavity.

    PubMed

    Konno, K; Oku, Y; Nonaka, N; Kamiya, M

    1999-06-01

    Rats heavily infected with Taenia taeniaeformis larvae in the liver show a remarkable increase in their stomach weight, hyperplasia, and hypergastrinemia. However, it is unknown what causes these phenomena. Hence, as a preliminary study to investigate the importance of larval parasitism in the liver, two experiments were done. In the first experiment, 14 donor rats were orally inoculated with 3,000 T. taeniaeformis eggs. In the second experiment, 136-300 of the larvae obtained from the rats were surgically implanted into the abdominal cavity of 7 recipient rats. Gastrin levels and histopathological changes in the gastric mucosa were investigated. In all, 11 donor rats showed hypergastrinemia and hyperplasia, 5 recipient rats showed gastric mucosal hyperplasia accompanied by excessive mucous cell proliferation, and 2 recipient rats showed hypergastrinemia. These results suggest that parasitism of the liver by the larvae is not essential for the development of hyperplasia and that factors from the larvae might cause these phenomena.

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

    SciTech Connect

    Herrmann, Karin Anna; Waggershauser, Tobias; Heinemann, Volker; Reiser, Maximilian

    2001-01-15

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

  2. Successful surgical treatment of primary aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm: A case report.

    PubMed

    Ikeda, K; Abe, T; Itou, M; Tamiya, Y; Tanaka, T; Kazui, T

    1999-06-01

    We report a rare case of a 50-year-old woman with intermittent gastrointestinal (GI) bleeding and diagnosed as having primary aortoenteric fistula (PAEF) with inflammatory abdominal aortic aneurysm (IAAA). She was transferred to our institution with suspected PAEF as assessed by duodenoscopy and CT scan. As the patient was in shock due to massive GI-bleeding two days after admission, we performed an emergency laparotomy. The fistula was closed and the aneurysm replaced by a Woven Dacron Graft with an inter-positioning omental flap. A high index of suspicion is the most important diagnostic aid to prevent overlooking this often fatal disease.

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

    PubMed

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

    2012-08-01

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

  4. Hip transposition as a universal surgical procedure for periacetabular tumors of the pelvis.

    PubMed

    Gebert, Carsten; Gosheger, Georg; Winkelmann, Winfried

    2009-03-01

    Surgical treatment of pelvic tumors represents one of the most challenging problems in musculoskeletal oncology, especially in the periacetabular region. Because of the complex anatomy and demanding biomechanical situation, surgery leads to a considerable disability while all possible types of reconstruction are often associated with high complication rates. Nevertheless, it is known that wide resection of the tumor is one of the key points for long-term survival in sarcoma therapy. Therefore, hip transposition was established in our clinic as a universal tool for periacetabular tumors excelling in small foreign parts and resulting in acceptable complication rates with good functional outcome. The following article gives an overview of the technique and the indications of different types of hip transposition, which were developed from the first procedure, described and published by Winkelmann in 1988.

  5. Chemotherapeutic and surgical induction of pathological complete remission and whole abdominal irradiation for consolidation does not enhance the cure of stage III ovarian carcinoma

    SciTech Connect

    Fuks, Z.; Rizel, S.; Biran, S.

    1988-03-01

    Thirty-eight patients with stage III ovarian carcinoma were treated with a protocol consisting of an initial phase of induction of remission with cyclophosphamide, hexamethylmelamine, doxorubicin, and cisplatin (CHAD) combination chemotherapy and a second laparotomy for resection of residual tumors, followed by a consolidation phase with curative doses of whole abdominal radiation. Six patients (16%) had stage IIIA disease, ten (26%) IIIB, and 22 (58%) had stage IIIC disease. All patients received three to 14 courses of CHAD chemotherapy with a clinical response rate (complete (CR) and partial (PR)) of 91%. Thirty-three patients underwent the second operation. In 14 patients no residual tumor was found, and in another 11 residual tumors found were totally resected. Thus, 25 of 33 (76%) were classified as in pathological complete remission (PCR) after this operation. Whole abdominal irradiation was well tolerated, although 12 of 29 (42%) of the irradiated patients required more than a 2-week interruption of the treatment course because of leukopenia and/or thrombocytopenia. The actuarial 5-year survival and disease-free survival rates for the whole group were 27% and 17%, respectively, and for the 29 patients who received the complete sequence of the prescribed protocol treatments, 35% and 20%, respectively. A univariate analysis of clinical parameters showed that inherent biological features, such as histology and grade, were the most dominant factors affecting prognosis, and that neither the aggressive surgical approach employed, nor the high-dose whole abdominal irradiation, significantly affected the outcome. The long-term results suggest that although our combined modality protocol was well tolerated, it failed to enhance the cure of stage III ovarian carcinoma. The possible biological and therapeutic vectors affecting this outcome are discussed.

  6. Surgical judgment in the management of abdominal stab wounds. Utilizing clinical criteria from a 10-year experience.

    PubMed Central

    Lee, W C; Uddo, J F; Nance, F C

    1984-01-01

    A 10-year retrospective study of patients with stab wounds to the abdomen managed under a protocol of selective management has been performed. Patients were assessed on the basis of clinical presentation and physical examination, with minimal diagnostic studies. Peritoneal lavage was not utilized in the evaluation of the patients. Two hundred and nineteen such patients were identified. One hundred and eleven of these patients were treated nonoperatively. Ninety patients were treated by immediate laparotomy. Eighteen patients, initially observed, underwent delayed laparotomy. One patient, not explored despite clear-cut indications for laparotomy, died of sepsis, emphasizing the need for strict adherence to the stated protocol. The negative or unnecessary laparotomy rate was 7.8%. The false-negative examination rate was 5.5%. Overall mortality rate was 2.3%. The accuracy of careful clinical evaluation and observation is comparable to, or better than, any other method currently available to identify intra-abdominal injuries in patients with abdominal stab wounds. The study suggests that selective management of stab wounds of the abdomen may be safely practiced in a smaller community hospital. PMID:6721604

  7. Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree

    PubMed Central

    Maloku, Halit; Gashi, Zaim; Lazovic, Ranko; Islami, Hilmi; Juniku-Shkololli, Argjira

    2014-01-01

    Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure with open surgical procedure for outpatient treatment of symptomatic hemorrhoids. Material and method: A comparison trial between hemorrhoid laser procedure or open surgical hemorrhoidectomy was made. This study was conducted at Aloka hospital in Kosovo. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 20 patients treated with the laser hemorrhoidoplasty, and 20 patients–with open surgery hemorrhoidectomy. Operative time and postoperative pain with visual analog scale, were evaluated. Results: A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty and open surgical procedure were observed in operative time and early postoperative pain. There was a statistically significant difference between the two groups regarding the early postoperative period: 1 week, 2 weeks, 3 weeks and 1 month after respective procedure (p<0.01). The procedure time for LHP was 15.94 min vs. 26.76 min for open surgery (p<0.01). Conclusion: The laser hemorrhoidoplasty procedure was more effective than open surgical hemorrhoidectomy. Postoperative pain and duration time are only two indicators for this difference between there procedures. PMID:25684841

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

    NASA Astrophysics Data System (ADS)

    Zheng, Guoyan

    2007-03-01

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

  9. Perspective: authentic patient perspectives in simulations for procedural and surgical skills.

    PubMed

    Nestel, Debra; Kneebone, Roger

    2010-05-01

    In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

  10. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    PubMed Central

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

    2005-01-01

    option between conservative and operative management of small lumbar disc herniations or protrusions causing sciatica. Two RCT comparing transforaminal endoscopic procedures with microdiscectomy in patients with sciatica and small non-sequestered disc herniations show comparable short and medium term overall success rates. Concerning speed of recovery and return to work a trend towards more favourable results for the endoscopic procedures is noted. It is doubtful though, whether these results from the eleven and five years old studies are still valid for the more advanced procedures used today. The only RCT comparing the results of automated percutaneous lumbar discectomy to those of microdiscectomy showed clearly superior results of microdiscectomy. Furthermore, success rates of automated percutaneous lumbar discectomy reported in the RCT (29%) differ extremely from success rates reported in case series (between 56% and 92%). The literature search retrieves no controlled trials to assess efficacy and/or effectiveness of laser-discectomy, percutaneous manual discectomy or endoscopic procedures using a posterior approach in comparison to the standard procedures. Results from recent case series permit no assessment of efficacy, especially not in comparison to standard procedures. Due to highly selected patients, modi-fications of operative procedures, highly specialised surgical units and poorly standardised outcome assessment results of case series are highly variable, their generalisability is low. The results of the five economical analyses are, due to conceptual and methodological problems, of no value for decision-making in the context of the German health care system. Discussion Aside from low methodological study quality three conceptual problems complicate the interpretation of results. Continuous further development of technologies leads to a diversity of procedures in use which prohibits generalisation of study results. However, diversity is noted not only for

  11. Corticotomies as a surgical procedure to accelerate tooth movement during orthodontic treatment: A systematic review

    PubMed Central

    Fernández-Ferrer, Laura; Montiel-Company, José-María; Candel-Martí, Eugenia; Almerich-Silla, José-Manuel; Peñarrocha-Diago, Miguel

    2016-01-01

    Background One of the main aims of orthodontists is to reduce the treatment time as much as possible, particularly in view of the rise in demand for orthodontic treatment among adult patients. The objective of this systematic review was to examine the effectiveness of corticotomy as a surgical procedure that accelerates orthodontic tooth movement, together with its possible adverse effects. Material and Methods A systematic review of articles in 4 databases, Pubmed, Cochrane, Scopus and Embase, complemented by a manual search, identified 772 articles. The duplicates were eliminated and a critical reading of titles and abstracts led to the rejection of articles that did not meet the objectives of the review, leaving 69. After reading the full text of these articles, 49 were excluded because they did not meet the inclusion criteria. On applying the CONSORT criteria as a quality filter, a further 4 were eliminated due to low quality. Finally, 16 articles (4 systematic reviews and 12 controlled trials) were reviewed. Results All the studies agree that corticotomy prior to orthodontic treatment accelerates dental movement, reducing the treatment time. With regard to side-effects, no periodontal damage was found, although this was only studied in the short term. Conclusions The evidence regarding the results of corticotomy is limited, given the small number of quality clinical studies available. Before this procedure is included as a routine practice in dental surgeries, studies of higher methodological quality are required, studying a greater number of individuals and examining the possible long-term adverse effects and the cost/benefit of the procedure. Key words:Corticotomy, orthodontics, adults, accelerated tooth movement, osteotomy. PMID:27475698

  12. [Pseudomembranous colitis after surgery for a ruptured abdominal aortic aneurysm].

    PubMed

    Lozano Sánchez, F; Sánchez Fernández, J; Palacios, E; Fernández, M; Ingelmo Morin, A; Gómez Alonso, A

    1993-01-01

    We present a rare postoperative complication after surgical procedures for rupture of abdominal aortic aneurysms. The disease, a pseudomembranous colitis, was early recognized (by evidence of clostridium difficile after a coprocultive) and satisfactorily treated with vancomycin. From the literature review we found only a similar case but results were absolutely different from our case.

  13. Risk factors and initial surgical failures of TMJ arthrotomy and arthroplasty: a four to nine year evaluation of 303 surgical procedures.

    PubMed

    Kirk, W S

    1998-07-01

    Studies exist which support the efficacy of TM joint arthrotomy, arthroplasty and arthroscopic surgery. Few, if any, studies have evaluated failures of arthroplasty and/or diskectomy and specific risk factors that might invite initial surgical failure. This paper is a retrospective review of 210 patients operated with arthrotomy/arthroplasty for painful and dysfunctional TM joint derangement. There were 303 surgical procedures evaluated over a follow-up period of 4-9 years. Patient ages ranged from 16-72 years. There was no age correlation seen with degree of joint derangement. All cases were operated by one surgeon. There were no cases of alloplastic materials in this group of patients. There were no cases of autograph such as auricular cartilage for dermal grafting or other disc substitution materials. Operations consisted of capsular arthroplasty in Wilkes' stage II, III, and IV. Diskectomy was performed in Wilkes' stages IV and V. Comparisons are made among staged groups and operation performed. Two hundred seventy-three of 303 operated joints met the criteria for surgical success for a technical success rate of 90.1%. Potential risk factors of missing molar teeth, preoperative joint collapse, and skeletal malocclusion were evaluated. The frequency of their presence in successful and non-successful surgical outcomes is noted. Patients with imaging confirmed osteoporosis were evaluated as group with potential systemic disease or a result of systemic disease that may influence long term surgical outcome. Predictable preoperative risk factors that may influence initial surgical outcome do appear to be significant in long term success. There were 30 cases of failure to evaluate. It is concluded that reconstructive arthroplasty is a stage specific operation with excellent results in Wilkes' stage II and good results in stage III derangement. Attempted arthroplasty failed significantly (50%) in a small number of attempts in stage IV cases. However, diskectomy was

  14. Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures

    PubMed Central

    Cavallo, Luigi Maria; Di Somma, Alberto; Solari, Domenico; de Divitiis, Oreste; Bracale, Umberto Marcello; Cappabianca, Paolo

    2016-01-01

    Purpose We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) in various neuroendoscopic procedures. Methods A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a) endoscopic endonasal transsphenoidal; b) frontal transcortical intraventricular; c) supraorbital. Results We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0–70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest. Conclusions The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have

  15. [Choice of surgical procedure in operations for chronic pancreatitis--personal experience].

    PubMed

    Sváb, J; Pesková, M; Fried, M; Gürlich, R; Krska, Z; Bortlík, M; Lukás, M; Horejs, J

    2002-01-01

    The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of

  16. [Focused surgical bedside ultrasound: E-FAST (focused assessment with sonography in trauma) - abdominal aortic aneurysm - cholecystolithiasis - acute appendicitis].

    PubMed

    Studer, Maria; Studer, Peter

    2014-06-04

    Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. The goal of ICAN is to improve and expand the education of surgeons in Switzerland. This article provides a short review of the most frequent surgical pathologies encountered in the emergency room.

  17. High Mobility Group Box-1 Protein and Outcomes in Critically Ill Surgical Patients Requiring Open Abdominal Management

    PubMed Central

    Malig, Michelle S.; Jenne, Craig N.; Ball, Chad G.; Roberts, Derek J.; Xiao, Zhengwen

    2017-01-01

    Background. Previous studies assessing various cytokines in the critically ill/injured have been uninformative in terms of translating to clinical care management. Animal abdominal sepsis work suggests that enhanced intraperitoneal (IP) clearance of Damage-Associated Molecular Patterns (DAMPs) improves outcome. Thus measuring the responses of DAMPs offers alternate potential insights and a representative DAMP, High Mobility Group Box-1 protein (HMGB-1), was considered. While IP biomediators are being recognized in critical illness/trauma, HMGB-1 behaviour has not been examined in open abdomen (OA) management. Methods. A modified protocol for HMGB-1 detection was used to examine plasma/IP fluid samples from 44 critically ill/injured OA patients enrolled in a randomized controlled trial comparing two negative pressure peritoneal therapies (NPPT): Active NPPT (ANPPT) and Barker's Vacuum Pack NPPT (BVP). Samples were collected and analyzed at the time of laparotomy and at 24 and 48 hours after. Results. There were no statistically significant differences in survivor versus nonsurvivor HMGB-1 plasma or IP concentrations at baseline, 24 hours, or 48 hours. However, plasma HMGB-1 levels tended to increase continuously in the BVP cohort. Conclusions. HMGB-1 appeared to behave differently between NPPT cohorts. Further studies are needed to elucidate the relationship of HMGB-1 and outcomes in septic/injured patients. PMID:28286376

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

    ERIC Educational Resources Information Center

    Cuming, Richard G.

    2009-01-01

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

  19. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for facility services related to covered... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs § 413.118 Payment for facility services related to covered ASC surgical procedures performed in hospitals on...

  20. Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis.

    PubMed

    Huang, Shou-Guo; Chen, Bo; Lv, Dong; Zhang, Yong; Nie, Feng-Feng; Li, Wei; Lv, Yao; Zhao, Huan-Li; Liu, Hong-Mei

    2017-01-01

    Purpose Using a network meta-analysis approach, our study aims to develop a ranking of the six surgical procedures, that is, Plate, titanium elastic nail (TEN), tension band wire (TBW), hook plate (HP), reconstruction plate (RP) and Knowles pin, by comparing the post-surgery constant shoulder scores in patients with clavicular fracture (CF). Methods A comprehensive search of electronic scientific literature databases was performed to retrieve publications investigating surgical procedures in CF, with the stringent eligible criteria, and clinical experimental studies of high quality and relevance to our area of interest were selected for network meta-analysis. Statistical analyses were conducted using Stata 12.0. Results A total of 19 studies met our inclusion criteria were eventually enrolled into our network meta-analysis, representing 1164 patients who had undergone surgical procedures for CF (TEN group = 240; Plate group = 164; TBW group  =  180; RP group  =  168; HP group  =  245; Knowles pin group  =  167). The network meta-analysis results revealed that RP significantly improved constant shoulder score in patients with CF when compared with TEN, and the post-operative constant shoulder scores in patients with CF after Plate, TBW, HP, Knowles pin and TEN were similar with no statistically significant differences. The treatment relative ranking of predictive probabilities of constant shoulder scores in patients with CF after surgery revealed the surface under the cumulative ranking curves (SUCRA) value is the highest in RP. Conclusion The current network meta-analysis suggests that RP may be the optimum surgical treatment among six inventions for patients with CF, and it can improve the shoulder score of patients with CF. Implications for Rehabilitation RP improves shoulder joint function after surgical procedure. RP achieves stability with minimal complications after surgery. RP may be the optimum surgical treatment for

  1. Abdominal Tuberculosis with an Acute Abdomen: Our Clinical Experience

    PubMed Central

    Dey, Ramprasad; Bhattacharya, Ujjwal

    2014-01-01

    Introduction: Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention. Materials and Methods: Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD). Results: The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency. Conclusion: Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a

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

    PubMed Central

    2009-01-01

    The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints. PMID:19826842

  3. Lateral high abdominal ovariopexy: an original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin's disease

    SciTech Connect

    Gaetini, A.; De Simone, M.; Urgesi, A.; Levis, A.; Resegotti, A.; Ragona, R.; Anglesio, S.

    1988-09-01

    An original surgical method for gonadal protection in young women given pelvic radiation for Hodgkin's disease is presented. Lateral high ovarian transposition (LHAO) consists of the transposition of the ovaries into the paracolic gutter during staging laparotomy, after disconnecting the gonads from the fallopian tubes by dividing the tubo-ovarian vessels. The technique's effectiveness was assessed by a study using clinical investigation, radioimmunoassay (RIA) determination of sex hormones, and dosimetry; of 18 patients treated, 10 participated in the study. All but one have normal menses and hormone values, and one pregnancy occurred. We also calculated the doses absorbed by the ovaries and proved that, during inverted Y irradiation following LHAO, the ovaries are exposed to nearly one-half the dose they receive after traditional medial transposition. During subtotal nodal irradiation after LHAO, the irradiation dose is higher than after medialisation, but absolute values are minimal and castration is not induced.

  4. Bilateral symmetry in vision and influence of ocular surgical procedures on binocular vision: A topical review.

    PubMed

    Arba Mosquera, Samuel; Verma, Shwetabh

    2016-01-01

    We analyze the role of bilateral symmetry in enhancing binocular visual ability in human eyes, and further explore how efficiently bilateral symmetry is preserved in different ocular surgical procedures. The inclusion criterion for this review was strict relevance to the clinical questions under research. Enantiomorphism has been reported in lower order aberrations, higher order aberrations and cone directionality. When contrast differs in the two eyes, binocular acuity is better than monocular acuity of the eye that receives higher contrast. Anisometropia has an uncommon occurrence in large populations. Anisometropia seen in infancy and childhood is transitory and of little consequence for the visual acuity. Binocular summation of contrast signals declines with age, independent of inter-ocular differences. The symmetric associations between the right and left eye could be explained by the symmetry in pupil offset and visual axis which is always nasal in both eyes. Binocular summation mitigates poor visual performance under low luminance conditions and strong inter-ocular disparity detrimentally affects binocular summation. Considerable symmetry of response exists in fellow eyes of patients undergoing myopic PRK and LASIK, however the method to determine whether or not symmetry is maintained consist of comparing individual terms in a variety of ad hoc ways both before and after the refractive surgery, ignoring the fact that retinal image quality for any individual is based on the sum of all terms. The analysis of bilateral symmetry should be related to the patients' binocular vision status. The role of aberrations in monocular and binocular vision needs further investigation.

  5. Surgical site infection following cesarean delivery: patient, provider and procedure specific risk factors

    PubMed Central

    SHREE, Raj; Park, Seo Young; Beigi, Richard H.; Dunn, Shannon L.; Krans, Elizabeth E.

    2016-01-01

    Objective To identify risk factors for cesarean delivery (CD) surgical site infection (SSI). Study Design Retrospective analysis of 2739 CDs performed at the University of Pittsburgh in 2011. CD SSI’s were defined using National Healthcare Safety Network (NHSN) criteria. Chi-square and t tests were used for bivariate analyses and multivariate logistic regression was used to identify SSI risk factors. Results Of 2739 CDs, 178 (6.5%) were complicated by SSI. Patients with a SSI were more likely to have Medicaid, have resident physicians perform the CD, an ASA class of ≥3, chorioamnionitis, use tobacco and labor prior to CD. In multivariable analysis, labor (2.35;1.65–3.38), chorioamnionitis (2.24;1.25–3.83), resident teaching service (2.15;1.54–3.00), tobacco use (1.70; 1.04–2.70), ASA class ≥3 (1.61; 1.06–2.39) and CDs performed for non-reassuring fetal status (0.43; 0.26–0.67) were significantly associated with CD SSI. Conclusion Multiple patient, provider and procedure specific-risk factors contribute to CD SSI risk which may be targeted in infection control efforts. PMID:26344010

  6. Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

    PubMed Central

    Mousavi, Seyed R.

    2016-01-01

    Background: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema. Materials and Methods: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively. Results: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection. Conclusion: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease. PMID:27990192

  7. [An example of multi-stage reconstruction of a full-thickness abdominal wall defect].

    PubMed

    Kaczmarzyk, Janusz; Elsaftawy, Ahmed; Jabłecki, Jerzy; Kaczmarzyk, Leszek

    2013-01-01

    Abdominal wall reconstruction is a highly complex procedure that may requires a multiple stages surgical operations. The aim of a such reconstruction is to close the abdominal wall defect and to create a support for the internal organs. It's a challenge for both general and reconstructive surgery. An incomplete thickness defects of the abdominal wall are so much easier to challenge than complete ones. Also the size of the primary defect determines the way and stages of the operation. Such defects can occur in necrotizing fasciitis of the abdominal wall, after abdominal walls tumors removal, in traffic accidents or after "open abdomen" procedures (acute severe pancreatitis). In this paper the authors present a case of 62-yo patient which was operated because of large intestine perforation with various complications of which the most serious was the abdominal wall defect.

  8. Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

    PubMed Central

    Gwon, Jun Gyo; Cho, Yong-Pil; Han, Young Jin; Noh, Min Su

    2016-01-01

    Purpose The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. Methods A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. Results Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival. Conclusion Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients. PMID:27904852

  9. Association between source control and mortality in 258 patients with intra-abdominal candidiasis: a retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain.

    PubMed

    Lagunes, L; Rey-Pérez, A; Martín-Gómez, M T; Vena, A; de Egea, V; Muñoz, P; Bouza, E; Díaz-Martín, A; Palacios-García, I; Garnacho-Montero, J; Campins, M; Bassetti, M; Rello, J

    2017-01-01

    Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC). Source control was defined as all physical actions taken to control a focus of infection and reduce the favorable conditions that promote microorganism growth or that maintain the impairment of host defenses. Two hundred and fifty-eight patients with IAC were identified. Sixty-one patients were at ICU for diagnosis. Mortality was higher in the ICU group compared to what was documented for the non-ICU group (35 % vs 19.5 %, p = 0011). Adequate source control within 48 h of diagnosis was achieved in 60 % of the cohort. In multivariate analysis, inadequate source control was identified as the only common risk factor for 30-day mortality in both groups (ICU group OR: 13.78 (95% CI: 2.60-72.9, p = 0.002) and non-ICU group OR: 6.53 (95% CI: 2.56-16.61, p = <0.001). The population receiving both adequate source control and adequate antifungal treatment was the one associated with a higher survival rate, in both the ICU and surgical groups. Source control remains a key element in IAC, inside and outside the intensive care unit. Early antifungal treatment among ICU patients was associated with lower mortality.

  10. Experience of development of the national surgical interventions coding system in Russia.

    PubMed

    Shtevnina, Julia I; Rauzina, Svetlana E; Shvyrev, Sergey L; Zarubina, Tatyana V

    2014-01-01

    The paper discusses development issues of surgical procedures coding systems for use at the national and international levels within the health information systems. The work was carried out using the Russian and foreign experiences, including international standard ISO/FDIS 1828:2012. The development system structure contains basic categories of medical entities (axes): surgical deed and surgical subdeed, objects, site and interventional equipment. Abdominal surgeries (528 procedures) were entered in the coding system database and structured according defined categories.

  11. Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt

    PubMed Central

    Moumoulidis, I; Del Pero, Martinez M; Brennan, L; Jani, P

    2010-01-01

    INTRODUCTION The aim of the study was to identify whether Trendelenburg position helps detect any further bleeding points following Valsalva manoeuvre in order to achieve adequate haemostasis in head and neck surgery. PATIENTS AND METHODS Fifty consecutive patients undergoing major head and neck surgical procedures were included. The protocol consisted in performing Valsalva manoeuvre to check haemostasis and treated any bleeding points identified. The operating table was tilted 30° and haemostasis was checked again and treated accordingly. The number of vessels identified and the treatment was recorded. RESULTS Twelve male and 38 female patients were included. The median age was 53 years and 74% had an ASA of 1. Twelve patients had complicating features such as retrosternal extensions or raised T4 levels pre-operatively. Thyroid resections were the most common operations performed. The total number of bleeding vessels identified in Trendelenburg tilt was significantly greater than when using Valsalva manoeuvre (P < 0.0001). All bleeding points found on Valsalva manoeuvre were minor (< 2 mm) and dealt with using diathermy. In Trendelenburg position, 11% of bleeding vessels required ties or stitching. The time taken during Valsalva manoeuvre was 60 s on average and 360 s in Trendelenburg position. CONCLUSIONS The results show that the Trendelenburg position is vastly superior to the Valsalva manoeuvre in identifying bleeding vessels at haemostasis. It has become our practice to put patients in Trendelenburg tilt routinely (we have discontinued the Valsalva manoeuvre), to check its adequacy before closing the wound. We have not noticed any intracranial complications using a tilt angle of 30°. PMID:20501015

  12. Perioperative normothermia depends on intraoperative warming procedure, extent of the surgical intervention and age of the experimental animal.

    PubMed

    Felies, Melanie; Poppendieck, Sonja; Nave, Heike

    2005-11-04

    The maintenance of a physiological body temperature during and early after surgical interventions in experimental animals such as rodents is often neglected. Therefore the positive influence of an adequate use of warming blankets (WB) on the rectal body temperature in rats was investigated during two different surgical interventions, with a special focus on possible differences between young adult (2.5+/-0.14 months) and adult animals (9.3+/-0.13 months). Anesthesia was induced with isoflurane short inhalation and maintained with ketamine and domitor intramuscularly. Animals were divided into ten groups according to (a) the age of the animals, (b) the temperature of the WB and (c) the kind of surgical intervention (either an intravenous [i.v.] cannulation of the right external jugular vein or an intra-aortal implantation of a telemetric transmitter or both). Results clearly show that the surface temperature of the WB has a major impact on the perioperative thermoregulation. The rectal body temperature of animals operated on a cooler WB dramatically decreased depending on the age of the rat and also on the extent of the surgical intervention. The opening of the abdominal cavity in older rats resulted in a severe hypothermia: they lost 5.6 degrees C compared to 3.2 degrees C in the young adult rats. The implantation of the i.v. catheter had no serious effect on the thermoregulation. In conclusion, the results clearly show that an adequate perioperative warming system positively influences the postoperative outcome in young adult and most notably in adult rats and thus enables early postoperative experiments without effects on measured parameters.

  13. Remodeling characteristics and collagen distribution in synthetic mesh materials explanted from human subjects after abdominal wall reconstruction: an analysis of remodeling characteristics by patient risk factors and surgical site classifications

    PubMed Central

    Cavallo, Jaime A.; Roma, Andres A.; Jasielec, Mateusz S.; Ousley, Jenny; Creamer, Jennifer; Pichert, Matthew D.; Baalman, Sara; Frisella, Margaret M.; Matthews, Brent D.

    2014-01-01

    Background The purpose of this study was to evaluate the associations between patient characteristics or surgical site classifications and the histologic remodeling scores of synthetic meshes biopsied from their abdominal wall repair sites in the first attempt to generate a multivariable risk prediction model of non-constructive remodeling. Methods Biopsies of the synthetic meshes were obtained from the abdominal wall repair sites of 51 patients during a subsequent abdominal re-exploration. Biopsies were stained with hematoxylin and eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell infiltration, cell types, extracellular matrix deposition, inflammation, fibrous encapsulation, and neovascularization) and a mean composite score (CR). Biopsies were also stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics or surgical site classification and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a threshold p value of ≤0.200. Results The model selection process for the extracellular matrix score yielded two variables: subject age at time of mesh implantation, and mesh classification (c-statistic = 0.842). For CR score, the model selection process yielded two variables: subject age at time of mesh implantation and mesh classification (r2 = 0.464). The model selection process for the collagen III area yielded a model with two variables: subject body mass index at time of mesh explantation and pack-year history (r2 = 0.244). Conclusion Host characteristics and surgical site assessments may predict degree of remodeling for synthetic meshes used to reinforce abdominal wall repair sites. These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances for which non

  14. [Importance of displacement ventilation for operations and small surgical procedures from the infection preventive point of view].

    PubMed

    Kramer, A; Külpmann, R; Wille, F; Christiansen, B; Exner, M; Kohlmann, T; Heidecke, C D; Lippert, H; Oldhafer, K; Schilling, M; Below, H; Harnoss, J C; Assadian, O

    2010-02-01

    Surgical teams need to breathe air that is conducive to their health. An adequate exchange of air ensures oxygen supply, the ventilation of humidity, smells, toxic substances, especially narcotic gases and surgical smoke, pathogens and particles. With regard to the infection risk, DIN 1946 / 4 -differentiates between operation theaters with the highest demand for clean air (operation room class I a), operation theatres with a high demand (operation room class I b) and rooms within the operation theatres without special requirements, meaning that the microbial load in the air is close to or equal to that of normal in-room air quality (room class II). For an operation room class I a, ventilation that displaces the used air is necessary, while a regular ventilation is sufficient for operation room class I b. Because of ambiguous -results in previous studies, the necessity to define a -class I a for operation rooms is being questioned. Therefore, this review focuses on the analysis of the existing publications with respect to this -question. The result of this analysis indicates that so far there is only one surgical procedure, the -implantation of hip endoprosthetics, for which a preventive effect on SSI of a class I a ventilation (displacement of the used air) is documented. One recent study, reviewed critically here, -showed opposite results, but lacks methodological clarity. Thus, it is concluded that evidence for the requirement of operation room classes can only be derived from risk assessment (infection risk by surgical intervention, extent of possible damages), but not from epidemiological studies. Risk assessment must be based on the following criteria: size and depth of the operation field, -duration of the procedure, vascular perfusion of the wound, implantation of alloplastic material and general risk of the patient for an infection. From an infection preventive point of view, no class I a "displacement ventilation" is necessary for small surgical

  15. Smart surgical needle actuated by shape memory alloys for percutaneous procedures

    NASA Astrophysics Data System (ADS)

    Konh, Bardia

    Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle's body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility

  16. Creating an animation-enhanced video library of hepato-pancreato-biliary and transplantation surgical procedures.

    PubMed

    Fung, Albert; Kelly, Paul; Tait, Gordon; Greig, Paul D; McGilvray, Ian D

    2016-01-01

    The potential for integrating real-time surgical video and state-of-the art animation techniques has not been widely applied to surgical education. This paper describes the use of new technology for creating videos of liver, pancreas and transplant surgery, annotating them with 3D animations, resulting in a freely-accessible online resource: The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery ( http://tvasurg.ca ). The atlas complements the teaching provided to trainees in the operating room, and the techniques described in this study can be readily adapted by other surgical training programmes.

  17. [Choice of surgical procedure and management of postoperative incision for anal fistula].

    PubMed

    Chen, Chaowen; Peng, Bo

    2015-12-01

    Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  18. [Evaluation of efficacy of selected antiseptics for hands disinfection before surgical procedures].

    PubMed

    Leksowski, K; Jasiński, A; Marszałek, A

    2001-08-01

    The most important in surgical hands washing and disinfections is long-term and effective reduction of bacteria number. The aim of this study was to compare the efficiency of some antiseptic fluids used for surgical hands disinfection's (AHD 2000, Biotensid, Manopronto and Medi-Scrub PVP Iodine). 62 doctors and surgical nurses were examined. The material for the bacteriological examination was collected before and after hands disinfection's. The bacterial flora reduction have been presented as a percent and a logarithmic reduction ratio. All estimated antiseptic fluids were very potent and provided prolonged efficiency when the operation team complied with orders of hands washing.

  19. A MATERIAL COST-MINIMIZATION ANALYSIS FOR HERNIA REPAIRS AND MINOR PROCEDURES DURING A SURGICAL MISSION IN THE DOMINICAN REPUBLIC

    PubMed Central

    Cavallo, Jaime A.; Ousley, Jenny; Barrett, Christopher D.; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J. Ross; Perotti, Gary; Frisella, Margaret M.; Matthews, Brent D.

    2013-01-01

    INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure

  20. Inflammatory abdominal aortic aneurysm.

    PubMed

    Savarese, R P; Rosenfeld, J C; DeLaurentis, D A

    1986-05-01

    Between January 1976 and December 1982, 181 patients with abdominal aortic aneurysms were treated surgically, and in 13 patients the aneurysms were found to be inflammatory. Inflammatory aneurysms of the abdominal aorta (IAAA) share important characteristics with typical atherosclerotic abdominal aortic aneurysms. Diagnosis and surgical management of IAAA are distinctive which suggests that IAAA should be considered separately, as a varient of typical abdominal aortic aneurysms. IAAA occur predominantly in males. The presenting symptoms are often idiosyncratic and include severe abdominal or back pain, or both, and ureteral obstruction; the diagnosis of IAAA should be considered when these symptoms are present. Although grossly and microscopically, the perianeurysmal fibrosis resembles idiopathic retroperitoneal fibrosis, the two conditions can be differentiated. At the present time, ultrasonography and computed tomography appear to offer reliable means for diagnosing IAAA. The presence of IAAA, whether established preoperatively or discovered unexpectedly at operation, necessitate certain modifications in the surgical approach, in order to avoid injuring the duodenum and the venous structures. Most patients can be successfully treated by resection and graft replacement. Rupture of the aneurysm in IAAA appears to be less frequent than in typical atherosclerotic abdominal aortic aneurysm.

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

    PubMed Central

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

    2012-01-01

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

  2. Surgical accuracy of three-dimensional virtual planning: a pilot study of bimaxillary orthognathic procedures including maxillary segmentation.

    PubMed

    Stokbro, K; Aagaard, E; Torkov, P; Bell, R B; Thygesen, T

    2016-01-01

    This retrospective study evaluated the precision and positional accuracy of different orthognathic procedures following virtual surgical planning in 30 patients. To date, no studies of three-dimensional virtual surgical planning have evaluated the influence of segmentation on positional accuracy and transverse expansion. Furthermore, only a few have evaluated the precision and accuracy of genioplasty in placement of the chin segment. The virtual surgical plan was compared with the postsurgical outcome by using three linear and three rotational measurements. The influence of maxillary segmentation was analyzed in both superior and inferior maxillary repositioning. In addition, transverse surgical expansion was compared with the postsurgical expansion obtained. An overall, high degree of linear accuracy between planned and postsurgical outcomes was found, but with a large standard deviation. Rotational difference showed an increase in pitch, mainly affecting the maxilla. Segmentation had no significant influence on maxillary placement. However, a posterior movement was observed in inferior maxillary repositioning. A lack of transverse expansion was observed in the segmented maxilla independent of the degree of expansion.

  3. Minimally invasive myotomy for the treatment of esophageal achalasia: evolution of the surgical procedure and the therapeutic algorithm.

    PubMed

    Bresadola, Vittorio; Feo, Carlo V

    2012-04-01

    Achalasia is a rare disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter, which may be hypertensive. The cause of this disease is unknown; therefore, the aim of the therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. This goal can be accomplished either by pneumatic dilatation or surgical myotomy, which are the only long-term effective therapies for achalasia. Historically, pneumatic dilatation was preferred over surgical myotomy because of the morbidity associated with a thoracotomy or a laparotomy. However, with the development of minimally invasive techniques, the surgical approach has gained widespread acceptance among patients and gastroenterologists and, consequently, the role of surgery has changed. The aim of this study was to review the changes occurred in the surgical treatment of achalasia over the last 2 decades; specifically, the development of minimally invasive techniques with the evolution from a thoracoscopic approach without an antireflux procedure to a laparoscopic myotomy with a partial fundoplication, the changes in the length of the myotomy, and the modification of the therapeutic algorithm.

  4. Mesh Sutured Repairs of Abdominal Wall Defects

    PubMed Central

    Lanier, Steven T.; Jordan, Sumanas W.; Miller, Kyle R.; Ali, Nada A.; Stock, Stuart R.

    2016-01-01

    Background: A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes. Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. PMID:27757361

  5. Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus

    PubMed Central

    Burnei, G; Gavriliu, Ş; Nepaliuc, I; Vlad, C; Drăgoescu, M; Georgescu, I; Ghita, RA; Muntean, L; Pârvan, AA; Dughilă, C; Ţiripa, I; Hamei, Ş; Klinaku, I

    2014-01-01

    Introduction. Supracondylar fractures of the humerus represent a current concern in the child’s and adolescent’s osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in “Prof. Dr. Alexandru Pesamosca” Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation. Material and method. The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications – 28 out of 96 (29.1%) – were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure. Results. The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow’s mobility was

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

    PubMed Central

    Akinbami, Babatunde O.

    2014-01-01

    Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3 ± (18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4 ± 10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures. PMID:25258698

  7. Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience.

    PubMed

    Ceccarelli, Graziano; Codacci-Pisanelli, Massimo; Patriti, Alberto; Ceribelli, Cecilia; Biancafarina, Alessia; Casciola, Luciano

    2013-09-01

    Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique

  8. The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures

    PubMed Central

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

    2012-01-01

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

  9. Elective procedures and anesthesia in children: pediatric surgeons enter the dialogue on neurotoxicity questions, surgical options, and parental concerns.

    PubMed

    Byrne, Mary W; Ascherman, Jeffrey A; Casale, Pasquale; Cowles, Robert A; Gallin, Pamela F; Maxwell, Lynne G

    2012-10-01

    The Pediatric Anesthesia NeuroDevelopment Assessment research group at Columbia University Medical Center Department of Anesthesiology has conducted biannual national Symposia since 2008 to evaluate study data and invigorate continued thinking about unresolved issues of pediatric anesthesia neurotoxicities. The third Symposium extended the dialogue between pediatric anesthesiologists and surgeons in panel presentations and discussions by four surgical specialists. This paper reports the prevailing opinions expressed by a pediatric general surgeon, urologist, plastic surgeon and ophthalmologist and explores factors related to delayed operative intervention, need for multiple procedures, and parental concerns.

  10. Radiofrequency-Assisted Partial Splenectomy Plus Splenopexy--A Modified Surgical Procedure for Wandering Spleen: A Case Report.

    PubMed

    Hao, Fulong; Wang, Wenping; Yang, Xiaoli

    2015-09-01

    Wandering spleen is an extremely rare clinical condition characterized by abnormal anatomical position of the spleen. Up to now, its etiology remains unknown, and the best surgical procedure is still an area to explore in the future. In this article, we present the case of a 24-year-old woman with wandering spleen combined with congenital heart disease and pigeon chest. Based on the clinical features and our experiences of radiofrequency ablation for preservation of the spleen in traumatic spleen rupture, we successfully performed a modified splenectomy and splenopexy method. Since the operation, the organ has remained in place with good perfusion and function.

  11. Creation and Global Deployment of a Mobile, Application-Based Cognitive Simulator for Cardiac Surgical Procedures.

    PubMed

    Brewer, Zachary E; Ogden, William David; Fann, James I; Burdon, Thomas A; Sheikh, Ahmad Y

    Several modern learning frameworks (eg, cognitive apprenticeship, anchored instruction, and situated cognition) posit the utility of nontraditional methods for effective experiential learning. Thus, development of novel educational tools emphasizing the cognitive framework of operative sequences may be of benefit to surgical trainees. We propose the development and global deployment of an effective, mobile cognitive cardiac surgical simulator. In methods, 16 preclinical medical students were assessed. Overall, 4 separate surgical modules (sternotomy, cannulation, decannulation, and sternal closure) were created utilizing the Touch Surgery (London, UK) platform. Modules were made available to download free of charge for use on mobile devices. Usage data were collected over a 6-month period. Educational efficacy of the modules was evaluated by randomizing a cohort of medical students to either module usage or traditional, reading-based self-study, followed by a multiple-choice learning assessment tool. In results, downloads of the simulator achieved global penetrance, with highest usage in the USA, Brazil, Italy, UK, and India. Overall, 5368 unique users conducted a total of 1971 hours of simulation. Evaluation of the medical student cohort revealed significantly higher assessment scores in those randomized to module use versus traditional reading (75% ± 9% vs 61% ± 7%, respectively; P < 0.05). In conclusion, this study represents the first effort to create a mobile, interactive cognitive simulator for cardiac surgery. Simulators of this type may be effective for the training and assessment of surgical students. We investigated whether an interactive, mobile-computing-based cognitive task simulator for cardiac surgery could be developed, deployed, and validated. Our findings suggest that such simulators may be a useful learning tool.

  12. Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips

    PubMed Central

    Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali

    2016-01-01

    Summary: Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable. PMID:27757342

  13. Surgical access through the stoma for laparoscopic reversal of Hartmann procedures.

    PubMed

    Parkin, Edward; Khurshid, Mujahid; Ravi, Srinivasan; Linn, Thu

    2013-02-01

    The rate of stoma reversal after Hartmann procedure is low, principally because of the technically demanding nature of the reversal procedure and preexisting comorbid disease frequently present in this patient group. Laparoscopic reversal of Hartmann procedure is an attractive alternative that can reduce perioperative morbidity but the feasibility of completing the procedure laparoscopically is often limited by extensive adhesion formation present after the initial open operation. We describe a technique for laparoscopic reversal of Hartmann procedure where the stoma is mobilized externally and a pneumoperitoneum established through this preexisting defect. Results for the first 7 cases show a median operative duration of 132 minutes and length of hospital stay of 6 days with no conversions. Insertion of the operating ports under direct vision and a more limited dissection to facilitate the anastomosis represents an alternative operative strategy that can be performed successfully, even in patients with comorbid disease.

  14. Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm.

    PubMed

    Fratesi, Francesca; Handa, Ashok; Uberoi, Raman; Sideso, Ediri

    2015-01-01

    Inflammatory and juxtarenal Abdominal Aortic Aneurysm (j-iAAA) represents a technical challenge for open repair (OR) due to the peculiar anatomy, extensive perianeurysmal fibrosis, and dense adhesion to the surrounding tissues. A 68-year-old man with an 11 cm asymptomatic j-iAAA was successfully treated with elective EVAR and chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency and normal renal function are present at 24-month follow-up. The treatment of j-iAAA can be technically challenging. ch-EVAR is a feasible and safe bail-out method for elective j-iAAA with challenging anatomy.

  15. Abdominal pregnancy- a case report.

    PubMed

    Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc

    2011-01-01

    A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

  16. Patient satisfaction and quality of care at four diagnostic imaging procedures: mammography, double-contrast barium enema, abdominal ultrasonography and vaginal ultrasonography.

    PubMed

    Loken, K; Steine, S; Laerum, E

    1999-01-01

    The objective of this study was to measure patient satisfaction and to investigate the practical implications of monitoring the quality of care at four radiology procedures. A survey was conducted immediately after the examinations in eight radiology departments: 550 patients attending for mammography, 110 for double-contrast barium enema (DCBE), 97 for abdominal ultrasonography and 90 for vaginal ultrasonography. Outcome measures were seven questionnaire scales: pain, emotional distress, information received, staff's punctuality and technical ability, facilities, and general satisfaction. Response rate was 87 %. Multivariate regression analysis showed significant differences between procedures on all scales (p < 0.001). Differences considered to be of practical importance, i. e. >/= 7 scale points, were detected on five of the scales. Mammography and DCBE caused the most pain, and vaginal US and DCBE caused the most distress. The US procedures entailed dissatisfaction with information about the procedures. The DCBE patients recorded dissatisfaction with the staff's lack of punctuality, and these and the mammography patients recorded dissatisfaction with the facilities. The findings indicate a potential for improving patients' experiences. Several aspects of care, i. e. pain management, attention to the patient's emotional concerns, explanation of procedures, punctuality and quality of the facilities, can be improved.

  17. [The role of laparoscopy in emergency abdominal surgery].

    PubMed

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  18. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002.

    PubMed

    Babalola, Ebenezer O; Bharucha, Adil E; Melton, L Joseph; Schleck, Cathy D; Zinsmeister, Alan R; Klingele, Christopher J; Gebhart, John B

    2008-09-01

    To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P < 0.001) and 32% (P = 0.02), respectively. In both groups, utilization decreased in all age groups over time except in women aged 80 years and older undergoing hysterectomy plus PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

  19. Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

    PubMed

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

    2016-01-01

    In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index.

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS) has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the “pros” of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other) in various subspecialties, and correlated these with patients’ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors) contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery), preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection), along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS. PMID:24843814

  2. Outcomes in Patients With Hemophilia and von Willebrand Disease Undergoing Invasive or Surgical Procedures.

    PubMed

    Chapin, John; Bamme, Jaqueline; Hsu, Fraustina; Christos, Paul; DeSancho, Maria

    2017-03-01

    Adults with hemophilia A (HA), hemophilia B (HB), and von Willebrand disease (VWD) frequently require surgery and invasive procedures. However, there is variability in perioperative management guidelines. We describe our periprocedural outcomes in this setting. A retrospective chart review from January 2006 to December 2012 of patients with HA, HB, and VWD undergoing surgery or invasive procedures was conducted. Type of procedures, management including the use of continuous factor infusion, and administration of antifibrinolytics were reviewed. Adverse outcomes were defined as acute bleeding (<48 hours), delayed bleeding (≥48 hours), transfusion, inhibitor development, and thrombosis. We identified 59 patients with HA and HB. In all, 24 patients had severe hemophilia and 12 had mild/moderate hemophilia. Twelve patients had inhibitors. There were also 5 female carriers of HA and 6 patients with VWD. There were 34 major surgeries (26 orthopedic, 8 nonorthopedic) and 129 minor surgeries. Continuous infusion was used in 55.9% of major surgeries versus 8.5% of minor surgeries. Antifibrinolytics were administered in 14.7% of major surgeries versus 23.2% of minor surgeries. In all, 4 patients developed acute bleeding and 10 patients developed delayed bleeding. Delayed bleeding occurred in 28.6% of genitourinary procedures and in 16.1% of dental procedures. Five patients acquired an inhibitor and 2 had thrombosis. In conclusion, patients with HA, HB, or VWD had similar rates of adverse outcomes when undergoing minor surgeries or major surgeries. This finding underscores the importance of an interdisciplinary management and procedure-specific guidelines for patients with hemophilia and VWD prior to even minor invasive procedures.

  3. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm

    PubMed Central

    Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure. PMID:27087879

  4. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm.

    PubMed

    Ohki, Satoshi; Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure.

  5. Evaluation of propofol as a general anesthetic agent for minor oral surgical procedure.

    PubMed

    Jaggi, Nitin; Kalra, Amit; Baghla, Gunpreet Kaur; Medsinge, Sonali V; Purohit, Nikhil

    2013-07-01

    Nausea and vomiting following anesthesia is a distressing problem for the patient as it increases the recovery time, intensity of nursing care and delays discharge. The aim of randomized controlled single blind study is to evaluate the efficacy and safety of subhypnotic doses of propofol for the prevention of postoperative nausea and vomiting (PONV) in day care management of cases in oral and maxillofacial surgeries. Twenty-five patient of ASA-1 with age ranging from 12 to 40 years were scheduled for various maxillofacial surgical cases like fracture, cyst enucleation, surgical removal of 3rd molar, etc. were given propofol at the dose of 2 to 2.5 mg/kg as induction dose and sedation was maintained with the dose 5 to 10 mg/min. There was no significant effect on heart rate, systolic and diastolic blood pressure, respiratory rate and oxygen saturation intraoperatively. In conclusion, a subhypnotic dose of propofol is fast acting, safe and easily controllable, short acting general anesthetic agent with rapid recovery. The study found that the PONV was significantly reduced in the patient with propofol, no hemodynamic derangements were noted in the postoperative period.

  6. Surgical sterilization: an underutilized procedure for evaluating the merits of induced sterility

    USGS Publications Warehouse

    Kennelly, James J.; Converse, Kathryn A.

    1993-01-01

    Despite more than 4 decades of effort, development of effective wildlife damage control programs based on sterilization of target species has met with limited success. This is partly due to the fact that investigators have assumed, rather than empirically tested, whether the reproductive strategies of the target populations were vulnerable to the planned treatment. Equally important, methods selected to include sterility usually involve a chemical agent that can affect sociosexual behaviors of the nuisance population. In this report, we illustrate how surgically induced sterility circumvents both problems--how the concept without the potentially confounding secondary effects of a chemical. We assessed the merits of initiating research to develop a male chemosterilant for Norway rats, red-winged blackbirds, beaver, and Canada geese by inducing sterility surgically. The infidelity of many red-winged females to their polygynous territorial male was surprising and argued against searching for a male sterilant. On the other hand, beaver and Canada goose studies confirmed previous reports that both form par-bonds and are monogamous. Both should be vulnerable to a male chemosterilant approach, and research toward this goal is justified.

  7. Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm

    PubMed Central

    Fratesi, Francesca; Handa, Ashok; Uberoi, Raman; Sideso, Ediri

    2015-01-01

    Inflammatory and juxtarenal Abdominal Aortic Aneurysm (j-iAAA) represents a technical challenge for open repair (OR) due to the peculiar anatomy, extensive perianeurysmal fibrosis, and dense adhesion to the surrounding tissues. A 68-year-old man with an 11 cm asymptomatic j-iAAA was successfully treated with elective EVAR and chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency and normal renal function are present at 24-month follow-up. The treatment of j-iAAA can be technically challenging. ch-EVAR is a feasible and safe bail-out method for elective j-iAAA with challenging anatomy. PMID:26064770

  8. [The abdominal catastrophe].

    PubMed

    Seiler, Christian A

    2011-08-01

    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  9. Optimizing cerebrovascular surgical and endovascular procedures in children via personalized 3D printing.

    PubMed

    Weinstock, Peter; Prabhu, Sanjay P; Flynn, Katie; Orbach, Darren B; Smith, Edward

    2015-07-31

    OBJECT Despite the availability of multiplanar imaging, understanding relational 3D anatomy for complex cerebrovascular lesions can be difficult. A 3D printed model allows for instantaneous visualization of lesional anatomy from all perspectives, with the added ability to simulate operative approaches with tactile feedback. The authors report their experience with customized 3D printed models of pediatric cerebrovascular lesions as an educational and clinical tool for patients, trainees, and physicians. METHODS Via an "in-house" 3D print service, magnetic resonance imaging (MRI) and computerized tomography (CT) studies of pediatric patients with arteriovenous malformations (AVMs) were processed with specialized software, and regions of interest were selected by the surgical/endovascular team. Multiple models for each patient were then printed on a 3D printer, with each construct designed to illustrate different aspects of the specific lesion. Intraoperative validation of model fidelity was performed using perioperative imaging, surgical filming, and post hoc analysis of models with intraoperative photography. RESULTS Four cases involving pediatric patients (ages 0-16 years) were studied for initial proof of principle. Three of the patients had AVMs and one had a vein of Galen malformation (VOGM). The VOGM was embolized successfully and the AVMs were resected without complication. In the AVM cases, intraprocedural imaging and photography were performed and verified millimeter-level fidelity of the models (n = 5, 98% concordance, range 94%-100% with average of < 2 mm variation in the largest AVM [6-cm diameter]). The use of 3D models was associated with a 30-minute reduction in operative time (12%) in 2 cases when they were compared with matched controls as a feasibility study. CONCLUSIONS Patient-specific 3D printed models of pediatric cerebrovascular conditions can be constructed with high fidelity. This proof-of-principle series demonstrates, for the first time

  10. Laparoscopic Gastric Plication: An Emerging Bariatric Procedure with High Surgical Revision Rate

    PubMed Central

    Albanese, Alice; Prevedello, Luca; Verdi, Daunia; Nitti, Donato; Vettor, Roberto

    2015-01-01

    Introduction: Laparoscopic gastric plication (LGCP) reduces gastric volume without resecting or implanting a foreign body. Although still considered investigational, it could be appropriate for young patients with a low body mass index (BMI) and for those unwilling to undergo sleeve gastrectomy, gastric banding, or bypass. Objectives: The aim of this study was to assess the mid-term results (2 years) of LGCP in terms of safety and efficacy. Methods: A total of 56 obese patients (47 female; mean age=30.5±11.7 years; mean BMI=40.31±4.7 kg/m2) were candidates for LGCP from January 2011 to October 2013. Early and late complications, BMI, and excess BMI loss (EBL) were prospectively recorded at 3, 6, 9, 12, 18, and 24 months follow-up. Results: Mean operative time was 72.4±15.6 minutes. No conversion was required. Mean hospital stay was 3 days. Mean %EBL was 34.3±18.40%, 40.1±24.5%, 47.4±30.2%, 46.5±34.6%, 47.8±43.2%, and 55.3±53.6% at 3, 6, 9, 12, 18, and 24 months, respectively. The overall complication rate was 32.14%. Perioperative mortality was zero. Surgical revision was needed in 30 patients: 12 for unsatisfactory weight loss and 18 for gastric prolapse (one acute within 30 days), respectively. Conclusion: LGCP showed high complication rates requiring surgical revision. PMID:26421246

  11. [The clinical estimation of ketoprofen lysine salt effect on the intensitivity of acute pain syndrome in the oral cavity during surgical procedures and postoperative period].

    PubMed

    Durnovo, E A; Shashurina, S V; Bespalova, N A; Khomutinnikova, N E; Gliavina, I A; Marochkina, M S; Iartseva, A V

    2013-01-01

    Is studying and control of the clinical efficacy and safety of ketoprofen lysine salt (КLS) (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in the form of sachets and solutions for application in postoperative period after dental surgeries procedures. The comparison of the analgetic effect of systemic and local forms of the "Oki" drug, depending on the type and extent of surgery procedures. Was carried out surgical treatment and patients examination in the postoperative period. Surgical procedures included: vestibulolasty, vestibulolasty with apically-displaced flap, vestibulolasty with apically-displaced flap and a free palatal mucogingival graft, removal impacted and dystopic teeth, periodontal surgery. The research was conducted in the Surgical stomatology and Maxillofacial surgery Department (stomatological policlinic of the Nizhny Novgorod State Medical Academy). Was noted rapid advanced of anesthesia when using sachets and solutions of the ketoprofen lysine salt (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in postoperative period after dental surgical procedures. Was noted a more advanced of analgetic effect in the application therapy by DCI solution when open surgical wound presented. Analgetic effect was observed after 20-30 min and was maintained in the postoperative period to an average of 8 hours. Local application sachets and solution of the ketoprofen lysine salt (KLS ), in our opinion, is the most appropriate and is highly effective when open surgical wound presented. Ketoprofen lysine salt (KLS) has a neutral pH and does not irritate the gastrointestinal tract, that determines the safety of its used.

  12. Abdominal ultrasound

    MedlinePlus

    ... Kidney - blood and urine flow Abdominal ultrasound References Chen L. Abdominal ultrasound imaging. In: Sahani DV, Samir ... the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used ...

  13. Abdominal tap

    MedlinePlus

    ... tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap Images Digestive system Peritoneal sample References Garcia-Tiso G. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  14. Quality of life after different surgical procedures for the treatment of spinal metastases: results of a single-center prospective case series.

    PubMed

    de Ruiter, Godard C W; Nogarede, Claudine O; Wolfs, Jasper F C; Arts, Mark P

    2017-01-01

    OBJECTIVE The performance of surgery for spinal metastases is rapidly increasing. Different surgical procedures, ranging from stabilization alone to stabilization combined with corpectomy, are thereby performed for various indications. Little is known about the impact of these different procedures on patient quality of life (QOL), but this factor is crucial when discussing the various therapeutic options with patients and their families. Thus, the authors of this study investigated the effect of various surgical procedures for spinal metastases on patient QOL. METHODS The authors prospectively followed a cohort of 113 patients with spinal metastases who were referred to their clinic for surgical evaluation between July 2012 and July 2014. Quality of life was assessed using the EQ-5D at intake and at 3, 6, 9, and 12 months after treatment. RESULTS Nineteen patients were treated conservatively, 41 underwent decompressive surgery with or without stabilization, 47 underwent a piecemeal corpectomy procedure with stabilization and expandable cage reconstruction, and 6 had a stabilization procedure without decompression. Among all surgical patients, the mean EQ-5D score was significantly increased from 0.44 pretreatment to 0.59 at 3 months after treatment (p < 0.001). Mean EQ-5D scores at 1 year after surgery further increased to 0.84 following decompression with stabilization, 0.74 after corpectomy with stabilization, and 0.94 after stabilization without decompression. Frankel scores also improved after surgery. There were no significant differences in improvements in EQ-5D scores and Frankel grades among the different surgical procedures. In addition, mortality and complication rates were similar. CONCLUSIONS Quality of life can improve significantly after various extensive and less extensive surgical procedures in patients with spinal metastases. The relatively invasive corpectomy procedure, as compared with alternative less invasive techniques, does not negatively

  15. Ilizarov techniques with limited adjunctive surgical procedures for the treatment of preadolescent recurrent or neglected clubfeet.

    PubMed

    Khanfour, Ashraf A

    2013-05-01

    When choosing the Ilizarov technique for the treatment of recurrent or neglected clubfeet deformity, there was a consensus on the treatment of 3-8-year-old children by the soft-tissue distraction 'bloodless method' either alone or with an adjunctive-limited soft tissue release; whereas, in older children, adjunctive osteotomies were required. Major foot osteotomies such as V, U, Y, or supramalleolar types were established for patients after puberty when the foot bones become fully ossified. So, children falling in the age group between 8 and 13 years (preadolescents) represents a transitional growing stage that has its identity that makes carrying out major foot osteotomies unsuitable. Twenty-five feet in 21 patients with a mean age at the time of operation of 10.9 years (range, 9-13 years) with recurrent or neglected clubfeet deformity who presented to the orthopedic department at Alexandria (Egypt) between February 2004 and December 2008 were treated with the Ilizarov technique combined with adjunctive limited bony and/or soft-tissue procedures as will be discussed. After a mean follow-up period of 3.6 years (range, 2-7 years), 21 children showed good results, four children showed fair results, and no poor results were recorded. No major complications were reported. The Ilizarov technique with limited bony and/or soft-tissue procedures can be considered as a suitable, convenient, efficient, and successful salvage procedure for preadolescent recurrent or neglected clubfeet.

  16. [Alternative surgical method in malalignment of healed distal radius fracture: Kapandji-Sauvé procedure].

    PubMed

    Pechlaner, S

    1998-11-01

    Malunion after distal radius fracture with subluxation of the distal radioulnar joint can considerably limit the function of the hand. If the malunion cannot be eliminated by the corrective osteotomy of the radius, care must be taken not to additionally impair the stability of the wrist joint and the carpus, in the event of any necessary salvage procedure. In the Kapandji-Sauvé procedure, an arthrodesis is carried out after repositioning of the distal radioulnar joint. By segment resection of the ulnar shaft, a new joint is made to permit forearm rotation. Between 1984 and 1995, a total of 96 patients were treated with this procedure in our hospital. It was possible to re-examine 87 of those patients after an average period of 4 1/2 (1 to 11) years. The average age of the patients was 59 (14 to 72) years. In 25 cases the results were very good and in 52 cases good. In nine cases the results were poor. In one case the result was unsatisfactory.

  17. Surgical management of a large peritoneal pseudocyst causing acute kidney injury secondary to abdominal compartment syndrome in a rare case of congenital absence of omentum during pregnancy.

    PubMed

    Jones, Benjamin P; Hunjan, Tia; Terry, Jayne

    2016-09-01

    Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.

  18. Abdominal Pain

    MedlinePlus

    ... call your doctor. In Spanish— Dolor abdominal en niños menores de 12 años What is recurrent abdominal ... Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to ...

  19. Intraoperative antibiotic wound lavage: an attempt to eliminate postoperative infection in arterial and clean general surgical procedures.

    PubMed

    Lord, J W; Rossi, G; Daliana, M

    1977-06-01

    Intraoperative antibiotic wound lavage has been used in all arterial reconstructive procedures for the past 7 years and reduced the incidence of early and late postoperative infections from 1.5% in 400 operations prior to 1969 to 0.23% (one post-hospital) in 434 patients operated since that date. In 226 consecutive clean major general surgical procedures since June 1971 there has been no early or late wound infections following intraoperative antibiotic wound lavage in contrast to an infection rate of 1.5% in 185 operations prior to that date. A double blind study of 200 patients undergoing operations for varicose veins was carried out as follows: The wounds of alternate patients were irrigated either with normal saline or with antibiotic solution. There were no gross (grade II) postoperative wound infections. Minor skin changes were noted in 93 of 632 incisions in the saline group and only 49 of 608 incisions irrigated with antibiotic solution (P less than 0.001). In clean operations without antibiotic wound lavage there was a 0.73% rate of in-hospital wound infections in 685 patients in contrast to a zero rate in 760 patients wherein intraoperative wound lavage was carried out throughout the operative procedure.

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

    PubMed Central

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

    2014-01-01

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

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

    USGS Publications Warehouse

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

    2011-01-01

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

  2. Perspectives on procedure-based assessments: a thematic analysis of semistructured interviews with 10 UK surgical trainees

    PubMed Central

    Shalhoub, Joseph; Ippolito, Kate

    2017-01-01

    Objectives The introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure-based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees' perspective on the value of PBA. Design Semistructured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed; following this, they were open and axial coded. Thematic analysis was then performed. Results Semistructured interviews yielded several topical and recurring themes. In trainees' experience, the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees' performance with reports of ‘gaming’ the system and trainees completing their own assessments. Trainees did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress. Conclusions The UK surgical trainees interviewed identified both limitations and benefits to PBAs; however, we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely as a summative tool; if so, further work is needed to audit, validate and standardise them for this purpose. PMID:28341687

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

    PubMed

    Matte, J J

    1999-07-01

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

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

    PubMed Central

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  5. Local antimicrobial administration for prophylaxis of surgical site infections.

    PubMed

    Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

    2012-11-01

    Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made.

  6. Non pigmented melanocytic nevus of the oral cavity: a case report with emphasis on the surgical excision procedures.

    PubMed

    Porrini, R; Valente, G; Colombo, E; Cannas, M; Sabbatini, M

    2013-01-01

    We report a case of a 37-year-old caucasian woman presenting a 1 cm pinkish nodular asymptomatic lesion of the hard palate, slowly growing in the last years. The lesion underwent to biopsy. Histological analysis showed the nevus tissue layered under a continuous squamous epithelium. The stroma contained nests of medium-sized round cells, with regular monomorphous nuclei. The nevus cells were immunohistochemically positive for S-100 protein, while melanin, visualized by Masson-Fontana silver staining, was absent. Therefore a diagnosis of non pigmented melanocytic nevus was formulated. Because of its rarity and to avoid any risk of malignant transformation, a surgical treatment with wide excision was chosen; the surgical wound was previously covered with a membrane of fibrin and autologous platelets, and subsequently sutured, resulting in a total heal. This procedure seems to be the most reliable to approach melanocytic lesions of the oral cavity. Clinical diagnosis of non-pigmented nevi, either flat or protruding, is difficult, because the nevus shows a pinkish colour that is indistinguishable from that of the surrounding mucosa. Moreover, attention is required when similar clinical evidence occurs, because the localization inside the oral cavity may offer several problems of differential diagnosis.

  7. Surgical correction of 639 pectus excavatum cases via the Nuss procedure

    PubMed Central

    Zhang, Dong-Kun; Tang, Ji-Ming; Ben, Xiao-Song; Xie, Liang; Zhou, Hai-Yu; Ye, Xiong; Zhou, Zi-Hao; Shi, Rui-Qing; Xiao, Pu

    2015-01-01

    Background To review the clinical experience and short- to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). Methods From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3±5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3±1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). Results A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3±41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5±17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2±2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. Conclusions Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined. PMID:26543607

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

    PubMed

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

    1999-12-01

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

  9. A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures

    PubMed Central

    Qiu, Hao; Wei, Zhihui; Liu, Yuting; Dong, Jing; Zhou, Xin; Yin, Liangjun; Zhang, Minhua; Lu, Minpeng

    2016-01-01

    Abstract Background: The optimal surgical procedure for humeral shaft fractures remains a matter of debate. We aimed to establish the optimum procedure by performing a Bayesian network meta-analysis. Methods: PubMed, EMBASE, the Cochrane Library, and Medline were searched for both randomized controlled trials and prospective studies of surgical treatment for humeral shaft fractures. The quality of the included studies was assessed according to the Cochrane Collaboration's “Risk of bias”. Results: Seventeen RCTs or prospective studies were included in the meta-analysis. The pooled results showed that the occurrence rate of radial nerve injury was lowest for minimally invasive plate osteosynthesis (MIPO; SUCRA probability, 95.1%), followed by open reduction and plate osteosynthesis (ORPO; SUCRA probability, 29.5%), and was highest for intramedullary nailing (IMN; SUCRA probability, 25.4%). The aggregated results of pairwise meta-analysis showed no significant difference in radial nerve injury rate when comparing ORPO versus IMN (OR, 1.92; 95% CI, 0.96 to 3.86), ORPO versus MIPO (OR, 3.38; 95% CI, 0.80 to 14.31), or IMN versus MIPO (OR, 3.19; 95% CI, 0.48 to 21.28). Regarding the nonunion, SUCRA probabilities were 90.5%, 40.2%, and 19.3% for MIPO, ORPO, and IMN, respectively. The aggregated results of a pairwise meta-analysis also showed no significant difference for ORPO versus IMN (OR, 0.83; 95% CI, 0.41 to 1.69), ORPO versus MIPO (OR, 2.42; 95% CI, 0.45 to 12.95), or IMN versus MIPO (OR, 2.49; 95% CI, 0.35 to 17.64). Conclusion: The current evidence indicates that MIPO is the optimum choice in the treatment of humeral shaft fractures and that ORPO is superior to IMN. PMID:28002327

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

    PubMed Central

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

    2009-01-01

    Background The possibility of using stem cells for regenerative medicine has opened a new field of investigation. The search for sources to obtain multipotent stem cells from discarded tissues or through non-invasive procedures is of great interest. It has been shown that mesenchymal stem cells (MSCs) obtained from umbilical cords, dental pulp and adipose tissue, which are all biological discards, are able to differentiate into muscle, fat, bone and cartilage cell lineages. The aim of this study was to isolate, expand, characterize and assess the differentiation potential of MSCs from human fallopian tubes (hFTs). Methods Lineages of hFTs were expanded, had their karyotype analyzed, were characterized by flow cytometry and underwent in vitro adipogenic, chondrogenic, osteogenic, and myogenic differentiation. Results Here we show for the first time that hFTs, which are discarded after some gynecological procedures, are a rich additional source of MSCs, which we designated as human tube MSCs (htMSCs). Conclusion Human tube MSCs can be easily isolated, expanded in vitro, present a mesenchymal profile and are able to differentiate into muscle, fat, cartilage and bone in vitro. PMID:19538712

  11. Blunt traumatic abdominal wall disruption with evisceration

    PubMed Central

    McDaniel, Ellen; Stawicki, Stanislaw PA; Bahner, David P

    2011-01-01

    Blunt traumatic abdominal wall disruptions associated with evisceration are very rare. The authors describe a case of traumatic abdominal wall disruption with bowel evisceration that occurred after a middle-aged woman sustained direct focal blunt force impact to the lower abdomen. Abdominal exploration and surgical repair of the abdominal wall defect were performed, with good clinical outcome. A brief overview of literature pertinent to this rare trauma scenario is presented. PMID:22229144

  12. Implanting intra-abdominal radiotransmitters with external whip antennas in ducks

    USGS Publications Warehouse

    Korschgen, C.E.; Kenow, K.P.; Gendron-Fitzpatrick, A.; Green, W.L.; Dein, F.J.

    1996-01-01

    We developed and evaluated a surgical procedure for implanting intra-abdominal radiotransmitters with external whip antennas in captive mallards (Anas platyrhynchos). Transmitters were implanted in the abdominal cavity and the antennas exited through the caudal abdominal wall and skin. Birds with implanted transmitters developed mild to moderate localized air sac reactions. These reactions involved adhesions of the right anterior abdominal air sac to the liver with contractions around the transmitters and antenna catheters. The adhesions were reinforced by a proliferation of connective tissue and lined by multinucleated giant cells (foreign body reaction). Casual observation indicated that neither behavior nor activity of the birds was altered by the histological reaction to the transmitter implant. No increase in systemic lesions (particularly liver or kidney) could be correlated with the histological reactions. Our evaluations indicate that the procedure is a reliable method for radiomarking ducks and the technique has been successfully used in 2 field studies.

  13. Decompressive laparotomy for abdominal compartment syndrome

    PubMed Central

    Kimball, E.; Malbrain, M.; Nesbitt, I.; Cohen, J.; Kaloiani, V.; Ivatury, R.; Mone, M.; Debergh, D.; Björck, M.

    2016-01-01

    Background The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28‐day and 1‐year all‐cause mortality. Changes in intra‐abdominal pressure (IAP) and organ function, and laparotomy‐related morbidity were secondary endpoints. Results Thirty‐three patients were included in the study (20 men). Twenty‐seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20–32). Median IAP was 23 (21–27) mmHg before decompressive laparotomy, decreasing to 12 (9–15), 13 (8–17), 12 (9–15) and 12 (9–14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non‐survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28‐day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non‐survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome. PMID:26891380

  14. TOT 8/4: A Way to Standardize the Surgical Procedure of a Transobturator Tape

    PubMed Central

    Ludwig, Sebastian; Stumm, Martin; Mallmann, Peter; Jager, Wolfram

    2016-01-01

    Suburethral tapes are placed “tension-free” below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named “TOT 8/4,” we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra. PMID:26981532

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

    PubMed

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

    2014-11-01

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

  16. TOT 8/4: A Way to Standardize the Surgical Procedure of a Transobturator Tape.

    PubMed

    Ludwig, Sebastian; Stumm, Martin; Mallmann, Peter; Jager, Wolfram

    2016-01-01

    Suburethral tapes are placed "tension-free" below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named "TOT 8/4," we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra.

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

    PubMed

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

    2013-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

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

  19. Occupational Radiation Exposure from C Arm Fluoroscopy During Common Orthopaedic Surgical Procedures and its Prevention

    PubMed Central

    Samuel, Sumant; Saran, Atul K; Mahajan, M K; Mam, M K

    2015-01-01

    Background: Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice. Materials and Methods: Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed. Results: Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall. Conclusion: Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one

  20. SU-F-207-14: Low Contrast Detectability (LCD) at Different Diagnostic Reference Levels for Adult Abdominal CT Procedures

    SciTech Connect

    Mahmood, U; Erdi, Y

    2015-06-15

    Purpose Using diagnostic reference levels (DRL) to optimize CT protocols has potential to reduce radiation dose and meet regulatory requirements. However, DRL’s tend to be misconstrued as dose limits, are typically designed for specific patient populations, and are assumed to have acceptable image quality (AIQ) associated with them. To determine the image quality that is associated with established DRL’s for adult abdominal CT studies, a LCD phantom study was employed. Methods: A CT phantom (CIRS) containing three columns of 7 spherical targets, ranging from 10mm to 2.4 mm, that are 5, 10, and 20 HU below the background (HUBB) matrix was scanned with a GE HD750 64 slice scanner. The phantom was scanned at the NEXT 2006 25th CTDIvol of 12 mGy, the NCRP 172 achievable dose (AD) CTDIvol of 17 mGy and 75th CTDIvol of 25 mGy and at the ACR recommended CTDIvol of 25 mGy. It was also scanned at a CTDIvol 20% greater than the AD at 20 mGy and the ACR maximum threshold of 30 mGy. Results: At the NEXT 2006 25th percentile CTDIvol of 12 mGy, a 6.3 mm low contrast lesion was detectable in the 20 HUBB; 6.3 mm in the 10 HUBB and 10 mm in the 5 HUBB column. Increasing the CTDIvol to the NCRP 172 AD of 17 mGy, an additional 4.8 mm lesion was visualized in the 20 HUBB column. At 20 mGy, an additional 4.8 mm lesion was detectable in the 10 HUBB column. No further lesions were visible between 20 and 30 mGy. However, conspicuity of all lesions increased with each additional step up in CTDI. Conclusion: Optimizing radiation dose to achieve AIQ is a critical aspect of any dose optimization committee. Hence, judicious monitoring of radiation exposure to patients has to be balanced with diagnostic image quality.

  1. Non-vascular interventional procedures: effective dose to patient and equivalent dose to abdominal organs by means of DICOM images and Monte Carlo simulation.

    PubMed

    Longo, Mariaconcetta; Marchioni, Chiara; Insero, Teresa; Donnarumma, Raffaella; D'Adamo, Alessandro; Lucatelli, Pierleone; Fanelli, Fabrizio; Salvatori, Filippo Maria; Cannavale, Alessandro; Di Castro, Elisabetta

    2016-03-01

    This study evaluates X-ray exposure in patient undergoing abdominal extra-vascular interventional procedures by means of Digital Imaging and COmmunications in Medicine (DICOM) image headers and Monte Carlo simulation. The main aim was to assess the effective and equivalent doses, under the hypothesis of their correlation with the dose area product (DAP) measured during each examination. This allows to collect dosimetric information about each patient and to evaluate associated risks without resorting to in vivo dosimetry. The dose calculation was performed in 79 procedures through the Monte Carlo simulator PCXMC (A PC-based Monte Carlo program for calculating patient doses in medical X-ray examinations), by using the real geometrical and dosimetric irradiation conditions, automatically extracted from DICOM headers. The DAP measurements were also validated by using thermoluminescent dosemeters on an anthropomorphic phantom. The expected linear correlation between effective doses and DAP was confirmed with an R(2) of 0.974. Moreover, in order to easily calculate patient doses, conversion coefficients that relate equivalent doses to measurable quantities, such as DAP, were obtained.

  2. Bowel and mesenteric injuries from blunt abdominal trauma: a review.

    PubMed

    Iaselli, Francesco; Mazzei, Maria Antonietta; Firetto, Cristina; D'Elia, Domenico; Squitieri, Nevada Cioffi; Biondetti, Pietro Raimondo; Danza, Francesco Maria; Scaglione, Mariano

    2015-01-01

    The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.

  3. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

    PubMed Central

    Huirne, Judith AF; Bouwsma, Esther VA; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter KG; Geomini, Peggy MAJ; Consten, Esther CJ; Schraffordt Koops, Steven E; van Kesteren, Paul JM; Stockmann, Hein BAC; ten Cate, A Dorien; Davids, Paul HP; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus JHJ; Bonjer, H Jaap; Anema, Johannes R

    2016-01-01

    Background Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social

  4. A Novel Surgical Procedure for Er:YAG Laser-Assisted Periodontal Regenerative Therapy: Case Series.

    PubMed

    Taniguchi, Yoichi; Aoki, Akira; Sakai, Kazuto; Mizutani, Koji; Meinzer, Walter; Izumi, Yuichi

    2016-01-01

    The objective of this study was to evaluate an Er:YAG laser (ErL) application for periodontal regenerative surgery in angular bone defects at nine sites in six patients. Debridement was thoroughly performed using a combination of curettage with a Gracey-type curette and ErL irradiation at a panel setting of 70 mJ/pulse and 20 Hz with sterile saline spray. After applying an enamel matrix derivative and autogenous bone grafting, ErL was used to form a blood clot coagulation on the grafted bone surface at 50 mJ/pulse and 20 Hz without water spray for approximately 30 seconds. Twelve months after surgery the mean probing depth had improved from 6.2 mm to 2.0 mm, the mean clinical attachment level had reduced from 7.5 mm to 3.4 mm, and bleeding on probing had improved from (+) to (-). Mean intrabony defect depth decreased from 6.0 mm before surgery to 1.0 mm 12 months after surgery. A novel procedure for periodontal regenerative surgery applying ErL irradiation for thorough decontamination during debridement as well as blood coagulation following autogenous bone grafting seems to have achieved favorable and stable healing of periodontal pockets with significant clinical improvement and desirable regeneration of angular bone defects, including one-wall defects.

  5. Abdominal wall abscesses in patients with Crohn's disease: clinical outcome.

    PubMed

    Neufeld, David; Keidar, Andrei; Gutman, Mordechai; Zissin, Rivka

    2006-03-01

    Abdominal wall abscess due to Crohn's Disease used to be one of the definitive indications for operative treatment. The advent of interventional radiology, the accessibility to percutaneous drainage, and the availability of new medications raised the possibility of nonoperative treatment of this condition. The clinical presentation, treatment, and follow-up of 13 patients with abdominal wall abscesses secondary to Crohn's Disease were retrospectively reviewed. During a 10-year period (1993-2003), 13 patients with abdominal wall abscess were treated. Five patients had an anterolateral abdominal wall abscess and eight had a posterior abscess (psoas). In 11 patients, 17 drainage procedures were performed: 12 percutaneous and 5 operative. Despite initial adequate drainage and resolution of the abscess, all 13 patients eventually needed resection of the offending bowel segment, which was undertaken in 12 patients. The mean time between abscess presentation and definitive operation was 2 months. Percutaneous drainage is an attractive option in most cases of abdominal abscesses. However, in Crohn's Disease patients with an abdominal wall abscess, we found a high failure rate despite initial adequate drainage. We suggest that surgical resection of the diseased bowel segment should be the definitive therapy.

  6. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management.

    PubMed

    Misra, A; Chowbey, P; Makkar, B M; Vikram, N K; Wasir, J S; Chadha, D; Joshi, Shashank R; Sadikot, S; Gupta, R; Gulati, Seema; Munjal, Y P

    2009-02-01

    Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medical institutions, hospitals, government funded research institutions, and policy making bodies. It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as overweight/obese and would require appropriate management. Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases.

  7. Recurrent pneumothorax following abdominal paracentesis.

    PubMed Central

    Stafford, P. J.

    1990-01-01

    A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax. This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease. PMID:2385561

  8. Ruptured abdominal aortic aneurysm.

    PubMed

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  9. Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures

    PubMed Central

    Kaur, Kiranpreet; Singh, Roop; Prasath, Vishnu; Magu, Sarita; Tanwar, Milind

    2016-01-01

    Background To collect a baseline computer software aided normative morphometric data of thoracic spine in the Indian population and analyze it to give pre-procedural guidelines to clinicians for safe surgical and anaesthetic procedures in the thoracic spine. Methods CT scans of thoracic spine of patients free from spinal disorders were reviewed in a total of 600 vertebrae in 50 patients. Parameters recorded with the help of computer software were pedicle width, length and height, transverse pedicle angles, chord length, canal dimensions, body width and height, spinous process angle and transverse process length. Results Pedicle width decreased from T1 (9.27 ± 1.01) to T4 (4.5 ± 0.93) and increased to T12 (8.31 ± 1.83). At T4 76% and at T5 62% of the pedicles were smaller than 5 mm and would not accept 4 mm screw with 1.0-mm clearance. However, at T1 2%, at T11 7% and at T12 8% would not accept a 4 mm screw. Chord length gradually increased in upper thoracic vertebrae and was relatively constant in middle and decreased in lower thoracic vertebrae. Shortest estimated chord length was at T1 (30.30 ± 2.11). On an average, from T1 to T6 and at T11 and T12, a screw length of 25–30 mm could be accommodated and from T7 to T10, 30–35 mm screw length could be accommodated. Transverse pedicle angle decreased from T1 (35.4 ± 2.21) to T12 (−9.8 ± 2.39). Canal dimensions were narrowest at T4/T5 (20.02 ± 1.23) in anteroposterior and 21.12 ± 1.23 in interpedicular diameters. Spinous process angle increased from T1 (30.11 ± 6.74) to T6 (57.89 ± 9.31) and decreased to 16.21 ± 7.38 at T12. Transverse process length increased from T1 to T7 (23.54 + 2.12 to 31.21 + 1.91) and then decreased to 12.11 + 2.3 at T12. Vertebral body dimensions showed increasing trends from T1 to T12. Conclusions A thorough knowledge of anatomical and radiological characteristics of the spine and their variations is essential for the clinicians. Data collected

  10. Clinician-led surgical site infection surveillance of orthopaedic procedures: a UK multi-centre pilot study.

    PubMed

    Morgan, M; Black, J; Bone, F; Fry, C; Harris, S; Hogg, S; Holmes, A; Hughes, S; Looker, N; McIlvenny, G; Nixon, J; Nolan, J; Noone, A; Reilly, J; Richards, J; Smyth, E; Howard, A

    2005-07-01

    The UK Department of Health established the Healthcare-associated Infection (HAI) Surveillance Steering Group in 2000 to develop a strategy for implementing a national programme for HAI surveillance in National Health Service trusts. A subgroup of this committee examined the surveillance of surgical site infections following orthopaedic surgery. This group oversaw a pilot scheme that was set up in 12 hospitals around the UK to explore the feasibility of implementing a system of surveillance that engaged clinical staff in its operation, provided a process for continuous data collection and could be maintained as part of routine hospital operation over time. A minimum data set was established by the subgroup, and Centers for Disease Control and Prevention (CDC) definitions of infection were used. By March 2003, the surveillance had been undertaken continuously in 11 sites for one to two years, depending on the date of implementation. Only one hospital had ceased data collection. The information was collected mainly by clinical staff, with support and co-ordination usually provided by infection control teams. Data on more than 5400 procedures were available for analysis for four core procedures: arthroplasty of the hip and knee; hemi-arthroplasty of the hip; and internal fixation of trochanteric fractures of the femur. The data set permitted the calculation of risk-adjusted rates, allowing comparisons between hospitals and within a hospital over time. The methodology enhanced clinical ownership of the surveillance process, re-inforced infection control as the responsibility of all staff, and provided timely feedback and local data analysis. The use of CDC definitions permitted international comparisons of the data.

  11. Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980

    SciTech Connect

    Morrow, M.; Hilaris, B.; Brennan, M.F.

    1984-01-01

    To examine the efficacy of a variety of procedures for treatment of biopsy proven exocrine adenocarcinoma of the pancreas, a retrospective review of 231 patients surgically treated at a single institution from January 1975 through December 1980 was performed. Thirty-nine patients underwent resection for cure, of which 19 were conventional resection, 33 I125 implantation, 76 biliary or GI bypass, and 83 biopsy alone, a resectability rate of 16.9%. There was one pancreatic fistula in the implant group. Median survival following implant was 8 months (0%, 30-day mortality) and, for conventional resection (n . 19), 17 months with an inhospital mortality of 16%. Median survival excluding inhospital mortality was 17 months for the conventional resection group. For bypass, median survival was 4 months with an inhospital mortality of 14%. Of patients discharged from hospital, 5 of 16 (31%) survived 2 years in the conventional resection group, while 4 of 132 (3%) survived 2 years in the nonresected groups. Only one patient (5% of resected) has survived 4 years in the conventional resection group, although eight others are alive and at risk in this group. Resectability rate for patients referred with adenocarcinoma of the pancreas remains low. The only long-term survivors are in those patients undergoing resection. Local implantation with I125 requires prospective evaluation because of an apparent influence on palliation without significant morbidity.

  12. Positional changes of the masseter and medial pterygoid muscles after surgical mandibular advancement procedures: an MRI study.

    PubMed

    Dicker, G J; Koolstra, J H; Castelijns, J A; Van Schijndel, R A; Tuinzing, D B

    2012-08-01

    This study evaluated whether surgical mandibular advancement procedures induced a change in the direction and the moment arms of the masseter (MAS) and medial pterygoid (MPM) muscles. Sixteen adults participated in this study. The sample was divided in two groups: Group I (n=8) with a mandibular plane angle (mpa) <39° and Group II (n=8) with an mpa >39°. Group I patients were treated with a bilateral sagittal split osteotomy (BSSO). Those in Group II were treated with a BSSO combined with a Le Fort I osteotomy. Pre- and postoperative direction and moment arms of MAS and MPM were compared in these groups. Postsurgically, MAS and MPM in Group II showed a significantly more vertical direction in the sagittal plane. Changes of direction in the frontal plane and changes of moment arms were insignificant in both groups. This study demonstrated that bimaxillary surgery in patients with an mpa >39° leads to a significant change of direction of MAS and MPM in the sagittal plane.

  13. A bizarre abdominal cystic lesion.

    PubMed

    Zucchini, Giorgia; Pezzilli, Raffaele; Ricci, Claudio; Casadei, Riccardo; Santini, Donatella; Calculli, Lucia; Corinaldesi, Roberto

    2010-09-06

    In spite of careful intraoperative precautions and gauze counts, mistakes can still occur during surgery. In the case reported, a retained gauze leaved during a surgical approach for removing a solid-cystic papillary tumor localized in the pancreatic tail, caused both persistent abdominal discomfort and the presence of an abdominal cystic lesion at imaging techniques. When a previous operative history is present, a foreign body should be taken into account in the differential diagnosis of a patient with an intra-abdominal cystic mass. Finally, radio-opaque marker should be routinely used by surgeons in order to reach a correct diagnosis in operated patients having retained gauze.

  14. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  15. Mastectomy -- The Surgical Procedure

    MedlinePlus

    ... and Staging Stages Molecular Subtypes Molecular Subtypes Triple Negative Breast Cancer Emerging Areas in Diagnosis Inflammatory Breast ... Accessing Sources of Support Accessing Sources of Support Social Support Local Support Support Groups Hospice Donate Now Fundraise ...

  16. IC Treatment: Surgical Procedures

    MedlinePlus

    ... Body-based Practices Energy Medicine Bringing Treatments to Market IC Healthcare Provider Toolkit Join the Provider Registry ... Body-based Practices Energy Medicine Bringing Treatments to Market IC Healthcare Provider Toolkit Join the Provider Registry ...

  17. Aortic transection and diverting bypass as treatment of repetitive recurrent abdominal aortic false aneurysm rupture in a patient with Behcet's disease.

    PubMed

    Kim, Sang-Dong; Won, Yong-Sung; Yun, Sang-Seob; Park, Sun-Cheol; Kim, Ji-Il; Moon, In-Sung; Koh, Yong-Bok

    2011-02-01

    Abdominal aortic false aneurysms in patients with Behcet's disease have been reported frequently and repaired successfully by various procedures; however, anastomotic false aneurysms have often been reported to occur after the operation. In this article, we report a case of four-time repetitive, recurrent suprarenal abdominal aortic false aneurysm ruptures that lasted for 7 years. The location of this aneurysm was not easy to repair not only by open surgical procedures but by endovascular stent because the aortic defect was too close to the visceral arterial branches. The last operation consisted of primary repair of aortic defect, transection of abdominal aorta at the level of supraceliac aorta with end closure, and a thoracic aorta to abdominal aorta bypass with Dacron graft. An 8-year follow-up revealed no more abdominal aortic aneurysm recurrence.

  18. MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery—the MA3RS study

    PubMed Central

    McBride, Olivia M B; Berry, Colin; Burns, Paul; Chalmers, Roderick T A; Doyle, Barry; Forsythe, Rachael; Garden, O James; Goodman, Kirsteen; Graham, Catriona; Hoskins, Peter; Holdsworth, Richard; MacGillivray, Thomas J; McKillop, Graham; Murray, Gordon; Oatey, Katherine; Robson, Jennifer M J; Roditi, Giles; Semple, Scott; Stuart, Wesley; van Beek, Edwin J R; Vesey, Alex; Newby, David E

    2015-01-01

    Introduction Population screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and currently relies on serial diameter measurements with ultrasound. Recently, a novel MRI-based technique using ultrasmall superparamagnetic particles of iron oxide (USPIO) has demonstrated considerable promise as a method of identifying aneurysm inflammation and expansion. Methods and analysis The MA3RS study is a prospective observational multicentre cohort study of 350 patients with AAA in three centres across Scotland. All participants will undergo MRI with USPIO and aneurysm expansion will be measured over 2 years with CT in addition to standard clinical ultrasound surveillance. The relationship between mural USPIO uptake and subsequent clinical outcomes, including expansion, rupture and repair, will be evaluated and used to determine whether the technique augments standard risk prediction markers. To ensure adequate sensitivity to answer the primary question, we need to observe 130 events (composite of rupture or repair) with an estimated event rate of 41% over 2 years of follow-up. The MA3RS study is currently recruiting and expects to report in 2017. Discussion This is the first study to evaluate the use of USPIO-enhanced MRI to provide additional information to aid risk prediction models in patients with AAA. If successful, this study will lay the foundation for a large randomised controlled trial targeted at applying this technique to determine clinical management. Trial registration number Current Controlled Trials: ISRCTN76413758. PMID:25932334

  19. Combined procedures in laparoscopic surgery.

    PubMed

    Wadhwa, Atul; Chowbey, Pradeep K; Sharma, Anil; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

    2003-12-01

    With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30-280 minutes). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1-21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different

  20. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  1. [Abdominal pain].

    PubMed

    Gschossmann, J M; Holtmann, G; Netzer, P; Essig, M; Balsiger, B M; Scheurer, U

    2005-10-01

    Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.

  2. Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures

    PubMed Central

    Parasa, Mrunalini; Yallapragada, Srivishnu Vardhan; Vemuri, Nagendra Nath; Shaik, Mastan Saheb

    2016-01-01

    Background: GlideScope (GS) is a video laryngoscope that allows a real-time view of the glottis and endotracheal intubation. It provides a better view of the larynx without the need for alignment of the airway axes. Aim: This prospective randomized comparative study is designed to compare the intubation time, hemodynamic response, and complications associated with intubation using a GS or Macintosh laryngoscope (ML) in adult subjects undergoing elective surgical procedures. Materials and Methods: Sixty American Society of Anesthesiologists physical status 1–2 patients were included in this prospective randomized comparative study. Patients were randomized to be intubated using either a GS or an ML. The primary outcome measure was the intubation time. The secondary outcome measures were the hemodynamic response to intubation and the incidence of mucosal injury. Statistical Analysis: Mean and standard deviation were calculated for different parameters under the study. The observed results were analyzed using Student's t-test for quantitative data and Z-test of proportions. P<0.05 was considered statistically significant. Results: Intubation time was longer in GS group (45.7033 ± 11.649 s) as compared to ML (27.773 ± 5.122 s) P< 0.0001 with 95% confidence interval (95% CI) −13.2794 to −22.5806. GS provided better Cormack and Lehane laryngoscopic view (P = 0.0016 for grade 1 view) with 95% CI −0.1389 to −0.5951. GS group exhibited more laryngoscopic response than ML group with more increase in blood pressure and heart rate, but the difference was not statistically significant. More cases of mucosal trauma were documented in GS group. Conclusion: Use of GS to facilitate intubation led to better glottic view but took a longer time to achieve endotracheal intubation. GS was associated with more hemodynamic response to intubation and mucosal injury in comparison with an ML. PMID:27212755

  3. Time-dependent RNA degradation affecting cDNA array quality in spontaneous canine tumours sampled using standard surgical procedures.

    PubMed

    Von Euler, Henrik; Khoshnoud, Reza; He, Qimin; Khoshnoud, Aida; Fornander, Tommy; Rutqvist, Lars-Erik; Skog, Sven

    2005-12-01

    Heterogeneous gene expression in tumours and the degradation of RNA when sampling under non-RNAse-free conditions may limit the potential benefit of cDNA array studies. This study examines changes in the integrity of RNA by means of RNA gel electrophoresis at various post-operative intervals on canine mammary tumours (n=10) and malignant lymphoma (n=1). The tumours were cut into pieces (3-5 mm diameter, approximately 50 mg) and kept in tubes without RNAse-free buffer at room temperature. No special precautions were taken to avoid the influences of Rnase; rather, normal surgical procedures were used. We found that total RNA of the mammary tumours started to degrade within 30 min of the operation, and the rate of degradation increased up to 4 h, which was the last time point included in this study. RNA in the lymphoma tumours degraded more rapidly, and was completely degraded at 30 min post-operation. The degradation of mRNA in the mammary tumours, as studied by human cDNA arrays, was heterogeneous, i.e. some mRNA degraded completely, some only partially. This indicates that the mRNA degradation rate varied depending on the type of mRNA. However, since we found that gene expression differs depending on the part of the mammary tumour examined, one cannot exclude that the variation in the mRNA degradation rate may simply reflect heterogeneous gene expression within the tumour. We conclude that RNA integrity is unaffected immediately after sampling under non-RNAse-free conditions; however, the tumour sample should be preserved under RNAse-free conditions within 15 min to avoid RNA degradation. This is a much shorter time interval than previously reported in other similar studies; however, these studies generally treated normal tissue, under which 3-5 h non-RNAse-free conditions have been found not to affect RNA quality.

  4. I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures

    PubMed Central

    Jadhav, Poonam A; Dalvi, Naina P; Tendolkar, Bharati A

    2015-01-01

    Background and Aims: Supraglottic airway devices have been established in clinical anesthesia practice and have been previously shown to be safe and efficient. The objective of this prospective, randomized trial was to compare I-Gel with LMA-Proseal in anesthetized spontaneously breathing patients. Material and Methods: Sixty patients undergoing short surgical procedures were randomly assigned to I-gel (Group I) or LMA- Proseal (Group P). Anesthesia was induced with standard doses of propofol and the supraglottic airway device was inserted. We compared the ease and time required for insertion, airway sealing pressure and adverse events. Results: There were no significant differences in demographic and hemodynamic data. I-gel was significantly easier to insert than LMA-Proseal (P < 0.05) (Chi-square test). The mean time for insertion was more with Group P (41 + 09.41 secs) than with Group I (29.53 + 08.23 secs) (P < 0.05). Although the airway sealing pressure was significantly higher with Group P (25.73 + 02.21 cm of H2O), the airway sealing pressure of Group I (20.07 + 02.94 cm of H2O) was very well within normal limit (Student's t test). The success rate of first attempt insertion was more with Group I (P < 0.05). There was no evidence of airway trauma, regurgitation and aspiration. Sore throat was significantly more evident in Group P. Conclusion: I-Gel is a innovative supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence I-Gel can be a good alternative to LMA-Proseal. PMID:25948905

  5. Endovascular Exclusion of Abdominal Aortic Aneurysms: Initial Experience with Stent-Grafts in Cardiology Practice

    PubMed Central

    Howell, Marcus H.; Zaqqa, Munir; Villareal, Rollo P.; Strickman, Neil E.; Krajcer, Zvonimir

    2000-01-01

    The use of an endovascular stent-graft prosthesis for the treatment of infrarenal abdominal aortic aneurysms is receiving increasing attention as an option that may avoid the significant morbidity and mortality associated with open surgical treatment. We studied the clinical effectiveness of stent-grafts in patients with infrarenal abdominal aortic aneurysms. Between October 1995 and May 1998, 33 patients underwent infrarenal abdominal aortic aneurysm exclusion with a homemade polytetrafluoroethylene-covered stent, and between November 1998 and September 1999, 56 patients underwent abdominal aortic aneurysm exclusion with the Medtronic AneuRx stent-graft. Overall, these patients represented a high-risk surgical group. The technical success rate was 100% in both groups. No patient required immediate conversion to open repair. With the polytetrafluoroethy-lene-covered stent, the primary success rate was 33%, and the secondary success rate was 76%. In the AneuRx group, the primary success rate was 82.8%, and the secondary success rate was 85.3% at 6 months. There was no procedural or 1-month mortality or major morbidity in either group. By showing that infrarenal abdominal aortic aneurysms can be treated safely and successfully with an endoluminal stent-graft, our early results provide additional support for the endovascular treatment of abdominal aortic aneurysms. Further follow-up studies will determine the long-term ability of such treatment to prevent aneurysmal rupture and death. PMID:10928501

  6. Abdominal sling surgery--artificial sacro-uterine ligament.

    PubMed

    Draca, Petar; Miljković, Stamenko; Jakovljević, Branislava

    2002-01-01

    Abdominal sling surgery is defined as attachment of either the connective tissue graft (fascia lata) or some synthetic material (Mersilene) to the anterior wall of the exposed vaginal vault following total hysterectomy or to the posterior wall of the uterine cervix in total and subtotal uterine prolapse, whereas the other end is attached to the anterior longitudinal ligament extending along the anterior surface of the vertebrae. Our analysis comprised 45 operations: 20 cases of vaginal vault prolapse following vaginal hysterectomy; 7 cases of vaginal vault prolapse following HTA: 2 cases of prolapse following subtotal hysterectomy; 3 cases of nondefined TH; 2 cases following Burch operation; 1 following Kocher; 1 following Manchester, 1 following Neugebauer-Le Fort operation in which HTA was performed 2 times. Abdominal sling operation was associated with the following surgical procedures: sling in 13 cases, sling + douglasorrhaphy in 16 cases, sling + douglasorrhaphy + colpoperineoplastics in 6 cases, sling + colpoperineoplastics in 9 cases and sling + marshall marcetti in 1 case. Recurrence of enterocele was recorded in 5 patients in whom closure of the douglas pouch had not been performed. This procedure was therefore later included into our approach to the operation. The abdominal sling operation has been a logical and physiologic approach to surgical therapy of genital prolapse, particularly of the vaginal vault prolapse following total hysterectomy. This operation ensures subsequent normal sexual relations.

  7. Abdominal emergencies during pregnancy.

    PubMed

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

  8. Quantitative anatomical labeling of the anterior abdominal wall

    NASA Astrophysics Data System (ADS)

    Allen, Wade M.; Xu, Zhoubing; Asman, Andrew J.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-03-01

    Ventral hernias (VHs) are abnormal openings in the anterior abdominal wall that are common side effects of surgical intervention. Repair of VHs is the most commonly performed procedure by general surgeons worldwide, but VH repair outcomes are not particularly encouraging (with recurrence rates up to 43%). A variety of open and laparoscopic techniques are available for hernia repair, and the specific technique used is ultimately driven by surgeon preference and experience. Despite routine acquisition of computed tomography (CT) for VH patients, little quantitative information is available on which to guide selection of a particular approach and/or optimize patient-specific treatment. From anecdotal interviews, the success of VH repair procedures correlates with hernia size, location, and involvement of secondary structures. Herein, we propose an image labeling protocol to segment the anterior abdominal area to provide a geometric basis with which to derive biomarkers and evaluate treatment efficacy. Based on routine clinical CT data, we are able to identify inner and outer surfaces of the abdominal walls and the herniated volume. This is the first formal presentation of a protocol to quantify these structures on abdominal CT. The intra- and inter rater reproducibilities of this protocol are evaluated on 4 patients with suspected VH (3 patients were ultimately diagnosed with VH while 1 was not). Mean surfaces distances of less than 2mm were achieved for all structures.

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

    PubMed Central

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

    2010-01-01

    Specular microscopy can provide a non-invasive morphological analysis of the corneal endothelial cell layer from subjects enrolled in clinical trials. The analysis provides a measure of the endothelial cell physiological reserve from aging, ocular surgical procedures, pharmaceutical exposure, and general health of the corneal endothelium. The purpose of this review is to discuss normal and stressed endothelial cell morphology, the techniques for determining the morphology parameters, and clinical trial applications. PMID:18245960

  10. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus

    PubMed Central

    Patel, N. K.; Griffiths, D.; Athanasiou, T.; Gupte, C. M.; Reilly, P.

    2016-01-01

    . Griffiths, T. Athanasiou, C. M. Gupte, P. Reilly. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysisBone Joint Res 2016;5:470–480. DOI: 10.1302/2046-3758.510.2000638. PMID:27756738

  11. Abdominal Sepsis.

    PubMed

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

  12. Acute Type B Aortic Dissection in a Patient with Previous Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Park, Sung Hun; Rha, Seung-Woon

    2017-01-01

    Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR. PMID:28377913

  13. Patients Awaiting Surgical Repair for Large Abdominal Aortic Aneurysms Can Exercise at Moderate to Hard Intensities with a Low Risk of Adverse Events

    PubMed Central

    Weston, Matthew; Batterham, Alan M.; Tew, Garry A.; Kothmann, Elke; Kerr, Karen; Nawaz, Shah; Yates, David; Danjoux, Gerard

    2017-01-01

    Purpose: Intervention fidelity refers to the extent an experimental manipulation has been implemented as intended. Our aim was to evaluate the fidelity of high-intensity interval training (HIT) in patients awaiting repair of large abdominal aortic aneurysms. Methods: Following a baseline cardiopulmonary exercise test, 27 participants performed a hospital-based, supervised HIT intervention in the 4 weeks preceding surgery. The intervention was performed thrice weekly on a cycle ergometer and involved either 8 × 2-min intervals, each interspersed by 2-min recovery periods, or 4 × 4-min intervals interspersed with 4-min recovery periods. When surgery was delayed, participants undertook one maintenance HIT session per week until surgery. Session one power output was set to baseline anaerobic threshold power output and then increased on subsequent sessions until ratings of perceived exertion (RPE; Borg CR-10) for the legs (RPE-L) and sense of breathlessness/ chest (RPE-C) were hard (5) to very hard (7) at the end of each interval. For safety, power output was maintained or reduced if systolic blood pressure exceeded 180 mm Hg or heart rate exceeded 95% of maximum. Results: Overall session attendance across the 4-week HIT intervention was 74%. Seventeen participants met our compliance criteria of ≥75% of intervention sessions and all maintenance sessions. When compared to non-compliance, compliant participants had higher fitness, performed more HIT sessions and were able to exercise at higher exercise intensities with a lower proportion of exercise safety breaches. In the 17 compliant participants, the proportion of repetitions meeting the HIT criterion was 30% (RPE-L) and 16% (RPE-C). Mean repetition intensity was 4.1 ± 2.0 Arbitrary Units [AU] (RPE-L) and 3.5 ± 1.9 AU (RPE-C) with a within-subject variability of ±1.4 AU and ±1.6 AU, respectively. We observed higher RPE scores (~0.5 AU) following 2-min intervals when compared to 4-min intervals and exercise

  14. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  15. [Diagnostic imaging and acute abdominal pain].

    PubMed

    Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-19

    Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

  16. Empyema following intra-abdominal sepsis.

    PubMed

    Ballantyne, K C; Sethia, B; Reece, I J; Davidson, K G

    1984-09-01

    Over the past 9 years, ten patients have presented to the Thoracic Unit, Glasgow Royal Infirmary, with 12 empyemas secondary to intra-abdominal sepsis. In eight patients, the presenting signs and symptoms were wrongly attributed to primary intra-thoracic pathology. All were subsequently found to have intra-abdominal sepsis. The presence of empyema after recent abdominal surgery or abdominal pain strongly suggests a diagnosis of ipsilateral subphrenic abscess. Adequate surgical drainage is essential. In our experience, limited thoracotomy with subdiaphragmatic extension offers the best access to both pleural and subphrenic spaces and provides the greatest chance of eradicating infection on both sides of the diaphragm.

  17. A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures.

    PubMed

    Kampf, G; Ostermeyer, C

    2009-11-01

    We studied the effect of a 1-min hand wash on the bacterial hand flora in two consecutive surgical hand disinfection procedures. A propanol-based hand rub (PBHR; Sterillium) and n-propanol (60%, v/v) were tested in a Latin-square design according to EN 12791 in four variations. The reference alcohol was always applied for 3 min after a 1-min hand wash (variation 1). The PBHR was applied for 1.5 min (first application) or 0.5 min (second application). Variation 2 included a 1-min hand wash before both applications, variation 3 included the hand wash before application 1, in variation 4 hands were not washed at all before application. Pre- and post-values were obtained according to EN 12791. The reference disinfection reduced bacteria by 2.99 log(10) (immediate efficacy) and 2.22 log(10) after 3 h. The second reference disinfection reduced bacteria by 0.95 log(10) (immediate efficacy) and 0.68 log(10) after 3 h. The PBHR always yielded an equivalent reduction with and without a preceding hand wash (p > 0.05; Friedman test). A 1-min hand wash before application of the PBHR did not significantly change its efficacy for surgical hand disinfection in two consecutive surgical procedures of 3 h.

  18. Modern reconstructive techniques for abdominal wall defects after oncologic resection.

    PubMed

    Khansa, Ibrahim; Janis, Jeffrey E

    2015-04-01

    Resection of abdominal wall tumors often leaves patients with debilitating soft tissue defects. Modern reconstructive techniques can be used to restore abdominal wall integrity. In this article, we present an overview of preoperative patient evaluation, analysis of the defect, surgical planning, and the spectrum of available surgical techniques, ranging from simple to complex. The established clinical evidence in the field of abdominal wall reconstruction is summarized and a case example is provided.

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

    PubMed

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

    2010-06-01

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

  20. Micro-surgical endodontics.

    PubMed

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  1. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    PubMed Central

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ≥75 years, respectively, and a 2.8-fold increase in procedures for those aged ≥60 years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100 000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100 000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical

  2. Abdominal tumors in children

    PubMed Central

    Oh, Chaeyoun; Youn, Joong Kee; Han, Ji-Won; Kim, Hyun-Young; Jung, Sung-Eun

    2016-01-01

    Abstract The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS. Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015. Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS. MIS was found to be both feasible and effective for the

  3. Abdominal cavity myolipoma presenting as an enlarging incisional hernia.

    PubMed

    Moore, Mark O; Richardson, Michael L; Rubin, Brian P; Baird, Geoffrey S

    2006-01-01

    We present a case of an abdominal cavity myolipoma which herniated through a low transverse abdominal (Pfannenstiel) incision, and presented as an enlarging abdominal wall mass. Magnetic resonance imaging (MRI) prior to surgery demonstrated an encapsulated solid tumor mass demonstrating fat signal and and increased T2-weighted signal. Postsurgical histological tissue diagnosis was myolipoma. Recognition of the intra- and extraperitoneal location of this abdominal tumor was essential for accurate surgical planning.

  4. [Gallstone ileus. Abdominal CT usefulness].

    PubMed

    Sukkarieh, F; Brasseur, P; Bissen, L

    2004-06-01

    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  5. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy

    PubMed Central

    2016-01-01

    Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care. PMID:28101395

  6. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy.

    PubMed

    Pillay, Yagan

    2016-01-01

    Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care.

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  9. Lateral Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage. PMID:23372458

  10. Efficacy and surgical procedures of preoperative splenic artery embolization for laparoscopic splenectomy of a massive splenomegaly: A case report

    PubMed Central

    Nitta, Toshikatsu; Fujii, Kensuke; Kawasaki, Hiroshi; Takasaka, Isao; Kawata, Shuhei; Onaka, Masahiko; Ishibashi, Takashi

    2015-01-01

    Here, we describe the case of a 58-year-old woman diagnosed with massive splenomegaly with a malignant lymphoma that had a maximum diameter of 24 cm. Splenectomy was indicated because of thrombocytopenia and abdominal distention. Therefore, a balloon catheter was inserted preoperatively through the splenic artery for embolization and continuous infusion to reduce the spleen volume. It enabled easy handling of the spleen and minimized bleeding. The volume of the spleen was estimated at 1896 g through the skin incision, as measured by volumetric computed tomography; thus, laparoscopy seemed difficult. However, the surgery was successfully performed only with laparoscopic surgery, and the volume of the resected spleen was 1020 g. This preoperative preparation is an effective alternative to laparoscopic removal of a huge splenomegaly. PMID:26479782

  11. Dioctophyma renale (Goeze, 1782) in the abdominal cavity of a capuchin monkey (Cebus apella), Brazil.

    PubMed

    Ishizaki, Mirian Naomi; Imbeloni, Aline Amaral; Muniz, José Augusto Pereira Carneiro; Scalercio, Sarah Raphaella Rocha de Azevedo; Benigno, Raimundo Nonato Moraes; Pereira, Washington Luiz Assunção; Cunha Lacreta Junior, Antonio Carlos

    2010-10-29

    This study reports a case of parasitism by Dioctophyma renale (Goeze, 1762) encysted in the abdominal cavity of a capuchin monkey (Cebus apella) coming from the Centro Nacional de Primatas, Brazil. The animal was sent to the Veterinary Clinic sector with an increase in abdominal volume and no occurrence of any other clinical signs. Upon palpation, a movable circular mass with a diameter of approximately 10 cm was found. Urinalysis, complete blood count and serum biochemistry were performed without revealing any alterations. The animal was then submitted to an abdominal ultrasound exam. The cyst was punctured and a surgical removal procedure was performed, revealing a brownish-colored cylindrical structure that was already deteriorated, making it impossible to perform morphological analysis and classification. In the sediment of the liquid found, eggs were encountered that had morphological characteristics compatible with D. renale. The objective of this paper is to report the first case of parasitism by D. renale in C. apella (Linnaeus, 1758).

  12. Endovascular repair of inflammatory abdominal aortic aneurysms: a valuable alternative?--Case report and review of literature.

    PubMed

    Ruppert, Volker; Verrel, Frauke; Kellner, Wolfgang; Brandl, Thomas; Reininger, Cornelia B; Steckmeier, Bernd

    2004-05-01

    While endovascular repair (ER) has become a routine procedure in the treatment of arteriosclerotic abdominal aortic aneurysms with a suitable configuration, only rare reports of interventional treatment of inflammatory aortic abdominal aneurysms (IAAA) exist. We present a case study of a male patient with IAAA, who presented with inflammatory thickening involving the entire circumference of the aortic vessel wall. The MRI performed 8 months after successful ER demonstrated complete regression of vessel wall induration. A patient with the appropriate anatomical configuration of IAAA should benefit from the lower morbidity and mortality of endovascular aneurysm repair (EVAR). In our view, EVAR is preferable to open surgical repair in the specific situation of IAAA.

  13. Assessing the performance characteristics and clinical forces in simulated shape memory bone staple surgical procedure: The significance of SMA material model.

    PubMed

    Saleeb, A F; Dhakal, B; Owusu-Danquah, J S

    2015-07-01

    This work is focused on the detailed computer simulation of the key stages involved in a shape memory alloy (SMA) osteosynthesis bone stapling procedure. To this end, a recently developed three-dimensional constitutive SMA material model was characterized from test data of three simple uniaxial-isothermal-tension experiments for powder metallurgically processed nickel-rich NiTi (PM/NiTi-P) material. The calibrated model was subsequently used under the complex, thermomechanical loading conditions involved in the surgical procedure using the body-temperature-activated PM/NiTi-P bone staple. Our aim here is to assess the immediate and post-surgical performance characteristics of the stapling operation using the material model. From this study: (1) it was found that adequate compressive forces were developed by the PM/NiTi-P bone staple, with the tendency of this force to even increase under sustained thermal loading due to the intrinsic "inverse relaxation phenomena" in the SMA material, (2) the simulation results correlated well with those from experimental measurements, (3) the body-temperature-activated PM/NiTi-P staple was proved to be clinically viable, providing a stable clamping force needed for speedy coaptation of the fractured bones, and (4) these realistic assessments crucially depend on the use of suitable and comprehensive SMA material models.

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

    PubMed Central

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

    2011-01-01

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

  15. Laparoendoscopic single-site (LESS) adrenalectomy and partial nephrectomy: current Italian experience with two challenging surgical procedures.

    PubMed

    Cindolo, Luca; Scoffone, Cesare; Salzano, Luigi; Autorino, Riccardo; Mirone, Vincenzo; Schips, Luigi

    2010-10-01

    Since its initial clinical use in urology, there has been an increasing enthusiasm and a growing interest for laparoendoscopic single-site surgery (LESS). Several clinical series have been reported with an estimated cumulative clinical experience of more than four hundred so far. Nowadays, virtually all extirpative and reconstructive urological procedures have been described and shown to be feasible and safe, including advanced reconstructive procedures and major extirpative ones. Among them, adrenalectomy and partial nephrectomy represent highly complex procedures. Initial clinical data have been recently reported to test the safety and efficacy of these interventions in selected patients. Herein, we describe our initial cases of unclamp LESS partial nephrectomy and adrenalectomy. In our opinion, LESS is an established technique within the field of minimally invasive surgery. Even if further studies are needed to demonstrate its actual benefits, early clinical outcomes are encouraging and LESS might represent the way to go in minimally invasive urological surgery.

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

    PubMed Central

    O'Malley, Sue P

    2006-01-01

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

  17. Cytoreductive strategy for multiple intra-abdominal and abdominal wall desmoid tumors in familial adenomatous polyposis: report of three cases.

    PubMed

    Tanaka, Koji; Toiyama, Yuji; Okugawa, Yoshinaga; Hiro, Junichiro; Kawamoto, Aya; Inoue, Yasuhiro; Uchida, Keiichi; Araki, Toshimitsu; Mohri, Yasuhiko; Kusunoki, Masato

    2012-10-01

    Desmoid tumors (DTs) are benign myofibroblastic neoplasms originating from the fascia or muscle aponeurosis, which occur in one-third of patients with familial adenomatous polyposis (FAP). Most FAP-associated DTs occur in the intra-abdominal or abdominal wall region, thus, their infiltrative or expansive growth causes life-threatening organ damage, such as intestinal obstruction, urethral obstruction, and mesenteric infiltration with the involvement of mesenteric vessels. Treatments including surgical resection, cytotoxic chemotherapy, nonsteroidal anti-inflammatory drugs and anti-estrogen therapy have all been tried with variable success. Here, we report on three patients with FAP who developed multiple intra-abdominal and abdominal wall DTs after total proctocolectomy and ileal pouch-anal anastomosis. Two cases underwent surgical resection of uncontrolled abdominal wall DTs after successful control of intra-abdominal DTs by systemic chemotherapy. The remaining case underwent repeated surgical resections of multiple intra-abdominal and abdominal wall DTs, and consequently had recurrent intra-abdominal DTs, with involvement of the small bowel and ureter. Surgical intervention as tumor volume reduction (cytoreduction) may be useful for cases with medical treatment-refractory or symptomatic FAP-associated abdominal DTs.

  18. Celiac axis compression syndrome: laparoscopic approach in a strange case of chronic abdominal pain in 71 years old man

    PubMed Central

    Eretta, Costantino; Olcese, Sonja; Imperatore, Mikaela; Francone, Elisa; Bianchi, Claudio; Bruno, Maria Santina; Sagnelli, Carlo; Di Martino, Maria; Ranghetti, Savina; Martino, Valter; Falco, Emilio; Berti, Stefano

    2016-01-01

    Abstract Celiac Axis Compression Syndrome by the Median Arcuate Ligament is a very rare condition characterized by chronic postprandial abdominal pain (angina abdominis), nausea, vomiting, which occurs mostly in young patients. The main treatment is a surgical procedure that consists of the division of the arcuate ligament combined with the section of the close diaphragmatic crus and the excision of the celiac plexus. Actually laparoscopic management is feasible and safe.

  19. Effect of abdominal surgery on the intestinal absorption of lipophilic drugs: possible role of the lymphatic transport.

    PubMed

    Gershkovich, Pavel; Itin, Constantin; Yacovan, Avihai; Amselem, Shimon; Hoffman, Amnon

    2009-06-01

    Although abdominal surgery is a routine procedure in clinical practice and in preclinical investigation, little is known regarding its effect on the intestinal absorption of drugs. The aim of this study was to investigate the effect of abdominal surgery on the intestinal absorption of highly lipophilic compounds with different absorption mechanisms following oral administration. The 2 compounds that were tested were biopharmaceutical classification system (BCS) class 2 model lipophilic cannabinoid derivatives, dexanabinol and PRS-211,220. Although dexanabinol is mostly absorbed via passive diffusion to the portal blood, PRS-211,220 is absorbed mostly via lymphatic transport. In this work, we compared the absorption of these compounds after abdominal surgery in rat with the absorption data obtained from naïve animals. The outcomes of this investigation showed that the abdominal surgery mostly affected the absorption process on the preenterocyte level, as indicated by the 2-fold increase in the extent of intestinal absorption of dexanabinol, which is a compound with a low degree of intestinal lymphatic transport. However, the lymphatic transport was not affected by the surgical procedure as evident by the absence of change in the extent of absorption of PRS-211,220, which is transported to the systemic circulation mainly by intestinal lymphatics. In conclusion, abdominal surgery can significantly affect the intestinal absorption of lipophilic drugs; however, intestinal lymphatic transport seems to be less affected by the abdominal surgery.

  20. Surgical ethics and the challenge of surgical innovation.

    PubMed

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  1. Results of surgical techniques for re-innervation of the triceps as additional procedures for patients with upper root injuries.

    PubMed

    Flores, L Pretto

    2013-03-01

    Patients with injuries restricted to the upper and middle trunks of the brachial plexus may obtain recovery of elbow extension via the lower trunk, which makes it difficult to assess the real effect of interventions to restore the triceps function in such cases. This study aimed to determine the impact of surgical strategies for re-innervation of the triceps in individuals with partial injuries of the brachial plexus. Patients were divided into two groups. Group 1 consisted of 21 participants in whom the surgery included one technique for re-innervation of elbow extension. In this group, six different extra- or intra-plexal donors were targeted to one of the motor branches of the triceps muscle. Group 2 was composed of 24 controls in which the reconstruction did not include any intervention for recovering triceps function. The individuals who underwent intervention for re-innervation of the triceps obtained significantly better outcomes for elbow extension than the controls.

  2. Reconstruction of a four-quadrant full-thickness abdominal wall defect after removal and debridement of an infected mesh hernioplasty.

    PubMed

    Schmitz, C; Schramm, S; Hankiss, J

    2011-02-01

    This case-report shows our experience with a patient, who underwent mesh hernioplasty followed by infection of the mesh and full-thickness loss of the abdominal wall after debridement due to necrosis. The anamnesis included generalised arteriosclerosis, chronic nicotine and alcohol abuse and recurring wound-healing disorders after surgical procedures. The initial infection was treated by radical debridement, targeted antibiotics and V.A.C.(®) Therapy. After this, a staged plastic reconstructive procedure with four pedicled flaps was performed. The functional integrity of the abdominal wall was completely re-established. The patient was able to continue her occupation as a facility manager. Although the use of free flaps is very common in modern plastic and reconstructive surgery, procedures such as pedicled flaps still have their significance for special indications. In this case, a full recovery of the abdominal wall with autologous tissue was successful under difficult vascular conditions by using local flaps.

  3. Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures.

    PubMed

    Ulkatan, Sedat; Jaramillo, Ana Maria; Téllez, Maria J; Kim, Jinu; Deletis, Vedran; Seidel, Kathleen

    2017-04-01

    OBJECTIVE The purpose of this study was to investigate the incidence of seizures during the intraoperative monitoring of motor evoked potentials (MEPs) elicited by electrical brain stimulation in a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. METHODS The authors retrospectively analyzed data from 4179 consecutive patients who underwent surgery or an interventional radiology procedure with MEP monitoring. RESULTS Of 4179 patients, only 32 (0.8%) had 1 or more intraoperative seizures. The incidence of seizures in cranial procedures, including craniotomies and interventional neuroradiology, was 1.8%. In craniotomies in which transcranial electrical stimulation (TES) was applied to elicit MEPs, the incidence of seizures was 0.7% (6/850). When direct cortical stimulation was additionally applied, the incidence of seizures increased to 5.4% (23/422). Patients undergoing craniotomies for the excision of extraaxial brain tumors, particularly meningiomas (15 patients), exhibited the highest risk of developing an intraoperative seizure (16 patients). The incidence of seizures in orthopedic spine surgeries was 0.2% (3/1664). None of the patients who underwent surgery for conditions of the spinal cord, neck, or peripheral nerves or who underwent cranial or noncranial interventional radiology procedures had intraoperative seizures elicited by TES during MEP monitoring. CONCLUSIONS In this largest such study to date, the authors report the incidence of intraoperative seizures in patients who underwent MEP monitoring during a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. The low incidence of seizures induced by electrical brain stimulation

  4. Abdominal SPECT imaging

    SciTech Connect

    Van Heertum, R.L.; Brunetti, J.C.; Yudd, A.P.

    1987-07-01

    Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined. 79 references.

  5. [Abdominal pregnancy care. Case report].

    PubMed

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino

    2008-10-01

    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  6. Abdominal tuberculosis.

    PubMed Central

    Kapoor, V. K.

    1998-01-01

    Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:9926119

  7. Torsion of an intra-abdominal testis.

    PubMed

    Lewis; Roller; Parra; Cotlar

    2000-09-01

    To present a case of torsion of a nonneoplastic intra-abdominal testis with an unusual clinical presentation.A 26-year-old active duty Navy Petty Officer presented to the emergency department on 3 occasions over a 5-day period with lower abdominal pain. Physical examination demonstrated acute tenderness in the left lower quadrant with sugestion of a normal spermatic cord and atrophic testis in the left scrotum. Computed tomography scan demonstrated an intra-abdominal lesion near the internal inguinal ring. The patient underwent surgical exploration through an inguinal incision. Torsion of a nonviable intra-abdominal testis was present. The scrotum contained only the vas deferens and cremasteric muscle. An orchiectomy was performed with removal of the vas deferens and other cord structures.The unusual clinical finding of acute torsion of an intra-abdominal testis, associated with an apparent atrophic scrotal testis, presented a confusing clinical picture. Computed tomography scan did not clarify the issue sufficiently to establish a definite preoperative diagnosis. Clinical suspicion prompted early surgical intervention. Review of the current literature produced 60 reported cases of torsion of an intra-abdominal testis. Two thirds of these involved testicular neoplasm, usually seminoma. Although the clinical presentation varied, most patients had recent onset of lower abdominal pain associated with tenderness and, in half the cases, a mass. Patients almost always presented with an absent scrotal testis on the involved side, and not infrequently reported previous surgery thought to be an orchiectomy.Diagnosis of an intra-abdominal testicular torsion is rare, particularly when no neoplasm is present. A high index of suspicion must be maintained whenever there is abdominal pain and undescended testis. The surgical history and imaging studies may not clarify a confusing clinical picture.

  8. [Correction of posttraumatic disorders of the distal radio-ulnar joint with the Sauvé-Kapandji surgical procedure].

    PubMed

    Voche, P; Van Overstraeten, L; Merle, M

    1993-01-01

    The Sauve-Kapandji procedure was performed on 21 patients with posttraumatic lesions between May of 1985 and May of 1991; average clinical and radiological follow-up was 3.4 years. Causal mechanisms were as follows: 12 cases were sequelae of fractures of the distal extremity of the radius; 5 cases were sequelae of fractures of the diaphyses of the two forearm bones and/or of the head of the radius; 2 cases of instability of the distal radio-ulnar joint; 2 cases of posttraumatic isolated arthritis of the distal radio-ulnar joint. Subjective evaluation by the patients of the results of surgery was as follows: 8 excellent, 6 good, 2 satisfactory and 5 poor. The most consistent improvement was a gain of mobility in pronation and supination which averaged 87 per cent of that of the healthy contralateral side. Nine patients were free of pain, 6 experienced some pain only during effort, and 6 still suffered constant pain. Grip strength was the factor that changed the most: it averaged 55 per cent of that of the healthy contralateral side. Indications for the Sauve-Kapandji procedure and its results in posttraumatic lesions are discussed. This procedure is compared to other techniques used to correct posttraumatic disorders of the distal radio-ulnar joint.

  9. [Urinary stress incontinence in the female: comparison of incontinence theories and new tension-free surgical procedures].

    PubMed

    Perucchini, D; Fink, D

    2002-01-01

    Urethral sphincter competence involves a complicated inter action of many factors which act in concert. Stress incontinence occurs due to damage to the urethral support and loss or deterioration of urethral sphincter function as a consequence of delivery or aging. Recent research indicates that a more integrated, comprehensive view regarding the different structures, both inside and outside the urethra, is needed to explain the mechanism of incontinence. According to the theories of de Lancey, urinary stress incontinence is caused by defects in the supporting tissues that both actively and passively stabilize the urethra in its correct anatomical position. The integral theory of Petros and Ulmstein explains how laxity in the vagina or its supporting ligaments may cause stress incontinence favored by laxity in the ligamentous insertion points of the vagina. Colposuspension procedures have dominated incontinence surgery for the last 50 years. The introduction of the tension-free vaginal tape procedure was a real innovation that has challenged our understanding of the continence mechanism and taught us the importance of the midurethra. Different modifications of the tension-free procedures have been introduced recently and are discussed in this paper.

  10. Deep Circumflex Iliac Artery-Related Hemoperitoneum Formation After Surgical Drain Placement: Successful Transcatheter Embolization

    SciTech Connect

    Park, Sang Woo; Chang, Seong-Hwan Yun, Ik Jin; Lee, Hae Won

    2010-04-15

    A 53-year-old woman with liver cirrhosis and hepatocellular carcinoma underwent living donor liver transplantation. After transplantation, her hemoglobin and hematocrit levels decreased to 6.3 g/dl and 18.5%, respectively, during the course of 3 days. A contrast-enhanced abdominal computed axial tomography (CAT) scan showed a hemoperitoneum in the right perihepatic space with no evidence of abdominal wall hematoma or pseudoaneurysm formation. An angiogram of the deep circumflex iliac artery (DCIA) showed extravasation of contrast media along the surgical drain, which had been inserted during the transplantation procedure. Transcatheter embolization of the branches of the DCIA was successfully performed using N-butyl cyanoacrylate.

  11. [Intra-abdominal mycoses].

    PubMed

    Boos, C; Kujath, P; Bruch, H-P

    2005-01-01

    The incidence of invasive mycoses in patients undergoing abdominal surgery amounts to approximately 8% and shows an upward trend in epidemiological studies. The lethality of these systemic mycoses, which are mostly based on Candida infections constitutes up to 60%. The development of a sytemic mycosis is marked by exogenic, endogenic and iatrogenic risk factors and typically displays tissue invasion after an initial fungal contamination or systemic dissemination via fungal sepsis. Fungal peritonitis is generally a monoinfection with Candida spp., where Candida albicans outweighs in 70% of cases. Aspergillus spp. are only detected abdominally in rare cases. The histological verification of a fungal invasion is regarded as proof of the existence of an invasive mycosis, but typical macroscopic findings with corresponding cultural findings can also confirm the diagnosis. Systemic mycosis requires an early initiation of a consistent antimycotic therapy as well as definitive surgical eradication of the focus in order to reduce high lethal rate. Resistances or incorrect dosages can be validated objectively by means of histological monitoring of the antimycotic therapy, thus affording early recognition of the need to change the substance class.

  12. Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures.

    PubMed

    Rizzotto, G; Crosetti, E; Lucioni, M; Succo, G

    2012-06-01

    Long-term oncological and functional results from a retrospective study on 469 patients over a 10-year period of subtotal laryngectomies (SL), 399 supracricoid partial laryngectomies (SCL) and 70 supratracheal partial laryngectomies (STL) are presented. The mean follow-up time was 97 months (range 60–165 months). Acute complications, types and rates of late sequelae, functional results, 2-year post-operative scores of laryngeal function and quality of life are reported. The observed long-term results were: SCL, 5-year overall and disease-free survival: 95.6, and 90.9%, respectively; 2-year post-operative laryngeal function preservation: 95.7%; STL, 5-year overall and disease-free survival: 80 and 72.9%, respectively; 2-year post-operative laryngeal function preservation: 80%. The performance status scale for laryngeal function preservation showed very high 2-year scores, with no significant differences depending on the type and extent of surgery. The adopted type of function-sparing surgery provided overall and disease-free survival rates that were somewhat better than those reported in studies based on organ-sparing protocols with chemoradiotherapy. The rate of total laryngectomy of completion in this series was 4.4%. A new classification of the current horizontal partial laryngectomies is also proposed, namely “Horizontal Laryngectomy System” (HOLS), based on the extent of surgical removal of laryngeal structures.

  13. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    PubMed

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-02-10

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  14. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    NASA Astrophysics Data System (ADS)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  15. Current status of endoluminal grafting for exclusion of abdominal aortic aneurysms. The beauty and the beast.

    PubMed Central

    Diethrich, E B

    1998-01-01

    The exclusion of abdominal aortic aneurysms with endoluminal grafts has generated a great deal of interest since the early 1990s, and many centers are currently evaluating the procedure and comparing it to classic surgical exclusion. Although endoluminal grafting procedures show promise, development and clinical testing of devices is a time-consuming process that is influenced greatly by the regulatory climate in the country where the clinical trials take place. Nevertheless, a number of devices are currently under study, and the advantages of 2nd- and 3rd-generation technology are reflected in reduced rates of complications such as endoleaks and thrombosis. Further study will be required to perfect these devices and observe their long-term success in the exclusion of abdominal aortic aneurysms. Images PMID:9566057

  16. The Utilization of Opioid Analgesics Following Common Upper Extremity Surgical Procedures: A National, Population-Based Study

    PubMed Central

    Waljee, Jennifer F.; Zhong, Lin; Hou, Hechuan; Sears, Erika; Brummet, Chad; Chung, Kevin C.

    2016-01-01

    Background The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. We examined the use of opioids following outpatient upper extremity procedures. We hypothesized that opioid use varies widely by procedure and patient factors. Methods We studied opioid prescriptions among 296,452 adults ages ≥ 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, and thumb carpometacarpal (CMC) arthroplasty from 2009 to 2013. We analyzed insurance claims drawn using Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, we compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. Results In this cohort, 59% filled a postoperative prescription for opioid medication, and 8.8% patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. In multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66% vs. 59%), receive longer prescriptions (24 vs. 5 days), receive refills following surgery (24% vs. 5%), and have at least one indicator of potentially inappropriate prescribing (19% vs 6%). Conclusions Current opioid users are more likely to require postoperative opioid analgesics for routine procedures, and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids in order to curb opioids prescriptions when alternative analgesics may be equally effective and available. PMID:26818326

  17. Serratia marcescens infected silk suture rejected by combined acupuncture, moxibustion and low-power laser therapy from the abdominal fascia.

    PubMed

    Sternfeld, M; Finkelstein, Y; Hod, I

    1988-01-01

    Upper abdominal pains lasting 12 years after cholecystectomy, were improved in an 82-year-old woman following the rejection of indigestable silk surgical sutures induced by combined therapy of acupuncture, moxibustion and low-power laser beam irradiation directed to an old post-cholecystectomy scar. An inflammatory reaction followed by granulation tissue mass was developed. Embedded in the granulation tissue were the above mentioned silk sutures which finally were expelled through the skin at the operation scar. A surgical procedure suggested to the patient, in case of acupuncture therapy failure, was obviously avoided. Serratia-marcescens infection of the expelled material was bacteriologically defined.

  18. What is the influence of single-entry models on access to elective surgical procedures? A systematic review

    PubMed Central

    Damani, Zaheed; Conner-Spady, Barbara; Nash, Tina; Tom Stelfox, Henry; Noseworthy, Tom W; Marshall, Deborah A

    2017-01-01

    Background Single-entry models (SEMs) for the management of patients awaiting elective surgical services are designed to increase access and flow through the system of care. We assessed scope of use and influence of SEMs on access (waiting times/throughput) and patient-centredness (patient/provider acceptability). Methods Systematic review of articles published in 6 relevant electronic databases included studies from database inception to July 2016. Included studies needed to (1) report on the nature of the SEM; (2) specify elective service and (3) address at least 1 of 3 research questions related to (1) scope of use of SEMs; (2) influence on timeliness and access; (3) patient-centredness and acceptability. Article quality was assessed using a modified Downs and Black checklist. Results 11 studies from Canada, Australia and the UK were included with mostly weak observational design—2 simulations, 5 before–after, 2 descriptive and 2 cross-sectional studies. 9 studies showed a decrease in patient waiting times; 6 showed that more patients were meeting benchmark waiting times; and 5 demonstrated that waiting lists decreased using an SEM as compared with controls. Patient acceptability was examined in 6 studies, with high levels of satisfaction reported. Acceptability among general practitioners/surgeons was mixed, as reported in 1 study. Research varied widely in design, scope, reported outcomes and overall quality. Conclusions This is the first review to assess the influence of SEMs on access to elective surgery for adults. This review demonstrates a potential ability for SEMs to improve timeliness and patient-centredness of elective services; however, the small number of low-quality studies available does not support firm conclusions about the effectiveness of SEMs to improve access. Further evaluation with higher quality designs and rigour is required. PMID:28237954

  19. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification

    NASA Astrophysics Data System (ADS)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas

    2015-03-01

    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

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

    NASA Astrophysics Data System (ADS)

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

    2002-06-01

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

  1. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

    PubMed Central

    Driscoll, Elizabeth BS; Maleki, Ana Hosseinzadeh; Jahromi, Leila; Hermecz, Brittany Nelson; Nelson, Lauren E; Vetter, Imelda L; Evenhuis, Spencer; Riesenberg, Lee Ann

    2016-01-01

    A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. PMID:27785097

  2. Niche reconstructive techniques for complex abdominal wall reconstruction: a review.

    PubMed

    Sue, Gloria R; Narayan, Deepak

    2014-04-01

    Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.

  3. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  4. [Laparoscopic abdominal drainage by sterile destructive pancreatitis].

    PubMed

    Kuznetsov, N A; Rodoman, G V; Shalaeva, T I; Trefilova, O I; Sosikova, N L

    2009-01-01

    90 patients with acute pancreatitis were observed, in 60 of them laparoscopic drainage was performed. The procedure by sterile pancreatonecrosis is indicated only in presence of extent amount of exudate in abdominal cavity. Duration of draining the abdominal cavity should be strictly limited because of the high risk of septic complications. Contraindications for the abdominal drainage by acute necrotic pancreatitis are not only adhesions in the abdomen and shock state of the patient at the moment of procedure necessity, but also unstable hemodynamics in anamnesis and even by the arterial pressure downtrend.

  5. Relationship between periodontics and restorative procedures: surgical treatment of the restorative alveolar interface (rai)--case series.

    PubMed

    Almeida, A L P F; Esper, L A; Sbrana, M C; Cunha, M J S; Greghi, S L A; Carrilho, G P B; Pegoraro, L F

    2013-12-01

    Maintenance of a healthy periodontium is fundamental for the long term success of prosthetic restorations. Thus, prosthetic procedures with subgingival margins may affect the periodontal health if the distances between the junctional epithelium and supracrestal connective tissue attachment aren't respected, or if there is insufficient space to maintain the health of the interproximal tissues, leading to gingival inflammation, connective tissue attachment loss and bone resorption. The restorative alveolar interface (RAI) technique was described as the portion of the root surface extending from the alveolar crest apically to the restorative margin coronally. RAI consists of modifying the restorative margin position into a healthier environment, respecting the biological width and therefore allowing effective plaque control. This paper describes four clinical cases with indication for the RAI technique for maintenance of periodontal health. The cases were associated with prostheses. All cases were evaluated at 90 days and exhibited a healthy periodontal tissue. Successful outcomes were observed in the different indications for the RAI technique.

  6. Analysis of the Blood Consumption for Surgical Programs

    PubMed Central

    Begic, Dzenana; Mujicic, Ermina; Coric, Jozo; Zec, Svjetlana Loga; Zunic, Lejla

    2016-01-01

    Introduction: Transfusion is an activity that assures sufficient supply of blood and blood components to treat the sick and injured. In transfusion departments is necessary to timely provide adequate amounts of blood and blood products for various surgical procedures. Material and methods: To determine the total amount of preoperative requirements (BT/AB and BT/AB/MT) for blood and blood products in surgical departments of General Hospital “Prim. Dr. Abdulah Nakas” in the period from June 1, 2014 – December 31, 2014 and analyze the requirements for blood in relation to surgical procedures, surgical discipline, period, age and gender of patients. To determine the maximum consumption levels surgeries. Results: The total amount of preoperative requirements for blood and blood products in surgical departments amounted to 927. Almost the same number of requests with a slightly higher percentage was in December and October and the lowest in June. The average age of patients was 52.2±20.1 years with the youngest patient aged 9 and the oldest at the age of 97 years. Women were more prevalent with 686 or 74% of the time compared to men. The largest number of requests for surgery elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement 98 (10.6%). Maximum consumption for surgical operations Hysterectomy totalis abdominals 15 doses of blood. Conclusion: The largest number of requests were for elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement with 98 (10.6%). Maximum consumed doses had gynecology surgery at Hysterectomy totalis abdominals 15 doses of blood, then orthopedics surgery at Primary hip prosthesis 11 doses. PMID:27703282

  7. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    PubMed

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

  8. Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure

    PubMed Central

    SALLUM, Rubens Antonio Aissar; PADRÃO, Eduardo Messias Hirano; SZACHNOWICZ, Sergio; SEGURO, Francisco C. B. C.; BIANCHI, Edno Tales; CECCONELLO, Ivan

    2015-01-01

    Background Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood. Aim To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy. Methods Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared. Results From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series. Conclusions Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic forms of achalasia had the

  9. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  10. Testicular Ectopia in the Anterior Abdominal Wall of a Neonate: A Rare Site of Ectopic Testis

    PubMed Central

    Siddiqui, Salman Atiq; Marei, Tamer Ibrahim; Al-Makhaita, Ghada

    2016-01-01

    Patient: Male, 3-day Final Diagnosis: Ectopic right testis in anterior abdominal wall Symptoms: — Medication: — Clinical Procedure: Testicular ultrasound and MRI abdomen Specialty: Radiology Objective: Unusual clinical course Background: Abnormal testicular descent can either be undescended or, less commonly, ectopic. Most undescended testes complete the course of descent by the first year of life only if these remain in the normal path of descent. The deviation of the testis may occur to an ectopic location during the transinguinal phase. Of the known ectopic sites, the anterior abdominal wall is the rarest site of testicular ectopia and to our knowledge only 3 cases of this nature have been reported in the available literature to date. Case Report: This rare case of testicular ectopia occurred in a 3-day-old boy in whom the right scrotal sac was empty; on abdominal ultrasound, the right testis was found in the subcutaneous tissues of the right antero-lateral abdominal wall. These findings were confirmed on abdominal MRI, where the right testis was seen beneath the skin between the subcutaneous tissues and external oblique aponeurosis. No aponeurotic or muscular defect was appreciable under the abdominal wall. The neonate underwent orchiopexy at the age of 6 months and remained uneventful postoperatively. Conclusions: Preoperative imaging is recommended to detect and confirm the ectopic site as well as the morphology of testis, thereby increasing the chance of surveillance and preservation of an ectopic testis. Imaging can serve as preoperative road mapping to localize the exact site for surgical exploration of an ectopic testis if there is no apparent or palpable swelling over the anterior abdominal wall. PMID:27411886

  11. The surgical team and outcomes management: focus on postoperative ileus.

    PubMed

    Carter, Susan

    2006-04-01

    Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). The fact that POI is generally transient and therefore self-limited should not deter the surgical team from seeking improved ways to mitigate its associated adverse effects, which can be substantial and immensely uncomfortable for the patient, and can have far-reaching implications regarding overall hospitalization costs for many types of surgeries. Optimization of POI management and prevention efforts is a responsibility of all members of the surgical team and can drastically affect the overall clinical outcome of major abdominal surgery. Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.

  12. [Inflammatory aneurysms of the abdominal aorta].

    PubMed

    Tovar Martín, E; Acea Nebril, B

    1993-01-01

    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  13. Stent-Grafts for Unruptured Abdominal Aortic Aneurysms: Current Status

    SciTech Connect

    Rose, John

    2006-06-15

    Aortic stent-grafts were introduced at the beginning of the 1990s as a less invasive method of dealing with aortic aneurysms in patients with poor cardiovascular reserve. The numbers of procedures performed worldwide has increased exponentially despite the current lack of any substantial evidence for long-term efficacy in comparison with the gold standard of open surgical grafting. This review summarizes the evolution of the abdominal aortic stent-graft, the techniques used for assessment and deployment, and the effect of the procedure on both the patient and the device. The recent publication of two national multicenter trials has confirmed that the endovascular technique confers a 2.5-fold reduction in 30-day mortality in comparison with open surgery. However, over 4 years of follow-up, there is a 3-fold increase in the risk of reintervention and the overall costs are 30% greater with endovascular repair. Although the improvement in aneurysm-related mortality persists in the mid-term, because of the initial reduction in perioperative mortality, the all-cause mortality rate at 4 years is actually no better than for open surgery. Longer-term data from the randomized trials are awaited as well as results from the latest trials utilizing state-of-the-art devices. Whilst the overall management of abdominal aortic aneurysms has undoubtedly benefited from the introduction of stent-grafts, open repair currently remains the gold standard treatment.

  14. Surgical Treatment of Hepatic Hydrothorax: A "Four-Step Approach".

    PubMed

    Jung, Yochun

    2016-03-01

    Recently, various video-assisted thoracoscopic surgical techniques have been reported with occasional success in treating hepatic hydrothorax (HH). In 2 patients with refractory HH, we applied a combination of four therapeutic modalities as a single procedure named as a "four-step approach": (1) pneumoperitoneum for localization of diaphragmatic defects, (2) thoracoscopic pleurodesis, (3) postoperative continuous positive airway pressure, and (4) drainage of ascites for abdominal decompression. The treatment was successful in both patients, without recurrence during the follow-up period of 24 and 3 months, respectively.

  15. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  16. Recovery after abdominal wall reconstruction.

    PubMed

    Jensen, Kristian Kiim

    2017-03-01

    Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect patients in several ways. This patient group often experiences pain, decreased perceived body image, and loss of physical function, which results in a need for surgical repair of the giant hernia, known as abdominal wall reconstruction. In the current thesis, patients with a giant hernia were examined to achieve a better understanding of their physical and psychological function before and after abdominal wall reconstruction. Study I was a systematic review of the existing standardized methods for assessing quality of life after incisional hernia repair. After a systematic search in the electronic databases Embase and PubMed, a total of 26 studies using standardized measures for assessment of quality of life after incisional hernia repair were found. The most commonly used questionnaire was the generic Short-Form 36, which assesses overall health-related quality of life, addressing both physical and mental health. The second-most common questionnaire was the Carolinas Comfort Scale, which is a disease specific questionnaire addressing pain, movement limitation and mesh sensation in relation to a current or previous hernia. In total, eight different questionnaires were used at varying time points in the 26 studies. In conclusion, standardization of timing and method of quality of life assessment after incisional hernia repair was lacking. Study II was a case-control study of the effects of an enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction for a giant hernia. Sixteen consecutive patients were included prospectively after the implementation of a new enhanced recovery after surgery pathway at the Digestive Disease Center, Bispebjerg Hospital, and compared to a control group of 16 patients included retrospectively in the period immediately prior to the

  17. CT of abdominal tuberculosis

    SciTech Connect

    Epstein, B.M.; Mann, J.H.

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.

  18. Risk of Essure microinsert abdominal migration: case report and review of literature

    PubMed Central

    Ricci, Giuseppe; Restaino, Stefano; Di Lorenzo, Giovanni; Fanfani, Francesco; Scrimin, Federica; Mangino, Francesco P

    2014-01-01

    Purpose To report a case of Essure microinsert abdominal migration and literature review. Methods A 41-year-old woman was counseled to undergo Essure sterilization. The procedure was hampered by the presence of endometrial cavity adhesions, obscuring left tubal ostium. By using microscissors the adhesions were progressively lysed. Since the procedure had become very painful, the patient required general anesthesia. Once adhesion lysis was completed, the tubal ostium was well visible. Both devices were then easily introduced into the fallopian tubes. At the end of the procedure, five coils were visible on the right side and five coils on the left side, as recommended. Results The 3-month hysterosalpingogram follow-up suspected abdominal migration of the left device. Laparoscopy confirmed the device displacement in the left lower abdominal quadrant. Both fallopian tubes and the uterus appeared normal. No signs of perforation were detected. The device was embedded into the omentum, but it was easily removed. Bilateral tubal sterilization was performed by bipolar coagulation. Conclusion There are only 13 cases, including the present, of Essure abdominal migration in the literature. In most cases, abdominal displacement of the microinsert is asymptomatic and does not induce tissue damage. However, in some cases, it may cause a severe adverse event, requiring major surgery. Therefore, removal of the migrated device should be performed as soon as possible. Moreover, during presterilization counseling, the patient should also be correctly informed about the risk of this rare but relevant complication, as well as about the surgical interventions that could be required to solve it. PMID:25484591

  19. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    PubMed

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  20. Management of strangulated abdominal wall hernias with mesh; early results

    PubMed Central

    Ozbagriacik, Mustafa; Bas, Gurhan; Basak, Fatih; Sisik, Abdullah; Acar, Aylin; Kudas, Ilyas; Yucel, Metin; Ozpek, Adnan; Alimoglu, Orhan

    2015-01-01

    OBJECTIVE: Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS: Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS: A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel’s diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1–7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION: The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases. PMID:28058336

  1. The influence of the risk factor on the abdominal complications in colon injury management

    PubMed Central

    TORBA, M.; GJATA, A.; BUCI, S.; BUSHI, G.; ZENELAJ, A.; KAJO, I.; KOCEKU, S.; KAGJINI, K.; SUBASHI, K.

    2015-01-01

    Introduction The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. Patients and methods This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Results Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 –1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 – 21.3, p<0.001). Conclusion Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries. PMID:26017103

  2. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis or plaque buildup causes the ... weak and bulge outward like a balloon. An AAA develops slowly over time and has few noticeable ...

  3. Abdominal aortic aneurysm

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  4. Evidence-Based Abdominal Wall Reconstruction: The Maxi-Mini Approach.

    PubMed

    Janis, Jeffrey E; Khansa, Ibrahim

    2015-12-01

    Complex abdominal wall reconstruction is a high-risk procedure, but it can be performed safely if a systematic approach is followed. In this article, the authors present their evidence-based technique for abdominal wall reconstruction. This approach aims at reducing rates of complications and hernia recurrence, starting with critical patient selection; preoperative patient optimization; adherence to intraoperative principles including preservation of vascular perforators through maintenance of composite tissue with limited undermining; direct supported mesh reinforcement of midline musculofascial reapproximation; use of percutaneous transfascial suture mesh fixation; careful attention to dead space obliteration in any plane; and aggressive soft-tissue resection of marginal, undermined, or tenuous skin and subcutaneous tissue. Postoperative strategies to decrease complications are also used. The authors' surgical technique is described in detail, and pilot data are presented to support the authors' approach.

  5. Conscious sedation for surgical procedures

    MedlinePlus

    Anesthesia - conscious ... have, what medicines you are taking, and what anesthesia or sedation you have had before. You may ... M. Intravenous anesthetics. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  6. Surgical Procedures for Vestibular Dysfunction

    MedlinePlus

    ... using only the opposite ear to maintain balance. Chemical labyrinthectomy A chemical labyrinthectomy is also known as transtympanic or intratympanic ... ear by filling the scala tympani with a chemical solution. Click here to download the "Surgery for ...

  7. Application of high-frequency ultrasound for the detection of surgical anatomy in the rodent abdomen.

    PubMed

    Chen, J Y; Chen, H L; Wu, S H; Tsai, T C; Lin, M F; Yen, C C; Hsu, W H; Chen, W; Chen, C M

    2012-02-01

    Rats are used extensively in abdominal disease research. To monitor disease progress in vivo, high-frequency ultrasound (HFU) can be a powerful tool for obtaining high-resolution images of biological tissues. However, there is a paucity of data regarding the correlation between rat anatomy and corresponding HFU images. Twenty-four adult male Sprague-Dawley (SD) rats underwent abdominal scans using HFU (40 MHz) surgical procedures to identify abdominal organs and major vessels as well as in situ scanning to confirm the imaging results. The results were compared with those of human abdominal organs in ultrasonographic scans. The rat liver, paired kidneys, stomach, intestines, and major blood vessels were identified by HFU and the ultrasonic morphologies of the liver and kidneys showed clear differences between rats and humans. Clinically relevant anatomical structures were identified using HFU imaging of the rat abdomen, and these structures were compared with the corresponding structures in humans. Increased knowledge with regard to identifying the anatomy of rat abdominal organs by ultrasound will allow scientists to conduct more detailed intra-abdominal research in rodents.

  8. Effects of abdominal CO2 insufflation and changes of position on hepatic blood flow in anesthetized pigs.

    PubMed

    Klopfenstein, C E; Morel, D R; Clergue, F; Pastor, C M

    1998-09-01

    During surgical laparoscopy, total hepatic blood flow (THBF) may be modified by CO2 insufflation, changes of tilt, ventilation with high tidal volume, hypercapnia, and anesthesia, but little information is available on the THBF during the procedure. To investigate the changes of hepatic blood flow following the combination of abdominal CO2 insufflation and changes of tilt, we measured mean arterial pressure (MAP), cardiac output, portal vein blood flow (PVBF), and hepatic artery blood flow (HABF) in anesthetized and ventilated pigs. CO2 was insufflated in the abdomen [intra-abdominal pressure (IAP) approximately 15 mmHg], and the hepatic blood flow was measured in various positions (horizontal, 10 degrees and 20 degrees head down, and 10 degrees and 20 degrees head up) before and during CO2 insufflation. CO2 insufflation in the horizontal position did not modify MAP, cardiac output, or PVBF but increased HABF. The head-up tilt decreased MAP, cardiac output, and both hepatic flows in the absence of pneumoperitoneum, but in the presence of abdominal CO2 only cardiac output and PVBF were decreased. The head-down tilt increased MAP and THBF in the absence of pneumoperitoneum, whereas no change was observed in the presence of abdominal CO2. The combination of CO2 insufflation and changes of tilt was not deleterious to hepatic perfusion. These results suggest that hepatic blood flow may be preserved during surgical laparoscopy if the tilt does not exceed 20 degrees and if IAP after CO2 insufflation remains <15 mmHg.

  9. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-11-14

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  10. Soft tissue coverage in abdominal wall reconstruction.

    PubMed

    Baumann, Donald P; Butler, Charles E

    2013-10-01

    Abdominal wall defects requiring soft tissue coverage can be either partial-thickness defects or full-thickness composite defects. Soft tissue flap reconstruction offers significant advantages in defects that cannot be closed primarily. Flap reconstruction is performed in a single-stage procedure obviating chronic wound management. If the defect size exceeds the availability of local soft tissue for coverage, regional pedicled flaps can be delivered into the abdominal wall while maintaining blood supply from their donor site. Microsurgical free tissue transfer increases the capacity to provide soft tissue coverage for abdominal wall defects that are not amenable to either local or regional flap coverage.

  11. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

    PubMed Central

    Kobayashi, Kosuke; Sasaki, Kazuhito; Iijima, Tatsuo; Yoshimi, Fuyo; Nagai, Hideo

    2016-01-01

    Introduction Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex. Presentation of case A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively. Discussion and conclusion Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures. PMID:27064744

  12. Technical aspects of abdominal stomas.

    PubMed

    Link, Brian A; Kropp, Bradley; Frimberger, Dominic

    2007-01-01

    Continent urinary diversion has gained increasing popularity in the pediatric population during the last few decades. In adults, continent diversions are usually needed to replace a bladder after cystectomy for invasive carcinoma. Subsequently, the creation of functional and cosmetically hidden urinary and cecal abdominal stomas has become an integral part of many urinary reconstructive procedures. These techniques, originally developed for pediatric urinary reconstruction have gained increasing popularity for adult patients in need of a continence procedure. In the current manuscript, we review the technical aspects of site selection, mucocutaneous anastomosis, cosmetic appearance, and management of associated complications.

  13. Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial.

    PubMed Central

    Metcalfe, Chris; Avery, Kerry; Berrisford, Richard; Barham, Paul; Noble, Sian M; Fernandez, Aida Moure; Hanna, George; Goldin, Robert; Elliott, Jackie; Wheatley, Timothy; Sanders, Grant; Hollowood, Andrew; Falk, Stephen; Titcomb, Dan; Streets, Christopher; Donovan, Jenny L; Blazeby, Jane M

    2016-01-01

    BACKGROUND Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. OBJECTIVES The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. DESIGN Pilot parallel three-arm randomised controlled trial nested within feasibility work. SETTING Two UK NHS departments of upper gastrointestinal surgery. PARTICIPANTS Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. INTERVENTIONS Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. MAIN OUTCOME MEASURE The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. RESULTS During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the

  14. Long Term Patient Satisfaction of Burch Colposuspension with or Without Concomitant Total Abdominal Hysterectomy

    PubMed Central

    Ozturk, Mustafa; Keskin, Ugur; Fidan, Ulas; Firatligil, Fahri Burcin; Alanbay, Ibrahim; Yenen, Mufit Cemal

    2015-01-01

    Introduction Urinary incontinence negatively affects the quality of life. Various methods are used in the treatment of stress incontinence. Burch colposuspension (BC) is the classical treatment of urinary incontinence. Aim To compare the long-term satisfaction in patients receiving BC with or without concomitant total abdominal hysterectomy. Materials and Methods One hundred and twenty patients with stress incontinence underwent burch colposuspension with or without concomitant total abdominal hysterectomy. Ninety-three (77.5%) patients were interviewed by telephone. Of these, 91(75, 8%) patients agreed to participate in the study. The patients were divided into two groups according to the type of the surgical procedure. Group 1(N=48, 52.7%) had received burch colposuspension with concomitant total abdominal hysterectomy. Group 2 (N=43, 47.3%) had received burch colposuspension without concomitant total abdominal hysterectomy. Results In Group 1, 41 patients (85%) were satisfied with the surgery and did not complain of urinary incontinence (p<0.05). In Group 2, 37 (86%) patients were satisfied with the surgery (p<0.05). Conclusion There were no difference in patient satisfaction between hysterectomy and BC and only BC to treat incontinence. PMID:26816948

  15. QUALITY OF LIFE OF IN PATIENTS SUBMITTED TO ANTERIOR ABDOMINAL WALL LAPAROSCOPIC HERNIOPLASTY

    PubMed Central

    ABDALLA, Ricardo Zugaib; GARCIA, Rodrigo Biscuola; SAID, Danniel Frade; ABDALLA, Beatrice Martinez Zugaib

    2014-01-01

    Background The laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate. Aim To evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique. Methods A retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone. Results Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery. Conclusion It was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure. PMID:24676295

  16. Bariatric Surgery Procedures

    MedlinePlus

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... minimally invasive techniques (laparoscopic surgery). The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric ...

  17. [Intraabdominal hypertension and abdominal compartment syndrome].

    PubMed

    Sonne, Morten; Hillingsø, Jens

    2008-02-11

    Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare conditions with high mortality. IAH is an intraabdominal pressure (IAP) above 12 mmHg and ACS an IAP above 20 mmHg with evidence of organ dysfunction. IAP is measured indirectly via the bladder or stomach. Various medical and surgical conditions increase the intraabdominal volume. When the content exceeds the compliance of the abdominal wall, the IAP rises. Increased IAP affects the functioning of the brain, lungs, circulation, kidneys, and bowel. The treatment of ACS is a reduction of IAP.

  18. [Long-term results of peripheral vascular injuries in patients' limbs following reconstructive surgical procedures and influence on the quality of life].

    PubMed

    Deja, Włodzimierz; Wieczorek, Dariusz; Deja, Agata; Lasek, Jerzy; Kawecka, Aleksandra; Marks, Wojciech

    2006-01-01

    Major vascular injuries in extremities are rare and constitute problems for surgeons and their sequelae strongly influence remote future of the patients. The aim of study is to evaluate surgical treatment of vascular injuries in extremities and some aspects of quality of life. Since 1983 until 2002 sixty four patients with vascular limbs injuries were treated in the department. Remote evaluation has been performed in 33 persons. Severity of limb injuries was measured by Mangled Extremity Severity Score (MESS). In 20 patients (60.6%) very good and good recent results were obtained, satisfactory in 24.2% and bad results in 15.2% persons. Evaluation of functional status has been made by means of locomotion test and Jebsen-Taylor's test, social approval questionnaire, depression Beck's scale, the scale of hypochondria and by an original questionnaire to evaluate the quality of life. As considerable interdependence has been found between the functional status and the following factors: injury severity expressed in MESS (p < 0.01), clinic reception procedure (p < 0.001), ischemia time (p < 0.01), coincidence of other injuries (fractures and dislocations, muscle, tendon and nerve lesions) (p < 0.01), limb amputation (p < 0.01). Hand function significantly influences the quality of life. Patients who were in shock after trauma in the remote assessment showed susceptibility to the lowered mood and depression (p < 0.05). Quality of life is strongly connected with the features of personality, correlating mainly with the mood and tendencies of concentration upon somatic symptoms. Function of the hand influences strongly the quality of life. Amputated patients may in spite of their crippling limitations are able to adapt to everyday life.

  19. Abdominal aortic aneurysm: A comprehensive review

    PubMed Central

    Aggarwal, Sourabh; Qamar, Arman; Sharma, Vishal; Sharma, Alka

    2011-01-01

    An arterial aneurysm is defined as a focal dilation of a blood vessel with respect to the original artery. The risk of abdominal aortic aneurysms (AAAs) increases dramatically in the presence of the following factors: age older than 60 years, smoking, hypertension and Caucasian ethnicity. The likelihood that an aneurysm will rupture is influenced by the aneurysm size, expansion rate, continued smoking and persistent hypertension. The majority of AAAs are asymptomatic and are detected as an incidental finding on ultrasonography, abdominal computed tomography or magnetic resonance imaging performed for other purposes. It can also present with abdominal pain or complications such as thrombosis, embolization and rupture. Approximately 30% of asymptomatic AAAs are discovered as a pulsatile abdominal mass on routine physical examination. Abdominal ultrasonography is considered the screening modality of choice for detecting AAAs because of its high sensitivity and specificity, as well as its safety and relatively lower cost. The decision to screen for AAAs is challenging. The United States Preventive Services Task Force recommended that men between the age of 65 to 75 years who have ever smoked should be screened at least once for AAAs by abdominal ultrasonography. Management options for patients with an asymptomatic AAA include reduction of risk factors such as smoking, hypertension and dyslipidemia; medical therapy with beta-blockers; watchful waiting; endovascular stenting; and surgical repair depending on the size and expansion rate of the aneurysm and underlying comorbidities. PMID:21523201

  20. Anesthetic Considerations for Common Procedures in Geriatric Patients: Hip Fracture, Emergency General Surgery, and Transcatheter Aortic Valve Replacement.

    PubMed

    Lester, Laeben

    2015-09-01

    The elderly population is growing. Geriatric patients undergo a large proportion of surgical procedures and have increased complications, morbidity, and mortality, which may be associated with increased intensive care unit time, length of stay, hospital readmission, and cost. Identification of optimal anesthetic care for these patients, leading to decreased complications and contributing to best possible outcomes, will have great value. This article reviews the anesthetic considerations for intraoperative care of geriatric patients and focus on 3 procedures (hip fractures, emergency abdominal surgery, and transcatheter aortic valve replacement). An approach to evaluation and management of the elderly surgical patient is described.

  1. Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report

    PubMed Central

    Samal, Sunita; Ghose, Seetesh

    2015-01-01

    Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act. PMID:26675988

  2. Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report.

    PubMed

    Begum, Jasmina; Samal, Sunita; Ghose, Seetesh

    2015-11-01

    Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.

  3. Peno-scrotal limphedema with giant hydrocele - surgical treatment particularities

    PubMed Central

    Mischianu, Dan; Florescu, Ioan; Madan, Victor; Iatagan, Cristian; Bratu, Ovidiu; Oporan, Anca; Giublea, C

    2009-01-01

    Introduction: The necessity for complex and multidisciplinary approach of “border” surgical pathology has unanimously been agreed upon for such a long period of time, its advantages becoming even more obvious in rare, particular cases. Patients and methods: We report the case of a 39 year-old man diagnosed with lymphangiomatosis back in his childhood. He is admitted with a giant pseudotumoral scrotal mass presenting an important scrotal enlargement (40/35 cm). Physical examination, blood tests, ultrasound, IVP, abdominal and chest CT, psychiatric and plastic surgery evaluation established the diagnosis: peno-scrotal lymphedema with gigantic hydrocele and depressive disorder. Taking into account the important enlargement of the scrotum associated with the alteration of the local skin, we decided to form a mixed surgical team: urology - plastic and reconstructive surgery. We performed bilateral surgical therapy of hydrocele with partial excision and eversion of sac edges, excision of peno-scrotal skin and subcutaneous tissue surplus. At the end we made a reconstruction by using a partial-thickness graft from the normal skin of the left thigh. Results: Spinal anaesthesia was sufficient in order to perform a qualitative complex surgery. Intra and postoperative course was uneventful with minimal blood loss. Conclusion: Rare cases like this one clearly reveal the advantages of a multidisciplinary surgical team by combining usual surgical procedures from different specialities that could lead to spectacular results. PMID:20108494

  4. Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus.

    PubMed

    Flancbaum, L; Nosher, J L; Brolin, R E

    1990-01-01

    Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.

  5. Laparoscopic management of intra-abdominal infections: Systematic review of the literature

    PubMed Central

    Coccolini, Federico; Tranà, Cristian; Sartelli, Massimo; Catena, Fausto; Saverio, Salomone Di; Manfredi, Roberto; Montori, Giulia; Ceresoli, Marco; Falcone, Chiara; Ansaloni, Luca

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections. METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically. RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source. CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections. PMID:26328036

  6. Practical Approaches to Definitive Reconstruction of Complex Abdominal Wall Defects.

    PubMed

    Latifi, Rifat

    2016-04-01

    With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.

  7. [Duodenal perforation after blunt abdominal trauma].

    PubMed

    Schneider, R; Moebius, C; Thelen, A; Jonas, S

    2009-12-01

    Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis.

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

    PubMed

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

    2012-10-01

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

  9. Miniature surgical robots in the era of NOTES and LESS: dream or reality?

    PubMed

    Zygomalas, Apollon; Kehagias, Ioannis; Giokas, Konstantinos; Koutsouris, Dimitrios

    2015-02-01

    Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.

  10. Remote revascularization of abdominal wall transplants using the forearm.

    PubMed

    Giele, H; Bendon, C; Reddy, S; Ramcharan, R; Sinha, S; Friend, P; Vaidya, A

    2014-06-01

    Primary abdominal wall closure following small bowel transplantation is frequently impossible due to contraction of the abdominal domain. Although abdominal wall transplantation was reported 10 years ago this, technique has not been widely adopted, partly due to its complexity, but largely because of concerns that storing the abdominal allograft until the end of a prolonged intestinal transplant procedure would cause severe ischemia-reperfusion injury. We report six cases of combined small bowel and abdominal wall transplantation where the ischemic time was minimized by remotely revascularizing the abdominal wall on the forearm vessels, synchronous to the intestinal procedure. When the visceral transplant was complete, the abdominal wall was removed from the forearm and revascularized on the abdomen (n = 4), or used to close the abdomen while still vascularized on the forearm (n = 2). Primary abdominal wall closure was achieved in all. Mean cold ischemia was 305 min (300-330 min), and revascularization on the arm was 50 min (30-60 min). Three patients had proven abdominal wall rejection, all treated successfully. Immediate revascularization of the abdominal wall allograft substantially reduces cold ischemia without imposing constraints on the intestinal transplant. Reducing storage time may also have benefits with respect to ischemia-reperfusion-related graft immunogenicity.

  11. Abdominal compartment syndrome following abdominoplasty: A case report and review

    PubMed Central

    Izadpanah, Arash; Izadpanah, Ali; Karunanayake, Mihiran; Petropolis, Christian; Deckelbaum, Dan L.; Luc, Mario

    2014-01-01

    Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery. PMID:25190927

  12. Abdominal compartment syndrome following abdominoplasty: A case report and review.

    PubMed

    Izadpanah, Arash; Izadpanah, Ali; Karunanayake, Mihiran; Petropolis, Christian; Deckelbaum, Dan L; Luc, Mario

    2014-05-01

    Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

  13. [Surgical site infections].

    PubMed

    Sganga, Gabriele

    2014-01-01

    Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14-16% of all infections observed in hospitalized patients and up to 38% of those observed among surgical patients. Knowledge of incidence, epidemiology, classification, process of wound healing, and pathogenesis of surgical site infection is of great importance. Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to improve our tools in order to reduce their incidence, as a reduction of only 0.1% can result in a considerable saving of economic resources to be allocated to other activities, such as screening and prevention programs.

  14. Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

    PubMed Central

    Ishii, Takuro; Aoe, Tomohiko; Yu, Wen-Wei; Ebihara, Yuma; Kawahira, Hiroshi; Isono, Shiro; Naya, Yukio

    2016-01-01

    Abstract Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free

  15. Successful use of talc sclerodesis to control a persistent high-output groin seroma following endovascular abdominal aortic aneurysm repair.

    PubMed

    Metcalfe, David; Sinha, Sidhartha; Sadek, Norah; Ho, Andrew L; Karthikesalingam, Alan; Jones, Keith G; Hinchliffe, Robert J; Thompson, Matt M; Black, Stephen A

    2013-08-01

    Groin wound lymphatic complications after vascular procedures are accompanied by increased risk of infection, prolonged hospital stay, and greater patient morbidity. High-output groin seromas can be difficult to manage and refractory to established interventions. Although subcutaneous talc has been used to prevent seroma accumulation in other high-risk surgical fields, such as after axillary lymph node dissection, it has not been described in the context of vascular surgery. This article presents the first reported case of a persistent high-output groin seroma after endovascular abdominal aortic aneurysm repair managed successfully with intraoperative application of sterile talc.

  16. Progression of perianeurysmal inflammation after endovascular aneurysm repair for inflammatory abdominal aortic and bilateral common iliac artery aneurysms.

    PubMed

    Igari, Kimihiro; Kudo, Toshifumi; Uchiyama, Hidetoshi; Toyofuku, Takahiro; Inoue, Yoshinori

    2015-02-01

    The use of endovascular aneurysm repair (EVAR) to treat inflammatory abdominal aortic aneurysms (IAAAs) has been reported, and this procedure appears to be preferable to open surgical repair because of intraoperative difficulties related to inflammation. We herein report a case of IAAA and bilateral inflammatory common iliac artery aneurysms that was successfully treated with bifurcated stent grafting. The perianeurysmal inflammation worsened postoperatively, requiring the placement of a ureteric stent. EVAR is feasible in cases of inflammatory aneurysms; however, the potential for an inflammatory response should be taken into account when considering the application of EVAR in patients with IAAA.

  17. Castleman's Disease Presenting as Localized Abdominal Mass and Paraneoplastic Pemphigus

    PubMed Central

    Kumar, Santosh; Bishnoi, Kshitij; Murugavaithianathan, Pragatheeswarane; Panwar, Vikas Kumar

    2016-01-01

    Castleman's disease is a rare, benign lymphoproliferative disorder of unknown origin. Paraneoplastic pemphigus is a common association which presents as oral mucosal ulcerations. Abdominal and retroperitoneal Castleman's disease present either as a localized disease or as a systemic disease. We hereby present a 15-year-old male patient with oral mucosal lesions with localized vague right lower abdominal mass who was diagnosed to have Castleman's disease with paraneoplastic pemphigus which was surgically excised. PMID:27014502

  18. [Abdominal pregnancy, institutional experience].

    PubMed

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

  19. Multiscale Surgical Telerobots

    SciTech Connect

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

    2002-01-23

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

  20. Are the surgeon's movements repeatable? An analysis of the feasibility and expediency of implementing support procedures guiding the surgical tools and increasing motion accuracy during the performance of stereotypical movements by the surgeon.

    PubMed

    Podsędkowski, Leszek Robert; Moll, Jacek; Moll, Maciej; Frącczak, Łukasz

    2014-03-01

    The developments in surgical robotics suggest that it will be possible to entrust surgical robots with a wider range of tasks. So far, it has not been possible to automate the surgery procedures related to soft tissue. Thus, the objective of the conducted studies was to confirm the hypothesis that the surgery telemanipulator can be equipped with certain routines supporting the surgeon in leading the surgical tools and increasing motion accuracy during stereotypical movements. As the first step in facilitating the surgery, an algorithm will be developed which will concurrently provide automation and allow the surgeon to maintain full control over the slave robot. The algorithm will assist the surgeon in performing typical movement sequences. This kind of support must, however, be preceded by determining the reference points for accurately defining the position of the stitched tissue. It is in relation to these points that the tool's trajectory will be created, along which the master manipulator will guide the surgeon's hand. The paper presents the first stage, concerning the selection of movements for which the support algorithm will be used. The work also contains an analysis of surgical movement repeatability. The suturing movement was investigated in detail by experimental research in order to determine motion repeatability and verify the position of the stitched tissue. Tool trajectory was determined by a motion capture stereovision system. The study has demonstrated that the suturing movement could be considered as repeatable; however, the trajectories performed by different surgeons exhibit some individual characteristics.

  1. Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound.

    PubMed Central

    Johnson, W C; Gerzof, S G; Robbins, A H; Nabseth, D C

    1981-01-01

    Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive therapy for intra-abdominal abscesses. To assess its efficacy, the results in the 27 patients treated percutaneously over the last five years have been compared with the results in the 43 patients treated by operative intervention over the past ten years. In the percutaneous group, complications (4%), inadequate drainage (11%), and duration of drainage (17 days) were less than in the operative group (16%, 21% and 29 days respectively). These results indicate that percutaneous drainage is at least as efficacious as operative drainage and avoids the risks of a major operative procedure. Images Fig. 2. Fig. 4. PMID:7283510

  2. Abdominal cocoon accompanied by multiple peritoneal loose body

    PubMed Central

    Cheng, Yongyuan; Qu, Lintao; Li, Jun; Wang, Bin; Geng, Junzu; Xing, Dong

    2017-01-01

    Abstract Rationale: Abdominal cocoon and peritoneal loose body are both rare abdominal diseases. Patient concerns: The patient reported in this case was a 47-year-old man who suffered from abdominal pain and distension for 3 days. Diagnosis: X-ray, computed tomography, and magnetic resonance imaging revealed multiple peritoneal loose body and small bowel obstruction, characterized by a total encapsulation of the small bowel with a fibrous membrane. Interventions: The patient underwent surgical treatment and exploratory laparotomy confirmed the diagnosis of abdominal cocoon. Outcomes: Histopathological examination of pelvic nodules confirmed peritoneal loose body. Lessons: To our knowledge, the herein reported case is the first abdominal cocoon that was accompanied by multiple peritoneal loose body. PMID:28248873

  3. Secondary abdominal pregnancy in human immunodeficiency virus-positive woman

    PubMed Central

    Manyanga, Hudson; Lwakatare, Flora

    2016-01-01

    We report on an abdominal pregnancy in human immunodeficiency virus-positive mother, currently on antiretroviral therapy, which was discovered incidentally while training the obstetric ultrasound capacity building program. Although abdominal pregnancy is a rare form of ectopic pregnancy, it may be more common in women with HIV infection because they tend to have a higher rate of sexually transmitted diseases than the general population. The positive diagnosis of abdominal pregnancy is difficult to establish and is usually missed during prenatal assessment particularly in settings that lack routine ultrasound examination as is the case in most developing countries. For the management of abdominal pregnancy, surgical intervention is recommended and removal of the placenta is a key controversy. Ultrasonography is considered the front-line and most effective imaging method and an awareness with a high index of suspicion of abdominal pregnancy is vital for reducing associated high maternal and even higher perinatal mortality. PMID:27896258

  4. Neurosurgical procedures in patients with liver cirrhosis: A review

    PubMed Central

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-01-01

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes. PMID:26413225

  5. Takedown of enterocutaneous fistula and complex abdominal wall reconstruction.

    PubMed

    Slade, Dominic Alexander James; Carlson, Gordon Lawrence

    2013-10-01

    Key steps in managing patients with enterocutaneous fistulation and an abdominal wall defect include dealing effectively with abdominal sepsis and providing safe and effective nutritional support and skin care, then assessing intestinal and abdominal anatomy, before undertaking reconstructive surgery. The complexity, cost, and morbidity associated with such cases justifies creation of specialized centers in which gastroenterologic, hernia, and plastic surgical expertise, as well as experienced wound and stoma nursing and nutritional and psychological support, can be made available for patients with these challenging problems.

  6. A mandibular surgical training model.

    PubMed

    Leser, Casey P; Jepsen, Shawn A

    2008-01-01

    Performing surgical procedures on the mandible can present many challenges due to the anatomy and the limited access available to the various areas of the mandibular arch. The experience of the surgeon and the complexity of the surgery must be considered before attempting treatment. A static mandibular training model provides dentists with the opportunity to practice multiple surgical procedures to develop the skills that are necessary to treat patients competently and comprehensively. The mandible's unique anatomy presents a number of challenges when performing surgical procedures. A surgical model that makes it possible to practice multiple techniques benefits the surgeon by building the confidence to attempt more complex surgical procedures and thus provide patients with additional treatment options. This mandibular surgical model serves as a learning tool and provides an avenue for learning different surgical techniques that may be performed in various areas of the mandible. A number of procedures can be performed on the model, including the extraction of third molars, incision and drainage of a vestibular/buccal swelling, excisional biopsy of intrabony lesions, tori removal, initial implant alignment procedures, and suturing/flap designs. A number of these procedures can be performed on one model.

  7. Standing diagnostic and therapeutic equine abdominal surgery.

    PubMed

    Graham, Sarah; Freeman, David

    2014-04-01

    The widespread use of laparoscopy in equine surgery has increased interest in the standing approach to a wide range of procedures typically regarded as feasible only through a ventral midline incision. Although a commonly cited benefit of standing surgery relates to avoiding costs of general anesthesia and risks associated with it, some procedures and horses are not suitable candidates for standing abdominal procedures. Some procedures, such as nephrectomy, colostomy, and closure of the nephrosplenic space, are not only suitable for standing surgery but are performed more easily and more safely through this approach than with general anesthesia.

  8. Definitive Surgical Treatment of Infected or Exposed Ventral Hernia Mesh

    PubMed Central

    Szczerba, Steven R.; Dumanian, Gregory A.

    2003-01-01

    Objective To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique. Summary Background Data The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration. Methods Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps. Results Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months). Conclusions Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh. PMID:12616130

  9. Morbidity and mortality of pancreatic tumors undergoing surgical treatment

    PubMed Central

    ZENI, Luiza Bueno; RUSSI, Ricardo Fantazzini; FIALHO, Alexandre Faleiro; FONSECA, Ana Luiza Pagani; SOMBRIO, Lyara Schaefer; ROCHA, Igor Cunha

    2014-01-01

    Background Pancreatic cancer has a high mortality rate due to late diagnosis and aggressive behavior. The prognosis is poor, with 5-year survival occurring in less than 5% of cases. Aim To analyze demographic characteristics, comorbidities, type of procedure and early postoperative complications of patients with pancreatic cancer submitted to surgical treatment. Methods Cross-sectional study with analysis of 28 medical records of patients with malignant tumors of the pancreas in a 62 month. Data collection was performed from the medical records of the hospital. Results Of the total, 53,6% were male and the mean age was 60.25 years. According to the procedure, 53,6% was submitted to duodenopancreactectomy the remainder to biliodigestive derivation or distal pancreatectomy. The ductal adenocarcinoma occurred in 82,1% and 92,9% of tumors were located in the pancreatic head. Early postoperative complications occurred in 64,3% of cases and the most prevalent was intra-abdominal abscess (32,1%). Among duodenopancreactectomies 77,8% had early postoperative complications. Conclusion Its necessary to encourage early detection of tumors of the pancreas to raise the number operations with curative intent. Refinements in surgical techniques and surgical teams can diminish postoperative complications and, so, operative morbimortality can also decrease over time. PMID:25626938

  10. Diagnostic laparoscopy and adhesiolysis: does it help with complex abdominal and pelvic pain syndrome (CAPPS) in general surgery?

    PubMed

    McClain, Gregory D; Redan, Jay A; McCarus, Steven D; Caceres, Aileen; Kim, John

    2011-01-01

    Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as "phantom pain" following amputation, which takes time to resolve after this type of surgery.

  11. [New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)].

    PubMed

    Palmieri, Beniamino; Grappolini, Simone; Blandini, Daniele; De-Anna, Dino; Savio, Stefano; Ferrari, Paolo; Ferrari, Giovanni; William, Pillosu; Campanini, Isabella; Guido, Vezzosi; Tenchini, Paolo; Benuzzi, Giorgia; Palmieri, Lucia

    2004-01-01

    Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation. All were affected by abdominal wall impairment, frank hernia or laparocele, and had been complaining of lumbar and sciatic pain for long periods without any definite intervertebral disk pathology. They underwent pre- and postoperative subjective and objective evaluation and insertion of a prefascial polypropylene mesh with a posterior martingale that passes across the spine and paravertebral muscles, ending in two wider rectangles that are criss-crossed ventrally and finally sutured to the iliopubic brim. All the patients improved either subjectively or objectively with the round mesh procedure. This new technique is particularly useful in cases of reduction or impairment of the recti abdominis, transverse and oblique muscles, because simple suture and plication of these muscles is no guarantee of long-term functional restoration.

  12. Abdominal Pain Syndrome

    MedlinePlus

    ... or cancer Infection of the tubes (salpingitis) Ectopic pregnancy Fibroid tumors of the uterus (womb) Malignant tumors of the uterus or cervix Endometriosis Adhesions (scars) Screening and Diagnosis How is the cause of abdominal pain determined? ...

  13. Abdominal ultrasound (image)

    MedlinePlus

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  14. Acute abdominal pain.

    PubMed

    Stone, R

    1998-01-01

    Abdominal pain is among the most frequent ailments reported in the office setting and can account for up to 40% of ailments in the ambulatory practice. Also, it is in the top three symptoms of patients presenting to emergency departments (ED) and accounts for 5-10% of all ED primary presenting ailments. There are several common sources for acute abdominal pain and many for subacute and chronic abdominal pain. This article explores the history-taking, initial evaluation, and examination of the patient presenting with acute abdominal pain. The goal of this article is to help differentiate one source of pain from another. Discussion of acute cholecystitis, pancreatitis, appendicitis, ectopic pregnancy, diverticulitis, gastritis, and gastroenteritis are undertaken. Additionally, there is discussion of common laboratory studies, diagnostic studies, and treatment of the patient with the above entities.

  15. Abdominal and Pelvic CT

    MedlinePlus Videos and Cool Tools

    ... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...

  16. Abdominal wall surgery

    MedlinePlus

    ... the results of abdominoplasty. Many feel a new sense of self-confidence. Alternative Names Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty Images Abdominoplasty - series Abdominal muscles References McGrath MH, Pomerantz J. Plastic surgery. In: Townsend ...

  17. Abdominal involvement in tuberculosis.

    PubMed

    Neyman, Edward G; Georgiades, Christos S; Fishman, Elliot K

    2002-10-01

    Rising incidence of disseminated and extrapulmonary tuberculosis (TB), especially in immunocompromised hosts and patients with multi-drug-resistant tuberculosis, has resulted in an increase of unusual clinical and radiographic presentations of TB. With CT being a common part of emergency room (ER) evaluation of abdominal pain, it is imperative that radiologists be able to recognize abdominal presentations of TB. We discuss and illustrate typical and less common CT manifestations of tuberculosis in the abdomen to help ER radiologists in this task.

  18. [Inflammatory abdominal aortic aneurysm. Role of corticosteroid therapy].

    PubMed

    Testart, J; Plissonnier, D; Peillon, C; Watelet, J

    2000-06-01

    For more than 20 years it has been generally acknowledged that operation for inflammatory abdominal aortic aneurysm (IAAA) using the common in-lay-graft procedure will induce the regression of peri-aortic fibrosis. However in prospective studies, after a 2 years follow-up, no regression appeared in approximated 8% of the cases (table I). Moreover in some IAAA a corticosteroid treatment (CS) was prescribed and it produced a regression of fibrosis and therefore facilitated the operation. Nevertheless the usefulness of the CS remains debated. We report 4 new cases of IAAA with CS. Based on our cases and an analysis of the literature we conclude that when there is no urgency to operate (diameter inferior to 50 mm) CS is the best option in IAAA with either severe inflammation or ureter involvement. Due to the regression of the fibrosis it can facilitate the surgical procedure. However it needs to be conducted with an adequate dose and duration. Finally the CS is the only possibility when the inflammation persist following the treatment of the IAAA.

  19. Surgical management of hemorrhoids.

    PubMed

    Agbo, S P

    2011-07-01

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

  20. Medical and surgical management of uroperitoneum in a foal

    PubMed Central

    Butters, Alyssa

    2008-01-01

    A 4-day-old, male, American paint foal was presented for abdominal distention, respiratory distress, and diarrhea. Bladder rupture and uroperitoneum were diagnosed following abdominal ultrasonography and abdominocentesis. The defect in the dorsocranial part of the bladder wall was surgically repaired. PMID:18481552

  1. Percutaneous endoscopic gastrostomy following previous abdominal surgery.

    PubMed Central

    Stellato, T A; Gauderer, M W; Ponsky, J L

    1984-01-01

    During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy. PMID:6428334

  2. Life-threatening abdominal injury during a soccer game: a rare clinical case.

    PubMed

    Kara, Eray; Içöz, Gökhan; Ersin, Sinan; Coker, Ahmet

    2011-03-01

    Soccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.

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

    PubMed

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

    2013-05-01

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

  4. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

    SciTech Connect

    Lagana, Domenico Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Caronno, Roberto; Castelli, Patrizio; Cuffari, Salvatore; Fugazzola, Carlo

    2006-04-15

    Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

  5. Abdominal pain and nausea in a 12-year-old girl.

    PubMed

    Walters, Randall; Bowen, Denise J

    2016-04-01

    Girls presenting with lower abdominal pain have a broad differential diagnosis. Transabdominal ultrasound should be performed in all girls presenting in the ED with lower abdominal pain. If ovarian torsion is suspected, surgical intervention should be initiated quickly to preserve the viability of the ovary.

  6. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25 cmH₂O: prospective, blind, and randomised study.

    PubMed

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

    2014-01-01

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

  7. Wandering spleen: a surgical enigma.

    PubMed

    Puranik, Ashok Kumar; Mehra, Rohit; Chauhan, Sushila; Pandey, Rahul

    2015-08-03

    Wandering spleen, also referred to as 'ptotic spleen', is a rare clinical condition characterized by splenic migration form its normal left hypochondrial position to any other abdominal or pelvic position. Among the multifactorial etiologies proposed, laxity of the spleen's primary supporting ligaments is the most agreed-upon hypothesis. We present one rare case of wandering spleen in an 11-year-old girl who presented with recurrent abdominal pain with no localizing features. Her abdominal examination revealed an intra-abdominal left iliac fossa lump with restricted mobility, which was confirmed as a wandering spleen by abdominal sonography and contrast-enhanced computed tomography. Intraoperatively, an infarcted spleen was encountered with tortuous, elongated, torsional splenic pedicle and a single dense adhesive band with descending colon. Splenectomy was offered to the patient. Post-operatively, the patient is healthy and symptom free at one-year follow-up. The rare clinical diagnosis of this condition, particularly in the paediatric age-group, makes it an enigma for the surgical world.

  8. Hospitals with briefer than average lengths of stays for common surgical procedures do not have greater odds of either re-admission or use of short-term care facilities.

    PubMed

    Dexter, F; Epstein, R H; Dexter, E U; Lubarsky, D A; Sun, E C

    2017-03-01

    We considered whether senior hospital managers and department chairs need to be concerned that small reductions in average hospital length of stay (LOS) may be associated with greater rates of re-admission, use of home health care, and/or transfers to short-term care facilities. The 2013 United States Nationwide Readmissions Database was used to study surgical Diagnosis Related Groups (DRG) with 1) national median LOS ≥3 days and 2) ≥10 hospitals in the database that each had ≥100 discharges for the DRG. Dependent variables were considered individually: 1) re-admission within 30 days of discharge, 2) discharge disposition to home health care, and/or 3) discharge disposition of transfer to short-term care facility (i.e., inpatient rehabilitation hospital or skilled nursing facility). While controlling for DRG, each one-day decrease in hospital median LOS was associated with an odds of re-admission nationwide of 0.95 (95% confidence interval [CI] 0.92-0.99; P=0.012), odds of disposition upon discharge being home care of 0.95 (95% CI 0.83-1.10; P=0.64), and odds of transfer to short-term care facility of 0.68 (95% CI 0.54-0.85; P=0.0008). Results were insensitive to the addition of patient-specific data. In the USA, patients at hospitals with briefer median LOS across multiple common surgical procedures did not have a greater risk for either hospital re-admission within 30 days of discharge or transfer to an inpatient rehabilitation hospital or a skilled nursing facility. The generalisable implication is that, across many surgical procedures, DRG-based financial incentives to shorten hospital stays seem not to influence post-acute care decisions.

  9. Back to Basics: Surgical Skin Antisepsis.

    PubMed

    Spruce, Lisa

    2016-01-01

    The fundamental basis for preventing surgical site infections is the antiseptic preparation of the skin at the surgical site. All perioperative nurses must learn this skill. The goal of surgical skin antisepsis, frequently referred to as prepping the skin, is to remove soil and transient (ie, temporary) microorganisms living on the skin that could pose a risk for surgical site infections. This Back to Basics article examines the origin of surgical skin antisepsis and the steps perioperative nurses should take to provide the patient with an aseptic surgical site before any surgical or other invasive procedure.

  10. Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage.

    PubMed

    Varela, N; Golvano, M; Monedero, P

    2016-10-01

    Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

  11. Comparative Efficacy of Pulse-Spray Thrombolysis and Angioplasty Versus Surgical Salvage Procedures for Treatment of Recurrent Occlusion of PTFE Dialysis Access Grafts

    SciTech Connect

    Polak, Joseph F.; Berger, Markus F.; Pagan-Marin, Heriberto; Aruny, John E.; Meyerovitz, Michael F.

    1998-07-15

    Purpose: To compare the efficacy of surgery versus pulse-spray thrombolysis and angioplasty in patients with recurrent thrombosis of polytetrafluoroethylene (PTFE) dialysis access grafts. Methods: We analyzed 96 consecutive interventions for thrombosed PTFE dialysis access grafts in 18 patients. Primary patency after thrombolysis and angioplasty (n= 25) was compared with primary patency following thrombectomy alone (n= 50) or thrombectomy followed by graft revision (n= 21) using life-table analysis. A Cox proportional hazards model that accounted for graft age and number of previous interventions was used to generate the relative risk for recurrent occlusion following therapy. Results: Life-table analysis showed that patency after thrombolysis and angioplasty was greater than that following thrombectomy alone (p= 0.02). After accounting for the age of the graft and the number of previous interventions (average six per patient), the relative risk for recurrent occlusion [3.0; 95% confidence intervals (CI): 1.5, 6.4] was greater for thrombectomy alone than for thrombolysis/angioplasty [0.6; CI = 0.3, 1.3]. The relative risks of repeat occlusion following thrombolysis/angioplasty [0.6; CI = 0.3, 1.3] and thrombectomy/surgical revision [1.0; CI = 0.5, 1.7] were similar. Conclusion: Outcome data from our retrospective study on recurrent thrombosis of PTFE dialysis access grafts suggest that thrombolysis/angioplasty is superior to thrombectomy alone, and equivalent to thrombectomy/surgical revision.

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

    PubMed Central

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

    2012-01-01

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

  13. Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity.

    PubMed

    Mike, Makio; Kano, Nobuyasu

    2015-02-01

    Laparoscopic surgery has generally been performed for digestive diseases. Many patients with colon cancer undergo laparoscopic procedures. The outcomes of laparoscopic colectomy and open colectomy are the same in terms of the long-time survival. It is important to dissect the embryological plane to harvest the lymph nodes and to avoid bleeding during colon cancer surgery. To date, descriptions of the anatomy of the fascial composition have mainly involved observations unrelated to fundamental embryological concepts, causing confusion regarding the explanations of the surgical procedures, with various vocabularies used without definitions. We therefore examined the fascia of the abdominal space using a fascia concept based on clinical anatomy and embryology. Mobilization of the bilateral sides of the colon involves dissection between the fusion fascia of Toldt and the deep subperitoneal fascia. It is important to understand that the right fusion fascia of Toldt is divided into the posterior pancreatic fascia of Treitz dorsally and the anterior pancreatic fascia ventrally at the second portion of the duodenum. A comprehensive understanding of fascia composition between the stomach and transverse colon is necessary for dissecting the splenic flexure of the colon. As a result of these considerations of the fascia, more accurate surgical procedures can be performed for the excision of colon cancer.

  14. Color Doppler ultrasonography of the abdominal aorta.

    PubMed

    Battaglia, S; Danesino, G M; Danesino, V; Castellani, S

    2010-09-01

    Alterations of the abdominal aorta are relatively common, particularly in older people. Technological advances in the fields of ultrasonography, computed tomography, angiography, and magnetic resonance imaging have greatly increased the imaging options for the assessment of these lesions. Because it can be done rapidly and is also non-invasive, ultrasonography plays a major role in the exploration of the abdominal aorta, from its emergence from the diaphragm to its bifurcation. It is indicated for the diagnosis and follow-up of various aortic diseases, especially aneurysms. It can be used to define the shape, size, and location of these lesions, the absence or presence of thrombi and their characteristics. It is also useful for monitoring the evolution of the lesion and for postoperative follow-up. However, its value is limited in surgical planning and in emergency situations.

  15. [Postoperative foreign objects in the abdominal cavity].

    PubMed

    Kazarian, V M

    2008-01-01

    The study was designed to elucidate the circumstances under which iatrogenic foreign objects can be mistakenly left inside the patient's body after surgical interventions and to outline measures to prevent such errors. The data obtained in forensic medical examination of two cases of urgent surgery on abdominal organs are analysed. They indicate that the main causes of leaving behind foreign bodies in a patient include improper organization of emergency medical aid, personal qualities of the surgeon, and psycho-emotional atmosphere during the operation. Comprehensive evaluation of the associated clinical symptoms and their dynamics is necessary for early identification and removal of foreign objects left in the abdominal cavity. It would help to avoid undesirable outcomes of surgery and reduce the number of legal proceedings against medical and preventive treatment facilities.

  16. Abdominal emergencies in pediatrics.

    PubMed

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  17. 3D Surgical Simulation

    PubMed Central

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

    2009-01-01

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

  18. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Mikami, Y; Kyogoku, M

    1994-08-01

    Inflammatory abdominal aortic aneurysm (IAAA) is a distinct clinicopathological entity, characterized by: (1) clinical presentation, such as back pain, weight loss, and increased ESR, (2) patchy and/or diffuse lymphoplasmacytic infiltration, and (3) marked periaortic fibrosis resulting in thickening of the aneurysmal wall and occasional retroperitoneal fibrosis. Its pathogenesis is unknown, but some authors support the theory that IAAA is a subtype of atherosclerotic abdominal aortic aneurysm because of close relationship between IAAA and atherosclerotic change. In this article, we describe clinical and histological features of IAAA on the basis of the literature and our review of 6 cases of IAAA, emphasizing the similarity and difference between IAAA and atherosclerotic abdominal aortic aneurysm. Our review supports that marked lamellar fibrosis completely replacing the media and adventitia, patchy lymphocytic infiltration (mostly B cells) and endarteritis obliterans are characteristic features of IAAA.

  19. Posterior approach to kidney dissection: An old surgical approach for integrated medical curricula.

    PubMed

    Daly, Frank J; Bolender, David L; Jain, Deepali; Uyeda, Sheryl; Hoagland, Todd M

    2015-01-01

    Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated curriculum, the renal system must be covered relatively quickly after the thorax in the cadaver laboratory, often without the opportunity to fully appreciate the rest of the abdominal contents. This article provides dissection instructions that follow one of the historical surgical approaches for nephrectomy, including preservation of the posterior abdominal wall neurovasclature. Dissection procedures were developed for first-year medical students, intending this posterior approach to the kidneys to be their first introduction to the renal system. It has been successfully implemented with the first-year medical students at the University of New England, College of Osteopathic Medicine. Utilizing this posterior approach to the kidney enabled the study of the anatomy of the kidneys, suprarenal glands, and renal vessels, as well as the muscles of the lumbar spine, while maintaining the integrity of the anterior abdominal wall and peritoneal cavity for future gastrointestinal and reproductive system-based dissections.

  20. 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.

  1. Computer Tomography Imaging Findings of Abdominal Follicular Dendritic Cell Sarcoma

    PubMed Central

    Li, Jing; Geng, Zhi-Jun; Xie, Chuan-Miao; Zhang, Xin-Ke; Chen, Rui-Ying; Cai, Pei-Qiang; Lv, Xiao-Fei

    2016-01-01

    Abstract Follicular dendritic cell sarcoma (FDCS) is a neoplasm that arises from follicular dendritic cells. FDCSs originating in the abdomen are extremely rare. Clinically, they often mimic a wide variety of other abdominal tumors, and correct preoperative diagnosis is often a challenging task. To date, only scattered cases of abdominal FDCS have been reported and few data are available on their radiological features. Here we present the computer tomography imaging findings of 5 patients with surgically and pathologically demonstrated abdominal FDCS. An abdominal FDCS should be included in the differential diagnosis when single or multiple masses with relatively large size, well- or ill-defined borders, complex internal architecture with marked internal necrosis and/or focal calcification, and heterogeneous enhancement with “rapid wash-in and slow wash-out” or “progressive enhancement” enhancement patterns in the solid component are seen. PMID:26735543

  2. Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture.

    PubMed

    Kontopodis, Nikolaos; Metaxa, Eleni; Papaharilaou, Yannis; Tavlas, Emmanouil; Tsetis, Dimitrios; Ioannou, Christos

    2015-02-01

    Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.

  3. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    PubMed Central

    Gadsden, Jeffrey; Ayad, Sabry; Gonzales, Jeffrey J; Mehta, Jaideep; Boublik, Jan; Hutchins, Jacob

    2015-01-01

    Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site. PMID:26677342

  4. Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy.

    PubMed

    Angelini, Diane J

    2003-01-01

    New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.

  5. Surgical reconstruction of TMJ.

    PubMed

    Ramil Novo, V M; Garcìa, A G; Berini Aytès, L; Escoda, C G

    1999-01-01

    Certain situations and pathological processes that arise with temporomandibular joint destruction can only be resolved with surgical reconstructive procedures in order to attempt a functional and anatomical rehabilitation of this joint. Many of these situations can be surgically treated with the patient's own autologous tissues. However, in some patients reconstruction is complex and the use of autologous tissues is unadvisable whereas reconstruction utilizing alloplastic materials may be an appropriate alternative. The following report describes 4 clinical cases in which autologous grafts or Christensen joint prosthesis are employed in temporomandibular joint reconstruction.

  6. Surgical treatment for epilepsy

    PubMed Central

    Engel, Jerome; Wiebe, Samuel; Radhakrishnan, Kurupath; Palmini, André

    2016-01-01

    Surgical treatment for epilepsy remains highly underutilized: in the United States, there has been no increase in the number of surgical procedures performed annually since 19901; for most patients referred, the average duration of epilepsy is 22 years2; and there has been no change in this delay to surgery3, despite two randomized controlled trials4, 5 and an American Academy of Neurology practice parameter that recommended surgery as the treatment of choice for medically refractory temporal lobe epilepsy6. This session addressed issues relevant to increasing the availability of epilepsy surgery, particularly in countries with limited resources.

  7. [Abdominal actinomycosis with IUD].

    PubMed

    Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A

    1997-01-01

    We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.

  8. Isolated Abdominal Wall Metastasis of Endometrial Carcinoma

    PubMed Central

    Simões, Jorge; Gonçalves, Matilde; Matos, Isabel

    2014-01-01

    A woman in her mid-60s presented with a bulky mass on the anterior abdominal wall. She had a previous incidental diagnosis of endometrial adenocarcinoma FIGO stage IB following a vaginal hysterectomy. Physical exam and imaging revealed a well circumscribed bulging tumour at the umbilical region, measuring 10 × 9 × 9 cm, with overlying intact skin and subcutaneous tissue. Surgical resection was undertaken, and histological examination showed features of endometrial carcinoma. She began chemotherapy and is alive with no signs of recurrent disease one year after surgery. This case brings up to light an atypical location of a solitary metastasis of endometrial carcinoma. PMID:25349753

  9. [Lymphosarcoma of abdominal lymph nodes in children].

    PubMed

    Kvirikashvili, T O

    2006-01-01

    We investigated 79 patients (76.0%) with lymphosarcoma of abdominal lymph nodes among all 104 with general abdominal lymphosarcoma. Ultrasound tomography was used in 98.1 % cases; also, in the urgent cases cancer transcutaneal puncture was performed with the purpose of cytological investigation. In complicated situations computer tomography was considered as a highly informative method of investigation. Surgical intervention and radial therapy is inexpedient in a treatment program of lymphosarcoma of abdominal lymph nodes in children. Besides, it is shown the superiority of intensive program of polychemical therapy OMDV: vincristine (oncovin) -- 1.5 mg/m(2) i/v in the 1 day; metotrexate -- 250 mg/m(2) i/v drop by drop in the I day; dexamethazone 10 mg/m(2) per os 1-5 day; vepesid -- 100 mg/m(2) i/v drop by drop in the 4 and 5 days.) in comparison with the ACOP scheme: adriamicine or rubomicine - 30 mg/m(2) i/v 1 time in week (N 4-6); cyclophosphane -- 600 mg/m(2) i/v 1 time in week (N 4-6); vincristine (oncovin) -- 1.4 mg/m(2) i/v 1 time in week (N 4-6); prednisolone -- 40 mg/m(2) every day 4-6 week quitting gradually) for treatment of lymphosarcoma of abdominal lymph nodes in childhood age. General recovery without recurrence in children with lymphosarcoma of abdominal lymph nodes was occurred in 44.2% cases. In the case of polychemical therapy according to ACOP scheme, recovery was 20% and in the case of polychemical therapy following OMDV scheme, 78.1% of the children recovered.

  10. Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

    PubMed Central

    Chen, Xiyang; Zhao, Jichun; Huang, Bin; Yuan, Ding; Yang, Yi; Ma, Yukui

    2016-01-01

    Abstract Introduction: Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA. Clinical Finding: An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient. Diagnosis: Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed. Interventions: Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient. Outcomes: Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed. Conclusion: ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management. PMID:27893667

  11. [Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap].

    PubMed

    Moullot, P; Philandrianos, C; Gonnelli, D; Casanova, D

    2014-10-01

    Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.

  12. Simultaneous surgical treatment of chronic post-traumatic aneurysm of the thoracic aorta, diaphragmatic hernia and giant emphysema bulla.

    PubMed

    Luciani, N; Lapenna, E; De Bonis, M; Pirronti, T; Possati, G F

    2002-10-01

    Thoraco-abdominal blunt trauma can lead to multiple injuries of several organs. We report a case of a patient in whom, 10 years after a trauma, a chest X-ray showed visceral herniation into the left thorax. Angio computed tomographic scan (CTS) and magnetic resonance imaging (MRI) confirmed these lesions and also showed a saccular thoracic aortic aneurysm. During the surgical procedure a giant post-traumatic emphysema bulla of the left lower pulmonary lobe was discovered and repaired. In the presence of diaphragmatic injuries, CTS and MRI are mandatory for excluding other organ involvement, and during the surgical procedure, careful inspection of left thorax and abdomen should always be done to repair other possible injuries not seen before.

  13. Abdominal Aortic Surgery: Anesthetic Implications

    PubMed Central

    Cunningham, Anthony J.

    1991-01-01

    The objectives of the review are to highlight the clinical characteristics of the patient population; to assess multivariate risk factor analysis and the invasive/non-invasive techniques available for risk factor identification and management in this high-risk surgical population; to assess the major hemodynamic, metabolic, and regional blood flow changes associated with aortic cross-clamping/unclamping procedures and techniques for their modification or attenuation; and to assess the influence of perioperative anesthetic techniques and management on patient outcome. PMID:1814052

  14. Peripheral surgical wounding may induce cognitive impairment through interlukin-6-dependent mechanisms in aged mice

    PubMed Central

    Dong, Yuanlin; Xu, Zhipeng; Huang, Lining; Zhang, Yiying; Xie, Zhongcong

    2016-01-01

    Post-operative cognitive dysfunction (POCD) is associated with morbidity, mortality and increased cost of medical care. However, the neuropathogenesis and targeted interventions of POCD remain largely to be determined. We have found that the peripheral surgical wounding induces an age-dependent Aβ accumulation, neuroinflammation and cognitive impairment in aged mice. Pro-inflammatory cytokine interlukin-6 (IL-6) has been reported to be associated with cognitive impairment in rodents and humans. However, the role of IL-6 in the neuropathogenesis of POCD is unknown. We therefore employed pharmacological (IL-6 antibody) and genetic (knockout of IL-6) approach to investigate whether IL-6 contributed to the peripheral surgical wounding-induced cognitive impairment in aged mice. Abdominal surgery under local anesthesia (peripheral surgical wounding) was established in 18-month-old wild-type and IL-6 knockout mice (n = 6 to 10 in each group). Brain level of IL-6 and cognitive function in the mice were determined by western blot, ELISA at the end of procedure, and Fear Conditioning System at 7 days after the procedure. The peripheral surgical wounding increased the level of IL-6 in the hippocampus of aged wild-type, but not IL-6 knockout mice. IL-6 antibody ameliorated the peripheral surgical wounding-induced cognitive impairment in the aged wild-type mice. Finally, the peripheral surgical wounding did not induce cognitive impairment in the aged IL-6 knockout mice. These data suggested that IL-6 would be a required pro-inflammatory cytokine for the peripheral surgical wounding-induced cognitive impairment. Given this, further studies are warranted to investigate the role of IL-6 in the neuropathogenesis and targeted interventions of POCD. PMID:28217289

  15. Abdominal exploration - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100049.htm Abdominal exploration - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  16. The modified Altemeier procedure for a loop colostomy prolapse.

    PubMed

    Watanabe, Makoto; Murakami, Masahiko; Ozawa, Yoshiaki; Uchida, Marie; Yamazaki, Kimiyasu; Fujimori, Akira; Otsuka, Koji; Aoki, Takeshi

    2015-11-01

    Loop colostomy prolapse is associated with an impaired quality of life. Surgical treatment may sometimes be required for cases that cannot be closed by colon colostomy because of high-risk morbidities or advanced disease. We applied the Altimeter operation for patients with transverse loop colostomy. The Altemeier operation is therefore indicated for rectal prolapse. This technique involves a simple operation, which includes a circumferential incision through the full thickness of the outer and inner cylinder of the prolapsed limb, without incising the abdominal wall, and anastomosis with sutures using absorbable thread. We performed the Altemeier operation for three cases of loop stomal prolapse. Those patients demonstrated no postoperative complications (including obstruction, prolapse recurrence, or hernia). Our findings suggest that this procedure is useful as an optional surgical treatment for cases of transverse loop colostomy prolapse as a permanent measure in patients with high-risk morbidities or advanced disease.

  17. The inflammatory abdominal aortic aneurysm and coronary artery disease. Case report and review.

    PubMed

    Monte, I; Capodanno, D; Licciardi, S; Ferraro, C; Giannone, M T; Grasso, S; Nicolosi, E

    2006-04-01

    Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic wall, encircled by a wide dense perianeurysmal and/or retroperitoneal fibrosis with adjacent tissues adhesion, and is now considered as an extreme shape of the common phlogistic process involved in atherosclerotic plaque formation. Latest studies demonstrated that inflammation plays an important role in coronary disease and in other atherosclerosis manifestations. We introduce the clinical case of a patient with IAAA who developed an acute myocardial infarction 6 months after the surgical procedure on the aorta. Through a literature review about IAAA we stress the clinical usefulness of the inflammatory markers as independent predictors in management of patients with coronary disease and we present the hypothesis, related to the introduced case, of an advanced coronary disease, aggravated or clinically revealed after the cytokine storm related to important localized inflammatory engagements or great vascular surgery treatments.

  18. Incision for abdominal laparoscopy (image)

    MedlinePlus

    Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...

  19. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  20. PET/CT detects abdominal wall and port site metastases of colorectal carcinoma.

    PubMed

    Goshen, E; Davidson, T; Aderka, D; Zwas, S T

    2006-07-01

    Abdominal wall metastases from colorectal cancer (CRC) may be resected with curative results. Such lesions, often indicators of additional intra-abdominal lesions, may appear in surgical scars, stomas and port site metastases after laparoscope-assisted surgery (LAS). Post-operative changes, primarily surgical scars, alter local physical findings making early detection of small lesions challenging. The purpose of this study was to retrospectively evaluate the contribution of PET/CT to the diagnosis of recurrent colorectal cancer in the post-operative abdominal wall. 120 patients were referred for PET/CT with suspected recurrent CRC based on clinical, radiological or laboratory findings. All underwent whole body PET/CT imaging. 12 of these 120 (10%), were found to have abdominal wall lesions. A total of 16 abdominal wall lesions were detected, located to surgical scars, stomas, drain and laparoscope ports. Additional findings on PET/CT in this group included liver metastases, intra-abdominal lesions and retroperitoneal lymph node involvement. In general, the patients in this small group were young with high grade tumours presenting in advanced stages. In conclusion, PET/CT appears to be a sensitive tool for the diagnosis of abdominal wall recurrence of CRC. The accuracy of localization afforded by the fused functional and anatomic images makes PET/CT a likely tool for diagnosing abdominal wall lesions, including port site metastases of other aetiologies.

  1. Quantification of abdominal aortic deformation after EVAR

    NASA Astrophysics Data System (ADS)

    Demirci, Stefanie; Manstad-Hulaas, Frode; Navab, Nassir

    2009-02-01

    Quantification of abdominal aortic deformation is an important requirement for the evaluation of endovascular stenting procedures and the further refinement of stent graft design. During endovascular aortic repair (EVAR) treatment, the aortic shape is subject to severe deformation that is imposed by medical instruments such as guide wires, catheters, and, the stent graft. This deformation can affect the flow characteristics and morphology of the aorta which have been shown to be elicitors for stent graft failures and be reason for reappearance of aneurysms. We present a method for quantifying the deformation of an aneurysmatic aorta imposed by an inserted stent graft device. The outline of the procedure includes initial rigid alignment of the two abdominal scans, segmentation of abdominal vessel trees, and automatic reduction of their centerline structures to one specified region of interest around the aorta. This is accomplished by preprocessing and remodeling of the pre- and postoperative aortic shapes before performing a non-rigid registration. We further narrow the resulting displacement fields to only include local non-rigid deformation and therefore, eliminate all remaining global rigid transformations. Finally, deformations for specified locations can be calculated from the resulting displacement fields. In order to evaluate our method, experiments for the extraction of aortic deformation fields are conducted on 15 patient datasets from endovascular aortic repair (EVAR) treatment. A visual assessment of the registration results and evaluation of the usage of deformation quantification were performed by two vascular surgeons and one interventional radiologist who are all experts in EVAR procedures.

  2. Retained Surgical Foreign Bodies after Surgery

    PubMed Central

    Zejnullahu, Valon A.; Bicaj, Besnik X.; Zejnullahu, Vjosa A.; Hamza, Astrit R.

    2017-01-01

    The problem of retained surgical bodies (RSB) after surgery is an issue for surgeons, hospitals and the entire medical team. They have potentially harmful consequences for the patient as they can be life threatening and usually, a further operation is necessary. The incidence of RSB is between 0.3 to 1.0 per 1,000 abdominal operations, and they occur due to a lack of organisation and communication between surgical staff during the process. Typically, the RSB are surgical sponges and instruments located in the abdomen, retroperitoneum and pelvis. PMID:28293325

  3. [Myxofibrosarcoma in the abdominal cavity].

    PubMed

    Janů, F

    2016-01-01

    A number of benign and malignant tumors may develop in the abdominal cavity. Sarcomas are rather rare tumors of the abdominal cavity. They are often diagnosed at advanced growth stages as their local growth can cause clinical problems to the patients. The author presents a case report of myxofibrosarcoma in the abdominal cavity.Key words: myxofibrosarcoma.

  4. Relationship between Patient Safety and Hospital Surgical Volume

    PubMed Central

    Hernandez-Boussard, Tina; Downey, John R; McDonald, Kathryn; Morton, John M

    2012-01-01

    Objective To examine the relationship between hospital volume and in-hospital adverse events. Data Sources Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008. Study Design In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure. Principal Findings Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05). Conclusion These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events. PMID:22091561

  5. Comparative evaluation of two surgical scrub preparations in cattle.

    PubMed

    Desrochers, A; St-Jean, G; Anderson, D E; Rogers, D P; Chengappa, M M

    1996-01-01

    One hundred seventeen cattle that had undergone surgery were assigned randomly to two preoperative skin preparation protocols. Group 1 (60 animals) skin preparation was with povidoneiodine soap and isopropyl alcohol, whereas group 2 (57 animals) had skin preparation with chlorhexidine gluconate and isopropyl alcohol. Quantitative microbial culture plates were used to estimate the number of colony forming units (CFUs) before skin preparation (prescrub), after skin preparation (postscrub), after surgery (postoperative), and in room air (environment). A significant decrease in CFU occurred postscrub for both skin preparations (P < .05). Chlorhexidine and alcohol preparation resulted in significantly fewer CFUs (LSMean +/- SE = 2.79 CFU +/- 1.74) and a greater percentage reduction in CFUs (98.64% +/- 2.01) postscrub than providone and alcohol (LSMean +/- SE = 10.27 CFUs +/- 1.51, 93.29% +/- 1.85); (P < .005). Group 2 had a significantly higher frequency of negative cultures postscrub (49.1%) compared with group 1 (18.3%) (P < .001). The number of postoperative CFUs were not significantly different between the two treatment groups. Wound infection frequency for clean surgical procedures was not significantly different between the two skin preparation protocols (group 1 = 9.8%, group 2 = 10.7%), however, infection frequency was significantly higher for surgical procedures with a ventral abdominal approach (5 of 14, 35.7%,) compared with a flank approach (1 of 41, 2.4%) or other approaches (orthopedic procedures) (1 of 16, 6.3%) (P < .05). Both skin preparation protocols were effective and safe in decreasing the skin microflora population of cattle before surgery and although preparation with chlorhexidine gluconate and alcohol resulted in less CFUs immediately postscrub, the frequency of surgical wound infection was similar for both protocols.

  6. Surgical technique of double switch procedure: Senning with arterial switch operation for congenitally corrected transposition of the great arteries with ventricular septal defect.

    PubMed

    Ilin, Alexey S; Teplov, Pavel V; Sakovich, Valeriy A; Ohye, Richard G

    2016-01-01

    We present a case of 12-month-old boy with congenitally corrected transposition of great arteries with L-looped ventricles and L-transposition of great arteries and ventricular septal defect. When admitted to the hospital, the patient had the appearance of congestive heart failure due to moderate to severe tricuspid valve regurgitation and right ventricle dysfunction. The pulmonary artery (PA) banding was required first because of low systolic pressure in the morphological left ventricle less than 70% confirmed by catheterization. Three months later, the patient appeared to be a good candidate for anatomical repair and a double switch procedure-Senning with arterial switch-was performed. The early postoperative period was relatively smooth and uneventful. Tricuspid valve insufficiency was resolved immediately after surgery. Mild systolic dysfunction of the left ventricle with mild mitral insufficiency was confirmed by the 2D strain method of echocardiography on the second day of the postoperative period and it improved over the next 21 days. Thirty days later after the procedure, the patient underwent catheterization of his superior vena cava tunnel because of the slightly increased blood flow velocity diagnosed by echocardiography. In 3 months after the surgery, the boy was asymptomatic and was doing well. The patient's functional status was I according to the NYHA classification.

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

    PubMed

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

    2009-03-01

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

  8. Modification of an endovascular stent graft for abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  9. [Optimizing surgical hand disinfection].

    PubMed

    Kampf, G; Kramer, A; Rotter, M; Widmer, A

    2006-08-01

    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  10. Treatment Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation.

    PubMed

    Wang, Y-G; Wu, J-S; Jiang, B; Wang, J-H; Liu, C-P; Peng, C; Tian, B-Z

    2015-06-01

    This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extensive bleeding of surgical wound leading to massive haematocele and infection around the liver, and one case had postoperative lower oesophageal fistula leakage causing massive hydrops and infection under the left diaphragm. After definite diagnosis, 12 cases underwent surgery within three days, with no death. Among the four cases that underwent surgery three days after diagnosis, one case died of multiple-organ failure five days after abdominal cavity exploration, which was performed 21 days after liver transplantation. Severe abdominal infections after liver transplantation were the most common causes of death in perioperative liver transplantation. Comprehensive treatment with efficacious antibiotics, multiple-organ support, controlled surgical removal of the lesion, and adequate drainage establishment was the key to the entire treatment.

  11. A Clinical Evaluation of the Surgical Treatment of Anorectal Malformations (Imperforate Anus)

    PubMed Central

    Smith, E. Ide; Tunell, William P.; Williams, G. Rainey

    1978-01-01

    The surgical correction of anorectal malformations remains a serious problem despite their relatively frequent occurrence. Our surgical experience with 90 patients, seen in the past ten years, includes abdominal-perineal or sacro-abdominal-perineal repair in 28 patients, complete perineal anoplasty in 13 patients, and “cut-back” perineal anoplasty in 38 patients. Secondary surgical procedures for “fecal reservoir syndrome” (seven patients), revision for stricture (11 patients) and excision of redundant mucous membrane (ten patients). The observations made from this clinical study are: 1) The importance of thorough urological and neurological evaluation of “high” abnormalities and the value of the cremasteric and bulbocavernosus reflexes as indicators of sacral innervation. 2) Increasing satisfaction with the “cut-back” anoplasty as a definitive procedure or as a temporary stage in low recto-vaginal or recto-vestibular fistulas. The technique for the “cut-back” is improved by the use of Burow's triangles and the use of nonabsorbable sutures. 3) The advisability of the complete perineal anoplasty with posterior positioning of the anus and construction of a perineal body in patients with low recto-vaginal and recto-vestibular fistulas. 4) A concern over the functional capacity of the distal bowel segment in high abnormalities. This is emphasized by the experience with six secondary resections of the rectosigmoid or left colon for “fecal reservoir syndrome.” 5) Heartening results with secondary operations for stricture and redundant mucous membrane which suggest the desirability of an earlier surgical approach to these complications. ImagesFig. 2. PMID:646498

  12. [The cutaneous groin flap for coverage of a full-thickness abdominal wall defect].

    PubMed

    Doebler, O; Spierer, R

    2010-08-01

    A full-thickness defect of the abdominal wall is rare and may occur as a complication of extended abdominal surgery procedures. We report about a 69-year-old patient who was presented to our department with a full-thickness abdominal wall defect and a fully exposed collagen-mesh for reconstructive wound closure. 13 operations with resections of necrotic parts of the abdominal wall were performed following a complicated intraabdominal infection. After debridement and mesh explantation, closure of the remaining defect of the lower abdominal region was achieved by a cutaneous groin flap.

  13. [Surgical management of chronic pancreatitis].

    PubMed

    Regimbeau, Jean-Marc; Dumont, Frédéric; Yzet, Thierry; Chatelain, Denis; Bartoli, Eacute Ric; Brazier, Franck; Bréhant, Olivier; Dupas, Jean-Louis; Mauvais, François; Delcenserie, Richard

    2007-01-01

    Surgical indications for chronic pancreatitis can be schematically separated into five main groups: pain, effects of fibrosis on adjacent organs, the consequences of main pancreatic duct rupture above an obstruction, and suspected cancer. Finally surgery is also indicated in patients who cannot undergo endoscopic procedures (no accessible papilla) or who have too recently undergone this procedure. Surgical procedures include derivation (pancreatic, cystic, biliary) or mixed procedures combining derivation/resection or pancreatic resection. Finally splanchnicectomy can be discussed. Whatever the indication, surgical treatment must meet several goals: the approach to surgery must be multidisciplinary, surgery must be associated with low morbidity and mortality, preserve as much endocrine function as possible, improve quality of life, and be evaluated in the long term, as well as prospectively if possible. We clarify some important points about the management of patients with chronic pancreatitis before discussing the various treatments in detail.

  14. [Early postoperative intestinal motility following abdominal surgery in an animal experiment].

    PubMed

    Schippers, E; Braun, J; Erhardt, W; Schumpelick, V

    1990-01-01

    Gastrointestinal myoelectrical activity was registered in 6 dogs after different surgical procedures such as laparotomy, segmental resection of the jejunum and right hemicolectomy. Animals were studied in the fasted- and fed state and after pharmacological stimulation with Ceruletide. The electrical activity was recorded by means of 6 bipolar electrodes implanted along the intestinal wall. Abdominal surgery abolished normal motility in the stomach and small intestine only for a short period of time. The time for the reappearance of regularly recurring activity fronts varied with the type of the surgical procedure from 3 h after segmental resection of the jejunum to 49 h after colon resection. Severe disturbances of the BER (basic electrical rhythm) in the stomach as tachygastria and tachyarrhythmia persist even after restoration of the MMC (migrating motor complex) in the small intestine. Feeding induced a typical fedpattern but never before restoration of the MMC. Stimulation of the intestine during postoperative ileus with Ceruletide increases segmental myoelectrical activity. The period of postoperative ileus was not reduced.

  15. Abdominal Problems in Children with Congenital Cardiovascular Abnormalities

    PubMed Central

    Güney, Lütfi Hakan; Araz, Coşkun; Beyazpınar, Deniz Sarp; Arda, İrfan Serdar; Arslan, Esra Elif; Hiçsönmez, Akgün

    2015-01-01

    Background: Congenital cardiovascular abnormality is an important cause of morbidity and mortality in childhood. Both the type of congenital cardiovascular abnormality and cardiopulmonary bypass are responsible for gastrointestinal system problems. Aims: Intra-abdominal problems, such as paralytic ileus, necrotizing enterocolitis, and intestinal perforation, are common in patients who have been operated or who are being followed for congenital cardiovascular abnormalities. Besides the primary congenital cardiovascular abnormalities, ischemia secondary to cardiac catheterization or surgery contributes to the incidence of these problems. Study Design: Cross-sectional study. Methods: In this study, we aimed to screen the intra-abdominal problems seen in patients with congenital cardiovascular abnormalities who had undergone surgical or angiographical intervention(s). Patients with congenital cardiovascular abnormalities who had been treated medically or surgically between 2000 and 2014 were analyzed retrospectively in terms of intra-abdominal problems. The patients’ demographic data, type of congenital cardiovascular abnormalities, the intervention applied (surgical, angiographic), the incidence of intra-abdominal problem(s), the interventions applied for the intra-abdominal problems, and the results were evaluated. Results: Fourteen (Group I) of the 76 patients with congenital cardiovascular abnormalities diagnosis were operated due to intra-abdominal problems, and 62 (Group II) were followed-up clinically for intra-abdominal problems. In Group I (10 boys and 4 girls), 11 patients were aged between 0 and 12 months, and three patients were older than 12 months. Group II included 52 patients aged between 0 and 12 months and 10 patients older than 12 months. Cardiovascular surgical interventions had been applied to six patients in Group I and 40 patients in Group II. The most frequent intra-abdominal problems were necrotizing enterocolitis and intestinal perforation

  16. [Peritoneal lavage and blunt abdominal injuries in childhood].

    PubMed

    Belgerden, S; Demirkol, K; Kayabali, M

    1987-01-01

    Traffic accidents are increasingly responsible for mortality in childhood in Turkey. Between 1982 and 1984, 197 children were admitted for contused abdominal injuries to the surgical casualty ward at the School of Medicine of Istanbul University. Most of these children had been involved in traffic accidents, and peritoneal lavage was applied to all of them. The diagnosis on admission was confirmed by laparotomy in 90 per cent of all cases. 20 children died (10.1 per cent). Uncontrollable abdominal bleeding was the cause of ten deaths and massive brain lesion of another six.

  17. Initial experience with the use of porcine acellular dermal matrix (Strattice) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction.

    PubMed

    Cicilioni, Orlando; Araujo, Gerson; Mimbs, Nancy; Cox, Matthew D

    2012-03-01

    Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, extrusion, and encapsulation are serious concerns with mesh use. Biologic tissue matrices may overcome some of these mesh-related complications. The initial experience of using Strattice for fascial closure after TRAM flap procedure is described in this article. Strattice was in-lain and sutured between the anterior and posterior layers of the rectus fascia, at the rectus muscle donor site. The abdominal wall was closed with progressive tension sutures. Postoperative complications at the donor site were assessed. A total of 16 unilateral and 9 bilateral reconstructions were performed in 25 patients. Length of hospital stay was 2 to 3 days which is shorter than with mesh repair (typically 4-5 days). During a mean follow-up period of 14.0 months, complications occurred in 7 patients (28%): seroma formation (2), minor skin separation (2), superficial skin infection (2), and superficial wound dehiscence (1). Complications were not directly related to Strattice and all, except one (superficial skin infection), were resolved without surgical intervention. In all patients, routine abdominal functions were restored 4 months postoperatively. Strattice is a safe, alternative option to synthetic mesh for fascial repair following TRAM flap breast reconstruction. When used in conjunction with progressive tension suture closure of the abdominal wall, dynamic reconstruction of the abdominal wall with resumption of abdominal function is possible with Strattice.

  18. Automatic abdominal lymph node detection method based on local intensity structure analysis from 3D x-ray CT images

    NASA Astrophysics Data System (ADS)

    Nakamura, Yoshihiko; Nimura, Yukitaka; Kitasaka, Takayuki; Mizuno, Shinji; Furukawa, Kazuhiro; Goto, Hidemi; Fujiwara, Michitaka; Misawa, Kazunari; Ito, Masaaki; Nawano, Shigeru; Mori, Kensaku

    2013-03-01

    This paper presents an automated method of abdominal lymph node detection to aid the preoperative diagnosis of abdominal cancer surgery. In abdominal cancer surgery, surgeons must resect not only tumors and metastases but also lymph nodes that might have a metastasis. This procedure is called lymphadenectomy or lymph node dissection. Insufficient lymphadenectomy carries a high risk for relapse. However, excessive resection decreases a patient's quality of life. Therefore, it is important to identify the location and the structure of lymph nodes to make a suitable surgical plan. The proposed method consists of candidate lymph node detection and false positive reduction. Candidate lymph nodes are detected using a multi-scale blob-like enhancement filter based on local intensity structure analysis. To reduce false positives, the proposed method uses a classifier based on support vector machine with the texture and shape information. The experimental results reveal that it detects 70.5% of the lymph nodes with 13.0 false positives per case.

  19. The Abdominal Circulatory Pump

    PubMed Central

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  20. Functional abdominal pain

    PubMed Central

    Matthews, P; Aziz, Q

    2005-01-01

    Functional abdominal p