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Sample records for accurate preoperative planning

  1. CT-based surgical planning software improves the accuracy of total hip replacement preoperative planning.

    PubMed

    Viceconti, M; Lattanzi, R; Antonietti, B; Paderni, S; Olmi, R; Sudanese, A; Toni, A

    2003-06-01

    The present study is aimed to compare accuracy and the repeatability in planning total hip replacements with the conventional templates on radiographs to that attainable on the same clinical cases when using CT-based planning software. The sizes of the cementless components planned with new computer aided preoperative planning system called Hip-Op and with standard templates were compared to those effectively implanted. The study group intentionally included only difficult clinical cases. The most common aetiology was congenital dysplasia of hip (65.6%). The Hip-Op planning system allowed the surgeons to obtain a preoperative planning more accurate than with templates, especially for the socket. Assuming correct a size planned one calliper above or below that implanted the accuracy increased from 83% for the stem and 69% for the socket when using templates to 86% for the stem and 93% for the socket when using the Hip-Op system. The repeatability of the Hip-Op system was found comparable to that of the template procedure, which is much more familiar to the surgeons. Furthermore, the repeatability of the preoperative planning with the Hip-Op system was consistent between surgeons, independently from their major or minor experience. The study clearly shows the advantages of a three-dimensional computer-based preoperative planning over the traditional template planning, especially when deformed anatomies are involved. The surgical planning performed with the Hip-Op system is accurate and repeatable, especially for the socket and for less experienced surgeons.

  2. Prediction of Preoperative Anxiety in Children: Who is Most Accurate?

    PubMed Central

    MacLaren, Jill E.; Thompson, Caitlin; Weinberg, Megan; Fortier, Michelle A.; Morrison, Debra E.; Perret, Danielle; Kain, Zeev N.

    2009-01-01

    Background In this investigation, we sought to assess the ability of pediatric attending anesthesiologists, resident anesthesiologists and mothers to predict anxiety during induction of anesthesia in 2 to 16-year-old children (n=125). Methods Anesthesiologists and mothers provided predictions using a visual analog scale and children's anxiety was assessed using a valid behavior observation tool the Modified Yale Preoperative Anxiety Scale (mYPAS). All mothers were present during anesthetic induction and no child received sedative premedication. Correlational analyses were conducted. Results A total of 125 children aged 2 to 16 years, their mothers, and their attending pediatric anesthesiologists and resident anesthesiologists were studied. Correlational analyses revealed significant associations between attending predictions and child anxiety at induction (rs= 0.38, p<0.001). Resident anesthesiologist and mother predictions were not significantly related to children's anxiety during induction (rs = 0.01 and 0.001, respectively). In terms of accuracy of prediction, 47.2% of predictions made by attending anesthesiologists were within one standard deviation of the observed anxiety exhibited by the child, and 70.4% of predictions were within 2 standard deviations. Conclusions We conclude that attending anesthesiologists who practice in pediatric settings are better than mothers in predicting the anxiety of children during induction of anesthesia. While this finding has significant clinical implications, it is unclear if it can be extended to attending anesthesiologists whose practice is not mostly pediatric anesthesia. PMID:19448201

  3. Computer-aided preoperative planning in knee osteotomy.

    PubMed Central

    Chao, E. Y.; Sim, F. H.

    1995-01-01

    It has been demonstrated that osteoarthritis (OA) is activity related and may worsen when joint contact stress becomes excessive due to overloading. Hence, joint alignment and loading are considered to be the key biomechanical determinants for OA. The initiation of pathologic changes in the knee has been described by the mechanism termed, "vicious cycle" in which joint axial malalignment creates excessive stresses to the localized joint cartilage/subchondral bone regions and the surrounding soft tissue which in turn produces more laxity and joint deformity and thus repeats the cyclic degradation mechanism. If this degenerative cycle can be broken with joint alignment surgery such as osteotomy, a procedure to realign the knee joint and thus redistribute joint forces applied to each compartment, performed properly and at the appropriate time, the osteoarthritic disease process can be decelerated and even reversed. The main goals of this paper are to emphasize the importance of accurate preoperative planning for osteotomy in order to properly correct joint alignment, and to justify the application of an existing computer program, OASIS (Osteotomy Analysis and Simulation Software) using plain radiographs to perform appropriate surgical planning. Normal subjects and knee osteotomy patients were studied to establish a database for the purpose of establishing the utility and efficacy of the presently proposed concept. We wish to rationalize knee osteotomy as a preferred and cost-effective treatment for patients with early symptoms of OA in the knee. This paper presents a new concept of preoperative planning for knee osteotomy based on the underlying etiology of the disease and biomechanical viewpoint with strong emphasis on surgical treatment rationales. The established principles in this paper can be applied to other joints of the body and will help implement preventive measures and other non-surgical means to manage patients with axial malalignment or early degenerative

  4. Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties.

    PubMed

    The, Bertram; Verdonschot, Nico; van Horn, Jim R; van Ooijen, Peter M A; Diercks, Ron L

    2007-09-01

    The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized radiographs by the surgeon who performed the arthroplasty the next day. The main outcome was accuracy of the preoperative plan. Secondary outcomes were operation time and a radiographic assessment of the arthroplasty. Digital preoperative plans were more accurate in planning the cup (P < .05) and scored higher on the postoperative radiologic assessment of cemented cup (P = .03) and stem (P < .01) components. None of the other comparisons reached statistical significance. We conclude that digital plans slightly outperform analogue plans.

  5. Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?

    PubMed

    Barron, M R; Roch, A M; Waters, J A; Parikh, J A; DeWitt, J M; Al-Haddad, M A; Ceppa, E P; House, M G; Zyromski, N J; Nakeeb, A; Pitt, H A; Schmidt, C Max

    2014-03-01

    Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7%) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4%) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4%) had invasive carcinoma. Alternatively, 2/50 (4%) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25% of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.

  6. Asian Rhinoplasty: Preoperative Simulation and Planning Using Adobe Photoshop.

    PubMed

    Kiranantawat, Kidakorn; Nguyen, Anh H

    2015-11-01

    A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

  7. New law requires 'medically accurate' lesson plans.

    PubMed

    1999-09-17

    The California Legislature has passed a bill requiring all textbooks and materials used to teach about AIDS be medically accurate and objective. Statements made within the curriculum must be supported by research conducted in compliance with scientific methods, and published in peer-reviewed journals. Some of the current lesson plans were found to contain scientifically unsupported and biased information. In addition, the bill requires material to be "free of racial, ethnic, or gender biases." The legislation is supported by a wide range of interests, but opposed by the California Right to Life Education Fund, because they believe it discredits abstinence-only material.

  8. Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know.

    PubMed

    Huppertz, Alexander; Radmer, Sebastian; Wagner, Moritz; Roessler, Torsten; Hamm, Bernd; Sparmann, Martin

    2014-08-01

    The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.

  9. The pelvic support osteotomy: indications and preoperative planning

    PubMed Central

    Pafilas, Dimitrios

    2008-01-01

    The pelvic support osteotomy is a double level femoral osteotomy with the objective of eliminating a Trendelenburg and short limb gait in young patients with severe hip joint destruction as a consequence of neonatal septic arthritis. The osteotomy has seen several changes and a brief historical overview is provided to set the evolution of the modifications of the procedure in context. We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure. Specifically, we set out to answer the following questions: (a) Where should the first osteotomy be performed and what is the magnitude of valgus and extension correction desired at this level? (b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level? PMID:18758686

  10. [Preoperative imaging/operation planning for liver surgery].

    PubMed

    Schoening, W N; Denecke, T; Neumann, U P

    2015-12-01

    The currently established standard for planning liver surgery is multistage contrast media-enhanced multidetector computed tomography (CM-CT), which as a rule enables an appropriate resection planning, e.g. a precise identification and localization of primary and secondary liver tumors as well as the anatomical relation to extrahepatic and/or intrahepatic vascular and biliary structures. Furthermore, CM-CT enables the measurement of tumor volume, total liver volume and residual liver volume after resection. Under the condition of normal liver function a residual liver volume of 25 % is nowadays considered sufficient and safe. Recent studies in patients with liver metastases of colorectal cancer showed a clear staging advantage of contrast media-enhanced magnetic resonance imaging (CM-MRI) versus CM-CT. In addition, most recent data showed that the use of liver-specific MRI contrast media further increases the sensitivity and specificity of detection of liver metastases. This imaging technology seems to lead closer to the ideal "one stop shopping" diagnostic tool in preoperative planning of liver resection.

  11. An evaluative tool for preoperative planning of brain tumor resection

    NASA Astrophysics Data System (ADS)

    Coffey, Aaron M.; Garg, Ishita; Miga, Michael I.; Thompson, Reid C.

    2010-02-01

    A patient specific finite element biphasic brain model has been utilized to codify a surgeon's experience by establishing quantifiable biomechanical measures to score orientations for optimal planning of brain tumor resection. When faced with evaluating several potential approaches to tumor removal during preoperative planning, the goal of this work is to facilitate the surgeon's selection of a patient head orientation such that tumor presentation and resection is assisted via favorable brain shift conditions rather than trying to allay confounding ones. Displacement-based measures consisting of area classification of the brain surface shifting in the craniotomy region and lateral displacement of the tumor center relative to an approach vector defined by the surgeon were calculated over a range of orientations and used to form an objective function. The objective function was used in conjunction with Levenberg-Marquardt optimization to find the ideal patient orientation. For a frontal lobe tumor presentation the model predicts an ideal orientation that indicates the patient should be placed in a lateral decubitus position on the side contralateral to the tumor in order to minimize unfavorable brain shift.

  12. Individual and ethnic aspects of preoperative planning for posttraumatic rhinoplasty.

    PubMed

    Szychta, Paweł; Rykała, Jan; Kruk-Jeromin, Julia

    2011-08-01

    The aim of this study was to compare the aesthetic results of post traumatic rhinoplasty among Europeans with populations of healthy Caucasians described in earlier reports, and to collate correct parameters of nasal shape in healthy representatives of both sexes and various races for improvement in aesthetic results of surgery. 3-D scanning of the face was performed in 54 patients after posttraumatic septorhinoplasty. Analysis of 3D model was based on two indices of the nasal proportions and four angles of the region from 18 anthropological points. Parameters of the nasal shape in addition to gender were compared to average values of healthy Caucasian population, described before. Normal characteristics of the nose among individuals of three races from previous studies were also compared to one another. In females, mean height and width of the nose as well as length of both nostrils was smaller. Neither were there any significant differences in width of the nostrils and length of the nasal pyramid nor nasal prominence. Nasal proportions were similar in both sexes. Some of the nasal angles differed in addition to gender. Posttraumatic rhinoplasty resulted in correct shape of the nose similar to the healthy Caucasian population. The aesthetic nose differ among healthy individuals of the three races analysed. While preoperative planning is important, knowledge of the normal values of parameters characterising shape in both genders is equally important as the individual differences in relation to the whole face.

  13. Preoperative misdiagnosis analysis and accurate distinguish intrathymic cyst from small thymoma on computed tomography

    PubMed Central

    Li, Xin; Han, Xingpeng; Sun, Wei; Wang, Meng; Jing, Guohui

    2016-01-01

    Background To evaluate the role of computed tomography (CT) in preoperative diagnosis of intrathymic cyst and small thymoma, and determine the best CT threshold for distinguish intrathymic cyst from small thymoma. Methods We retrospectively reviewed the medical records of 30 patients (17 intrathymic cyst and 13 small thymoma) who had undergone mediastinal masses resection (with diameter less than 3 cm) under thoracoscope between January 2014 and July 2015 at our hospital. Clinical and CT features were compared and receiver-operating characteristics curve (ROC) analysis was performed. Results The CT value of small thymoma [39.5 HU (IQR, 33.7–42.2 HU)] was significantly higher than intrathymic cyst [25.8 HU (IQR, 22.3–29.3 HU), P=0.004]. When CT value was 31.2 HU, it could act as a threshold for identification of small thymoma and intrathymic cyst (the sensitivity and specificity was 92.3% and 82.4%, respectively). The ΔCT value of enhanced CT value with the non-enhanced CT value was significantly different between small thymoma [18.7 HU (IQR, 10.9–19.0 HU)] and intrathymic cyst [4.3 HU (IQR, 3.0–11.7 HU), P=0.04]. The density was more homogenous in intrathymic cyst than small thymoma, and the contour of the intrathymic cyst was more smoothly than small thymoma. Conclusions Preoperative CT scans could help clinicians to identify intrathymic cyst and small thymoma, and we recommend 31.2 HU as the best thresholds. Contrast-enhanced CT scans is useful for further identification of the two diseases. PMID:27621863

  14. [Definition of accurate planning target volume margins for esophageal cancer radiotherapy].

    PubMed

    Lesueur, P; Servagi-Vernat, S

    2016-10-01

    More than 4000 cases of esophagus neoplasms are diagnosed every year in France. Radiotherapy, which can be delivered in preoperative or exclusive with a concomitant chemotherapy, plays a central role in treatment of esophagus cancer. Even if efficacy of radiotherapy no longer has to be proved, the prognosis of esophagus cancer remains unfortunately poor with a high recurrence rate. Toxicity of esophageal radiotherapy is correlated with the irradiation volume, and limits dose escalation and local control. Esophagus is a deep thoracic organ, which undergoes cardiac and respiratory motion, making the radiotherapy delivery more difficult and increasing the planning target volume margins. Definition of accurate planning target volume margins, taking into account the esophagus' intrafraction motion and set up margins is very important to be sure to cover the clinical target volume and restrains acute and late radiotoxicity. In this article, based on a review of the literature, we propose planning target volume margins adapted to esophageal radiotherapy.

  15. Computer assisted 3D pre-operative planning tool for femur fracture orthopedic surgery

    NASA Astrophysics Data System (ADS)

    Gamage, Pavan; Xie, Sheng Quan; Delmas, Patrice; Xu, Wei Liang

    2010-02-01

    Femur shaft fractures are caused by high impact injuries and can affect gait functionality if not treated correctly. Until recently, the pre-operative planning for femur fractures has relied on two-dimensional (2D) radiographs, light boxes, tracing paper, and transparent bone templates. The recent availability of digital radiographic equipment has to some extent improved the workflow for preoperative planning. Nevertheless, imaging is still in 2D X-rays and planning/simulation tools to support fragment manipulation and implant selection are still not available. Direct three-dimensional (3D) imaging modalities such as Computed Tomography (CT) are also still restricted to a minority of complex orthopedic procedures. This paper proposes a software tool which allows orthopedic surgeons to visualize, diagnose, plan and simulate femur shaft fracture reduction procedures in 3D. The tool utilizes frontal and lateral 2D radiographs to model the fracture surface, separate a generic bone into the two fractured fragments, identify the pose of each fragment, and automatically customize the shape of the bone. The use of 3D imaging allows full spatial inspection of the fracture providing different views through the manipulation of the interactively reconstructed 3D model, and ultimately better pre-operative planning.

  16. Calcaneal osteotomy preoperative planning system with 3D full-sized computer-assisted technology.

    PubMed

    Chou, Yi-Jiun; Sun, Shuh-Ping; Liu, Hsin-Hua

    2011-10-01

    In this study, we developed a CT-based computer-assisted pre-operative planning and simulating system for the calcaneal osteotomy by integrating different software's function. This system uses the full-scaled 3D reverse engineering technique in designing and developing preoperative planning modules for the calcaneal osteotomy surgery. The planning system presents a real-sized three-dimensional image of the calcaneus, and provides detailed interior measurements of the calcaneus from various cutting planes. This study applied computer-assisted technology to integrate different software's function to a surgical planning system. These functions include 3-D image model capturing, cutting, moving, rotating and measurement for relevant foot anatomy, and can be integrated as the user's function. Furthermore, the system is computer-based and computer-assisted technology. Surgeons can utilize it as part of preoperative planning to develop efficient operative procedures. This system also has a database that can be updated and extended and will provide the clinical cases to different users for experienced based learning.

  17. Preoperative implant planning considering alveolar bone grafting needs and complication prediction using panoramic versus CBCT images

    PubMed Central

    Guerrero, Maria Eugenia; Noriega, Jorge

    2014-01-01

    Purpose This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. Materials and Methods One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. Results In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Conclusion Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor. PMID:25279342

  18. Fusion of intraoperative cortical images with preoperative models for neurosurgical planning and guidance

    NASA Astrophysics Data System (ADS)

    Wang, An; Mirsattari, Seyed M.; Parrent, Andrew G.; Peters, Terry M.

    2009-02-01

    During surgery for epilepsy it is important for the surgeon to correlate the preoperative cortical morphology (from preoperative images) with the intraoperative environment. We extend our visualization method presented earlier, to achieves this goal by fusing a direct (photographic) view of the surgical field with the 3D patient model. To correlate the preoperative plan with the intraoperative surgical scene, an intensity-based perspective 3D-2D registration was employed for camera pose estimation. The 2D photographic image was then texture-mapped onto the 3D preoperative model using the solved camera pose. In the proposed method, we employ direct volume rendering to obtain a perspective view of the brain image using GPU-accelerated ray-casting. This is advantageous compared to the point-based or other feature-based registration since no intermediate processing is required. To validate our registration algorithm, we used a point-based 3D-2D registration, that was validated using ground truth from simulated data, and then the intensity-based 3D-2D registration method was validated using the point-based registration result as the gold standard. The registration error of the intensity-based 3D- 2D method was around 3mm when the initial pose is close to the gold standard. Application of the proposed method for correlating fMRI maps with intraoperative cortical stimulation is shown for surgical planning in an epilepsy patient.

  19. Congenital hip disease in adults: terminology, classification, pre-operative planning and management.

    PubMed

    Karachalios, T; Hartofilakidis, G

    2010-07-01

    This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.

  20. Sampling and analysis plan for the preoperational environmental survey for the immobilized low activity waste (ILAW) project W-465

    SciTech Connect

    Mitchell, R.M.

    1998-09-28

    This document provides a detailed description of the Sampling and Analysis Plan for the Preoperational Survey to be conducted at the Immobilized Low Activity Waste (ILAW) Project Site in the 200 East Area.

  1. Use of 3-Dimensional Printing for Preoperative Planning in the Treatment of Recurrent Anterior Shoulder Instability

    PubMed Central

    Sheth, Ujash; Theodoropoulos, John; Abouali, Jihad

    2015-01-01

    Recurrent anterior shoulder instability often results from large bony Bankart or Hill-Sachs lesions. Preoperative imaging is essential in guiding our surgical management of patients with these conditions. However, we are often limited to making an attempt to interpret a 3-dimensional (3D) structure using conventional 2-dimensional imaging. In cases in which complex anatomy or bony defects are encountered, this type of imaging is often inadequate. We used 3D printing to produce a solid 3D model of a glenohumeral joint from a young patient with recurrent anterior shoulder instability and complex Bankart and Hill-Sachs lesions. The 3D model from our patient was used in the preoperative planning stages of an arthroscopic Bankart repair and remplissage to determine the depth of the Hill-Sachs lesion and the degree of abduction and external rotation at which the Hill-Sachs lesion engaged. PMID:26759768

  2. Preoperative diagnosis of a pulmonary artery sarcoma.

    PubMed Central

    Velebit, V.; Christenson, J. T.; Simonet, F.; Maurice, J.; Schmuziger, M.; Hauser, H.; Didier, D.

    1995-01-01

    A pulmonary artery sarcoma was diagnosed preoperatively by magnetic resonance imaging enhanced with gadolinium and confirmed by percutaneous computed tomographic guided needle biopsy. Accurate preoperative diagnosis allowed planned curative surgery with removal of the right ventricular outflow tract and reconstructive surgery using a cryopreserved homograft. Images PMID:8539663

  3. [Preoperative analysis in rhinoplasty].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Levet, Y; Aiach, G

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.

  4. Augmenting intraoperative ultrasound with preoperative magnetic resonance planning models for percutaneous renal access

    PubMed Central

    2012-01-01

    Background Ultrasound (US) is a commonly-used intraoperative imaging modality for guiding percutaneous renal access (PRA). However, the anatomy identification and target localization abilities of the US imaging are limited. This paper evaluates the feasibility and efficiency of a proposed image-guided PRA by augmenting the intraoperative US with preoperative magnetic resonance (MR) planning models. Methods First, a preoperative surgical planning approach is presented to define an optimal needle trajectory using MR volume data. Then, a MR to US registration is proposed to transfer the preoperative planning into the intraoperative context. The proposed registration makes use of orthogonal US slices to avoid local minima while reduce processing time. During the registration, a respiratory gating method is used to minimize the impact of kidney deformation. By augmenting the intraoperative US with preoperative MR models and a virtual needle, a visual guidance is provided to guarantee the correct execution of the surgical planning. The accuracy, robustness and processing time of the proposed registration were evaluated by four urologists on human data from four volunteers. Furthermore, the PRA experiments were performed by the same four urologists on a kidney phantom. The puncture accuracy in terms of the needle-target distance was measured, while the perceptual quality in using the proposed image guidance was evaluated according to custom scoring method. Results The mean registration accuracy in terms of the root mean square (RMS) target registration error (TRE) is 3.53 mm. The RMS distance from the registered feature points to their average is 0.81 mm. The mean operating time of the registration is 6'4". In the phantom evaluation, the mean needle-target distance is 2.08 mm for the left lesion and 1.85 mm for the right one. The mean duration for all phantom PRA tests was 4'26". According to the custom scoring method, the mean scores of the Intervention Improvement

  5. Virtual endoscopy is a useful device for training and preoperative planning of transsphenoidal endoscopic pituitary surgery.

    PubMed

    Wolfsberger, S; Forster, M-T; Donat, M; Neubauer, A; Bühler, K; Wegenkittl, R; Czech, T; Hainfellner, J A; Knosp, E

    2004-08-01

    Virtual endoscopy (vE) allows simulated three-dimensional (3-D) visualisation of anatomical structures by computerised reconstruction of radiological images. The aim of this study was to evaluate the feasibility of vE and its potential benefits for endoscopic transsphenoidal pituitary surgery. vE was realised using a commercially available ray-casting software plugin of a picture archiving and communications system (PACS). For this study, the vE system was enhanced with volume segmentation, transparency and cutting tools. The data for vE were derived from high resolution computed tomography (CT) scans of 22 patients with pituitary pathology (20 pituitary adenomas, 2 Rathke's cleft cysts) preoperatively. Anatomic structures were identified on vE images and compared with the intraoperative endoscopic views. The simulated 3-D vE images were found to be comparable to the intraoperative endoscopic anatomy in terms of distortion and angle of view. vE was found to be particularly useful for the preoperative depiction of 1) the nasal anatomy and its variations for choosing the side of the approach, 2) the sphenoid sinus septae and chambers for improved intraoperative orientation, 3) the transparent 3-D simulated visualisation of the pituitary gland, tumour and adjacent anatomic structures in relation to the sphenoid sinus landmarks for planning the opening of the sellar floor. We conclude that vE harbours the potential to become a valuable tool in endoscopic pituitary surgery for training purposes and preoperative planning. Furthermore, vE may add to the safety of interventions in case of anatomic variations.

  6. Planned preoperative radiation therapy for advanced laryngeal carcinoma. [/sup 60/Co

    SciTech Connect

    Kazem, I.; van den Broek, P.; Huygen, P.L.M.

    1982-09-01

    One hundred ten patients with predominantly advanced laryngeal carcinoma were treated in the period 1969-1978 with planned preoperative radiation therapy followed by surgery. Site distribution was: 63 supraglottic, 26 glottic, 15 transglottic and 6 subglottic. There were 4 Stage II patients, 66 Stage III and 40 Stage IV. Preoperative radiation therapy consisted of Telecobalt irradiation to a total dose of 25 Gy given to a target volume encompassing the larynx and regional neck nodes, given in 5 equal daily fractions of 5 Gy in 5 consecutive days. Surgery was performed 2 days later. Total laryngectomy was performed on 48 patients, total laryngectomy with neck dissection on 55 patients, supraglottic laryngectomy on 5 and supraglottic laryngectomy with neck dissection on 2 patients. Crude actuarial 5 and 10 year survival probability for the whole group is 71 and 61%, respectively. The corrected 5 and 10 year survival is 75%. For patients with T/sub 3/-T/sub 4/-N/sub 0/ tumors 5 and 10 year survival probability is: crude 65 and 58%, and corrected 70% respectively. For T/sub 3/-T/sub 4/-N/sub +/ crude: 75 and 60% and corrected: 78%. Of 110 patients, one died postoperative, three died of intercurrent disease, five died as a result of second malignancy, and 23 died of their larynx carcinoma: 12/23 because of locoregional failure, and 11/23 because of distant metastasis. We concluded that short intensive preoperative radiation therapy and surgery offer a high cure rate in the treatment of advanced resectable laryngeal carcinoma. The merits of this technique are outlined in the text.

  7. Correlation between nipple elevation and breast resection weight: How to preoperatively plan breast reduction.

    PubMed

    Moio, Mariagrazia; Schonauer, Fabrizio

    2015-08-01

    Breast hypertrophy is often associated with functional limitations. Beyond the aesthetic concerns, breast reduction can improve symptoms and self-esteem. In different countries, health-care system regulations have fixed the threshold for reimbursement in 500 g of predicted tissue resection for each breast. Different preoperative measurements have been proposed to predict breast-tissue weight to be removed, showing a variable correlation with post-operative evaluation. We describe a reliable, simple measurement to predict the quantity of breast reduction in grams, which can be applicable to any surgical technique. A total of 128 patients undergoing bilateral breast reduction were evaluated. The correlation between the preoperative nipple-areola complex (NAC) lift distance and the weight of removed breast tissue was tested with linear regression and Pearson's test. Other anthropometric measurements were tested as a control. The ratio between resected grams and lift distance was explored to find a multiplication coefficient to be used at preoperative planning. The mean resection weight was 686.65 g. The mean NAC-lift distance was 7.6 cm. Positive correlation between the NAC-lift distance and the weight of breast tissue removed was found (r: 0.87; p < 0.001). The mean weight of the removed breast tissue (g) per centimetre of NAC lift was 81 g/cm in the group between 6 and 12 cm and 70 g/cm in the group with >12 cm of lift distance. The NAC-lift distance is a single, objective, repeatable measure that can provide a reliable prediction of breast-tissue grams to be removed; it helps in classifying breast-reduction indications.

  8. Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications

    PubMed Central

    Rozen, Warren Matthew; Chowdhry, Muhammad; Band, Bassam; Ramakrishnan, Venkat V.; Griffiths, Matthew

    2016-01-01

    requiring a return to theatre in the immediate postoperative period. Modern scanners and techniques can reduce the level of ionising radiation, facilitating patients being able to benefit from the advantages that this preoperative planning can convey. PMID:27047777

  9. Three-dimensional printing for preoperative planning of total hip arthroplasty revision: case report.

    PubMed

    Zerr, Joseph; Chatzinoff, Yonatan; Chopra, Rajiv; Estrera, Kenneth; Chhabra, Avneesh

    2016-10-01

    Three dimensional (3D) printing can be used to create material models to aid preoperative planning of complex orthopedic procedures as exemplified by this case of total hip arthroplasty failure due to infection with resulting severe acetabular bone stock deficiency. The 3D model allowed for trialing of the acetabular component to determine cup size, position, and screw placement. Most importantly, the model confirmed that there was not a pelvic discontinuity and the revision shell would be sufficient for the reconstruction. Previously, the cost and complexity of utilization of 3D printers were prohibitive. Recent improvements in commercially available 3D printers have made rapid prototype model creation a realistic option, which can facilitate difficult surgery.

  10. F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer

    PubMed Central

    Ha, Tae Kyung; Choi, Yun Young; Song, Soon Young

    2011-01-01

    Purpose To investigate the clinical benefits of F18-fluorodeoxyglucose-positron emission tomography and computed tomography (18F-FDG-PET/CT) over multi-detector row CT (MDCT) in preoperative staging of gastric cancer. Methods FDG-PET/CT and MDCT were performed on 78 patients with gastric cancer pathologically diagnosed by endoscopy. The accuracy of radiologic staging retrospectively was compared to pathologic result after curative resection. Results Primary tumors were detected in 51 (65.4%) patients with 18F-FDG-PET/CT, and 47 (60.3%) patients with MDCT. Regarding detection of lymph node metastasis, the sensitivity of FDG-PET/CT was 51.5% with an accuracy of 71.8%, whereas those of MDCT were 69.7% and 69.2%, respectively. The sensitivity of 18F-FDG-PET/CT for a primary tumor with signet ring cell carcinoma was lower than that of 18F-FDG-PET/CT for a primary tumor with non-signet ring cell carcinoma (35.3% vs. 73.8%, P < 0.01). Conclusion Due to its low sensitivity, 18F-FDG-PET/CT alone shows no definite clinical benefit for prediction of lymph node metastasis in preoperative staging of gastric cancer. PMID:22066108

  11. Careful Planning Key to Accurate Fixed Reports Assets.

    ERIC Educational Resources Information Center

    MaRous, Arnold M.

    1986-01-01

    Only with careful planning can school business managers develop fixed asset information and good recordkeeping. Use of a simple inventory system and discussion with school districts already utilizing this system will assist planning. (CJH)

  12. Pre-operative segmentation of neck CT datasets for the planning of neck dissections

    NASA Astrophysics Data System (ADS)

    Cordes, Jeanette; Dornheim, Jana; Preim, Bernhard; Hertel, Ilka; Strauss, Gero

    2006-03-01

    For the pre-operative segmentation of CT neck datasets, we developed the software assistant NeckVision. The relevant anatomical structures for neck dissection planning can be segmented and the resulting patient-specific 3D-models are visualized afterwards in another software system for intervention planning. As a first step, we examined the appropriateness of elementary segmentation techniques based on gray values and contour information to extract the structures in the neck region from CT data. Region growing, interactive watershed transformation and live-wire are employed for segmentation of different target structures. It is also examined, which of the segmentation tasks can be automated. Based on this analysis, the software assistant NeckVision was developed to optimally support the workflow of image analysis for clinicians. The usability of NeckVision was tested within a first evaluation with four otorhinolaryngologists from the university hospital of Leipzig, four computer scientists from the university of Magdeburg and two laymen in both fields.

  13. Sampling and analysis plan for the preoperational environmental survey of the spent nuclear fuel project facilities

    SciTech Connect

    MITCHELL, R.M.

    1999-04-01

    This sampling and analysis plan will support the preoperational environmental monitoring for construction, development, and operation of the Spent Nuclear Fuel (SNF) Project facilities, which have been designed for the conditioning and storage of spent nuclear fuels; particularly the fuel elements associated with the operation of N-Reactor. The SNF consists principally of irradiated metallic uranium, and therefore includes plutonium and mixed fission products. The primary effort will consist of removing the SNF from the storage basins in K East and K West Areas, placing in multicanister overpacks, vacuum drying, conditioning, and subsequent dry vault storage in the 200 East Area. The primary purpose and need for this action is to reduce the risks to public health and safety and to the environment. Specifically these include prevention of the release of radioactive materials into the air or to the soil surrounding the K Basins, prevention of the potential migration of radionuclides through the soil column to the nearby Columbia River, reduction of occupational radiation exposure, and elimination of the risks to the public and to workers from the deterioration of SNF in the K Basins.

  14. Printed Three-dimensional Anatomic Templates for Virtual Preoperative Planning Before Reconstruction of Old Pelvic Injuries: Initial Results

    PubMed Central

    Wu, Xin-Bao; Wang, Jun-Qiang; Zhao, Chun-Peng; Sun, Xu; Shi, Yin; Zhang, Zi-An; Li, Yu-Neng; Wang, Man-Yi

    2015-01-01

    Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures. Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8–17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure. Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6–9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3–29 months (median: 5 months). The fracture healing time was 9–17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The

  15. Complete, accurate, mammalian phylogenies aid conservation planning, but not much.

    PubMed

    Rodrigues, Ana S L; Grenyer, Richard; Baillie, Jonathan E M; Bininda-Emonds, Olaf R P; Gittlemann, John L; Hoffmann, Michael; Safi, Kamran; Schipper, Jan; Stuart, Simon N; Brooks, Thomas

    2011-09-27

    In the face of unprecedented global biodiversity loss, conservation planning must balance between refining and deepening knowledge versus acting on current information to preserve species and communities. Phylogenetic diversity (PD), a biodiversity measure that takes into account the evolutionary relationships between species, is arguably a more meaningful measure of biodiversity than species diversity, but cannot yet be applied to conservation planning for the majority of taxa for which phylogenetic trees have not yet been developed. Here, we investigate how the quality of data on the taxonomy and/or phylogeny of species affects the results of spatial conservation planning in terms of the representation of overall mammalian PD. The results show that the better the quality of the biodiversity data the better they can serve as a basis for conservation planning. However, decisions based on incomplete data are remarkably robust across different levels of degrading quality concerning the description of new species and the availability of phylogenetic information. Thus, given the level of urgency and the need for action, conservation planning can safely make use of the best available systematic data, limited as these data may be.

  16. Digital correction of magnification in pelvic x rays for preoperative planning of hip joint replacements: Theoretical development and clinical results of a new protocol

    SciTech Connect

    The, B.; Diercks, R.L.; Stewart, R.E.; Ooijen, P.M.A. van; Horn, J.R. van

    2005-08-15

    The introduction of digital radiological facilities leads to the necessity of digital preoperative planning, which is an essential part of joint replacement surgery. To avoid errors in the preparation and execution of hip surgery, reliable correction of the magnification of the projected hip is a prerequisite. So far, no validated method exists to accomplish this. We present validated geometrical models of the x-ray projection of spheres, relevant for the calibration procedure to correct for the radiographic magnification. With help of these models a new calibration protocol was developed. The validity and precision of this procedure was determined in clinical practice. Magnification factors could be predicted with a maximal margin of error of 1.5%. The new calibration protocol is valid and reliable. The clinical tests revealed that correction of magnification has a 95% margin of error of -3% to +3%. Future research might clarify if a strict calibration protocol, as presented in this study, results in more accurate preoperative planning of hip joint replacements.

  17. [Preoperative planning and surgical technic in achieving stability and leg length equality in total hip joint arthroplasty].

    PubMed

    Cech, O; Fassbender, M; Kirschner, P; Rozkydal, Z

    2002-01-01

    One of the prerequisites for a good outcome of total hip arthroplasty is preoperative planning. Using a roentgenogram, the size of an implant, incision level on the femoral neck, depth required for fitting the cup, restoration of the center of hip rotation and, if necessary, correction of length descrepancy between the legs are determined. The preoperative planning based on an X-ray image was introduced by M. E. Müller and, in 1976, was modified by R. Schneider who used a transparent sheet for a template on which all relevant points guiding the surgical procedure are marked, i.e., the right position for implantation of the cup and stem, and incision lines. In uncomplicated cases, however, this approach is not necessary and the "planning principle of parallel lines" developed by L. Spotorno in 1988 can be used instead. The determination of length discrepancy between the legs is derived from a drawing of three reference lines on the roentgenogram. The lines parallel to each other indicace the same length for both legs. If the legs differ in length, the lines will diverge from each other in a way typical for this condition.

  18. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning

    SciTech Connect

    Tho, Lye Mun . E-mail: l.tho@beatson.gla.ac.uk; Glegg, Martin; Paterson, Jennifer; Yap, Christina; MacLeod, Alice; McCabe, Marie; McDonald, Alexander C.

    2006-10-01

    Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V{sub 5}, V{sub 1}, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p < 0.03), with strongest correlation at lowest doses. Median VSB differed significantly between patients experiencing Grade 0-1 and Grade 2-4 diarrhea (p {<=} 0.05). No correlation was found with anorexia, nausea, vomiting, abdominal cramps, age, body mass index, sex, tumor position, or number of fields. Analysis of 8 patients showed that inverse planning reduced median dose to small bowel by 5.1 Gy (p = 0.008) and calculated late normal tissue complication probability (NTCP) by 67% (p = 0.016). We constructed a model using mathematical analysis to predict for acute diarrhea occurring at V{sub 5} and V{sub 15}. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further

  19. An Approach for Preoperative Planning and Performance of MR-guided Interventions Demonstrated With a Manual Manipulator in a 1.5T MRI Scanner

    SciTech Connect

    Seimenis, Ioannis; Tsekos, Nikolaos V.; Keroglou, Christoforos; Eracleous, Eleni; Pitris, Constantinos; Christoforou, Eftychios G.

    2012-04-15

    Purpose: The aim of this work was to develop and test a general methodology for the planning and performance of robot-assisted, MR-guided interventions. This methodology also includes the employment of software tools with appropriately tailored routines to effectively exploit the capabilities of MRI and address the relevant spatial limitations. Methods: The described methodology consists of: (1) patient-customized feasibility study that focuses on the geometric limitations imposed by the gantry, the robotic hardware, and interventional tools, as well as the patient; (2) stereotactic preoperative planning for initial positioning of the manipulator and alignment of its end-effector with a selected target; and (3) real-time, intraoperative tool tracking and monitoring of the actual intervention execution. Testing was performed inside a standard 1.5T MRI scanner in which the MR-compatible manipulator is deployed to provide the required access. Results: A volunteer imaging study demonstrates the application of the feasibility stage. A phantom study on needle targeting is also presented, demonstrating the applicability and effectiveness of the proposed preoperative and intraoperative stages of the methodology. For this purpose, a manually actuated, MR-compatible robotic manipulation system was used to accurately acquire a prescribed target through alternative approaching paths. Conclusions: The methodology presented and experimentally examined allows the effective performance of MR-guided interventions. It is suitable for, but not restricted to, needle-targeting applications assisted by a robotic manipulation system, which can be deployed inside a cylindrical scanner to provide the required access to the patient facilitating real-time guidance and monitoring.

  20. Planned preoperative cisplatin and radiation therapy for locally advanced bladder cancer.

    PubMed

    Herr, H W; Yagoda, A; Batata, M; Sogani, P C; Whitmore, W F

    1983-12-15

    Cisplatin (DDP) is an active agent in the treatment of disseminated bladder cancer. In addition to its direct tumor cytotoxicity, recent animal and clinical data suggest synergism with radiation therapy (RT). Since improved survival with preoperative RT is largely restricted to bladder cancer patients in whom radiation-induced downstaging (P less than T) may be recognized, the authors administered DDP + RT preoperatively to patients with locally advanced (T3, T4) bladder tumors selected for cystectomy. The aim was to evaluate the feasibility of such a combination in relation to surgical and hematologic complications, the immediate effect on tumor downstaging, disease progression, and survival. Two thousand rad (400 rad X 5 days) was delivered to the whole pelvis, followed by cystectomy in 2 days. DDP (70 mg/m2) was given intravenously on day 2 of the RT. Twenty-four patients received preoperative DDP + RT and underwent attempted cystectomy; however, six patients were nonresectable owing to extensive pelvic disease, and an additional five patients had resectable pelvic lymph node metastases. Pelvic complications developed in 3 of 24 (12%) patients, but none required reoperation. No patient had a wound dehiscence. Transient myelosuppression was similar to that induced by 2000 rad preoperative RT alone. Tumor downstaging (P less than T) was seen in 9 of 24 (38%) patients, and in 5 (21%) patients, no tumor was found in the surgical specimen (P0). Distant metastases alone have been detected in 4 of 18 (22%) patients who had a cystectomy (all 4 had nodal metastases). Disease-free survival at a median follow-up of 22 months (range, 12-34 months) is 60% (14/24) for all patients (89% for P less than T and 40% for P greater than or equal to T patients) and 78% (14/18) for the resected patients. Combined preoperative DDP + RT proved to be a safe and feasible regimen which resulted in a possibly greater recognition of radioresponsive bladder tumors, and after cystectomy, an

  1. Atlas and feature based 3D pathway visualization enhancement for skull base pre-operative fast planning from head CT

    NASA Astrophysics Data System (ADS)

    Aghdasi, Nava; Li, Yangming; Berens, Angelique; Moe, Kris S.; Bly, Randall A.; Hannaford, Blake

    2015-03-01

    Minimally invasive neuroendoscopic surgery provides an alternative to open craniotomy for many skull base lesions. These techniques provides a great benefit to the patient through shorter ICU stays, decreased post-operative pain and quicker return to baseline function. However, density of critical neurovascular structures at the skull base makes planning for these procedures highly complex. Furthermore, additional surgical portals are often used to improve visualization and instrument access, which adds to the complexity of pre-operative planning. Surgical approach planning is currently limited and typically involves review of 2D axial, coronal, and sagittal CT and MRI images. In addition, skull base surgeons manually change the visualization effect to review all possible approaches to the target lesion and achieve an optimal surgical plan. This cumbersome process relies heavily on surgeon experience and it does not allow for 3D visualization. In this paper, we describe a rapid pre-operative planning system for skull base surgery using the following two novel concepts: importance-based highlight and mobile portal. With this innovation, critical areas in the 3D CT model are highlighted based on segmentation results. Mobile portals allow surgeons to review multiple potential entry portals in real-time with improved visualization of critical structures located inside the pathway. To achieve this we used the following methods: (1) novel bone-only atlases were manually generated, (2) orbits and the center of the skull serve as features to quickly pre-align the patient's scan with the atlas, (3) deformable registration technique was used for fine alignment, (4) surgical importance was assigned to each voxel according to a surgical dictionary, and (5) pre-defined transfer function was applied to the processed data to highlight important structures. The proposed idea was fully implemented as independent planning software and additional

  2. Modification of planned postoperative occlusion in orthognathic surgery, based on computer-aided design/computer-aided manufacturing-engineered preoperative surgical simulation.

    PubMed

    Kang, Sang-Hoon; Kim, Moon-Key; You, Tae-Kwon; Lee, Ji-Yeon

    2015-01-01

    In orthognathic surgery, it is important to have a planned postoperative occlusion. A 3-dimensional preoperative simulation, based on 3-dimensional optically scanned occlusion data, can predict how the planned postoperative occlusion will affect the maxilla-mandibular relationship that results from orthognathic surgery. In this study we modified the planned postoperative occlusion, based on computer-aided design/computer-aided manufacturing-engineered preoperative surgical simulations. This modification made it possible to resolve the facial asymmetry of the patient successfully with a simple bilateral intraoral vertical ramus osteotomy and no additional maxillary or mandibular surgery.

  3. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note.

    PubMed

    Yoshino, Masanori; Nakatomi, Hirofumi; Kin, Taichi; Saito, Toki; Shono, Naoyuki; Nomura, Seiji; Nakagawa, Daichi; Takayanagi, Shunsaku; Imai, Hideaki; Oyama, Hiroshi; Saito, Nobuhito

    2016-08-26

    Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3-5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.

  4. Preoperative intraoral evaluation of planned fixed partial denture pontics using silicone putty.

    PubMed

    Mysore, Ashwin Raghunandan; Aras, Meena Ajay

    2013-06-01

    A preoperative visualization and evaluation of fixed partial denture (FPD) pontics in the anterior dentition is necessary for both the patient and the dentist. Such an evaluation allows patients to decide whether the esthetic and functional parameters of the restoration meet their requirements and expectations. To facilitate such an assessment, a method that allows stable intraoral positioning of the pontics is required. This article describes a technique to achieve this in a simple and effective way before the abutments are prepared. In addition, it also allows the operator to modify the pontics intraorally for esthetics and later incorporate the same pontics into the interim prosthesis. The integration of this pretreatment pontic evaluation procedure into FPD restorations assures better results and patient satisfaction.

  5. Comparison of 3D reconstruction of mandible for pre-operative planning using commercial and open-source software

    NASA Astrophysics Data System (ADS)

    Abdullah, Johari Yap; Omar, Marzuki; Pritam, Helmi Mohd Hadi; Husein, Adam; Rajion, Zainul Ahmad

    2016-12-01

    3D printing of mandible is important for pre-operative planning, diagnostic purposes, as well as for education and training. Currently, the processing of CT data is routinely performed with commercial software which increases the cost of operation and patient management for a small clinical setting. Usage of open-source software as an alternative to commercial software for 3D reconstruction of the mandible from CT data is scarce. The aim of this study is to compare two methods of 3D reconstruction of the mandible using commercial Materialise Mimics software and open-source Medical Imaging Interaction Toolkit (MITK) software. Head CT images with a slice thickness of 1 mm and a matrix of 512x512 pixels each were retrieved from the server located at the Radiology Department of Hospital Universiti Sains Malaysia. The CT data were analysed and the 3D models of mandible were reconstructed using both commercial Materialise Mimics and open-source MITK software. Both virtual 3D models were saved in STL format and exported to 3matic and MeshLab software for morphometric and image analyses. Both models were compared using Wilcoxon Signed Rank Test and Hausdorff Distance. No significant differences were obtained between the 3D models of the mandible produced using Mimics and MITK software. The 3D model of the mandible produced using MITK open-source software is comparable to the commercial MIMICS software. Therefore, open-source software could be used in clinical setting for pre-operative planning to minimise the operational cost.

  6. Does cone-beam CT alter treatment plans? Comparison of preoperative implant planning using panoramic versus cone-beam CT images

    PubMed Central

    Guerrero, Maria Eugenia; Noriega, Jorge; Castro, Carmen

    2014-01-01

    Purpose The present study was performed to compare the planning of implant placement based on panoramic radiography (PAN) and cone-beam computed tomography (CBCT) images, and to study the impact of the image dataset on the treatment planning. Materials and Methods One hundred five partially edentulous patients (77 males, 28 females, mean age: 46 years, range: 26-67 years) seeking oral implant rehabilitation were referred for presurgical imaging. Imaging consisted of PAN and CBCT imaging. Four observers planned implant treatment based on the two-dimensional (2D) image datasets and at least one month later on the three-dimensional (3D) image dataset. Apart from presurgical diagnostic and dimensional measurement tasks, the observers needed to indicate the surgical confidence levels and assess the image quality in relation to the presurgical needs. Results All observers confirmed that both imaging modalities (PAN and CBCT) gave similar values when planning implant diameter. Also, the results showed no differences between both imaging modalities for the length of implants with an anterior location. However, significant differences were found in the length of implants with a posterior location. For implant dimensions, longer lengths of the implants were planned with PAN, as confirmed by two observers. CBCT provided images with improved scores for subjective image quality and surgical confidence levels. Conclusion Within the limitations of this study, there was a trend toward PAN-based preoperative planning of implant placement leading towards the use of longer implants within the posterior jaw bone. PMID:24944961

  7. Computer assisted preoperative planning of bone fracture reduction: Simulation techniques and new trends.

    PubMed

    Jiménez-Delgado, Juan J; Paulano-Godino, Félix; PulidoRam-Ramírez, Rubén; Jiménez-Pérez, J Roberto

    2016-05-01

    The development of support systems for surgery significantly increases the likelihood of obtaining satisfactory results. In the case of fracture reduction interventions these systems enable surgery planning, training, monitoring and assessment. They allow improvement of fracture stabilization, a minimizing of health risks and a reduction of surgery time. Planning a bone fracture reduction by means of a computer assisted simulation involves several semiautomatic or automatic steps. The simulation deals with the correct position of osseous fragments and fixation devices for a fracture reduction. Currently, to the best of our knowledge there is no computer assisted methods to plan an entire fracture reduction process. This paper presents an overall scheme of the computer based process for planning a bone fracture reduction, as described above, and details its main steps, the most common proposed techniques and their main shortcomings. In addition, challenges and new trends of this research field are depicted and analyzed.

  8. 3D-printed haptic "reverse" models for preoperative planning in soft tissue reconstruction: a case report.

    PubMed

    Chae, Michael P; Lin, Frank; Spychal, Robert T; Hunter-Smith, David J; Rozen, Warren Matthew

    2015-02-01

    In reconstructive surgery, preoperative planning is essential for optimal functional and aesthetic outcome. Creating a three-dimensional (3D) model from two-dimensional (2D) imaging data by rapid prototyping has been used in industrial design for decades but has only recently been introduced for medical application. 3D printing is one such technique that is fast, convenient, and relatively affordable. In this report, we present a case in which a reproducible method for producing a 3D-printed "reverse model" representing a skin wound defect was used for flap design and harvesting. This comprised a 82-year-old man with an exposed ankle prosthesis after serial soft tissue debridements for wound infection. Soft tissue coverage and dead-space filling were planned with a composite radial forearm free flap (RFFF). Computed tomographic angiography (CTA) of the donor site (left forearm), recipient site (right ankle), and the left ankle was performed. 2D data from the CTA was 3D-reconstructed using computer software, with a 3D image of the left ankle used as a "control." A 3D model was created by superimposing the left and right ankle images, to create a "reverse image" of the defect, and printed using a 3D printer. The RFFF was thus planned and executed effectively, without complication. To our knowledge, this is the first report of a mechanism of calculating a soft tissue wound defect and producing a 3D model that may be useful for surgical planning. 3D printing and particularly "reverse" modeling may be versatile options in reconstructive planning, and have the potential for broad application.

  9. PRE-OPERATIVE PLANNING AND SURGICAL TECHNIQUE OF THE OPEN WEDGE SUPRACONDYLAR OSTEOTOMY FOR CORRECTION OF VALGUS KNEE AND FIXATION WITH A FIXED-ANGLE IMPLANT

    PubMed Central

    Paccola, Cleber Antonio Jansen

    2015-01-01

    The step-by-step preoperative planning for supracondylar opening wedge osteotomy of the femur for precise correction of the load axis of the lower limb using a fixed-angle implant (95° AO blade plate) is presented. The surgical technique and the use of a bone graft from the same site for filling in the defect are also presented. PMID:27026976

  10. The NASA MERIT program - Developing new concepts for accurate flight planning

    NASA Technical Reports Server (NTRS)

    Steinberg, R.

    1982-01-01

    It is noted that the rising cost of aviation fuel has necessitated the development of a new approach to upper air forecasting for flight planning. It is shown that the spatial resolution of the present weather forecast models used in fully automated computer flight planning is an important accuracy-limiting factor, and it is proposed that man be put back into the system, although not in the way he has been used in the past. A new approach is proposed which uses the application of man-computer interactive display techniques to upper air forecasting to retain the fine scale features of the atmosphere inherent in the present data base in order to provide a more accurate and cost effective flight plan. It is pointed out that, as a result of NASA research, the hardware required for this approach already exists.

  11. Holding versus seeing pathology. Three-dimensional printing of the bony pelvis for preoperative planning of a complex pelvis fracture: A case report

    PubMed Central

    Sanghavi, Parang S; Jankharia, Bhavin G

    2016-01-01

    Pelvic injuries are not uncommon. The complex anatomy of the pelvic bones, the complex pattern of injuries, associated important structures such as neurovascular bundles, and difficult access make the reduction and fixation of these fractures difficult. Often the surgical outcomes are not satisfactory. Three-dimensional (3D) imaging using computed tomography (CT) scan (3DCT) has been the mainstay of preoperative evaluation since the 1980s, however, even with these images it may be difficult to understand complex injury patterns. Preoperative printing of a 3D model using the same CT scan data allows surgeons to hold the pelvis in their hands and then plan appropriate treatment. We report one such case of complex pelvic injury and its management using the novel method of preoperative 3D model printing. PMID:27857469

  12. Prognosis of locally advanced rectal cancer can be predicted more accurately using pre- and post-chemoradiotherapy neutrophil-lymphocyte ratios in patients who received preoperative chemoradiotherapy

    PubMed Central

    Sung, SooYoon; Park, Eun Young; Kay, Chul Seung

    2017-01-01

    Purpose The neutrophil-lymphocyte ratio (NLR) has been suggested as an inflammation-related factor, but also as an indicator of systemic anti-tumor immunity. We aimed to evaluate the prognostic value of the NLR and to propose a proper cut-off value in patients with locally advanced rectal cancer who received preoperative chemoradiation (CRT) followed by curative total mesorectal excision (TME). Methods A total of 110 rectal cancer patients with clinical T3-4 or node-positive disease were retrospectively analyzed. The NLR value before preoperative CRT (pre-CRT NLR) and the NLR value between preoperative CRT and surgery (post-CRT NLR) were obtained. Using a maximally selected log-rank test, cut-off values were determined as 1.75 for the pre-CRT NLR and 5.14 for the post-CRT NLR. Results Patients were grouped as follows: group A, pre-CRT NLR ≤ 1.75 and post-CRT NLR ≤ 5.14 (n = 29); group B, pre-CRT NLR > 1.75 and post-CRT NLR ≤ 5.14, or pre-CRT NLR ≤ 1.75 and post-CRT NLR > 5.14 (n = 61); group C, pre-CRT NLR > 1.75 and post-CRT NLR > 5.14 (n = 20). The median follow-up time was 31.1 months. The 3-year disease-free survival (DFS) and overall survival (OS) rates showed significant differences between the NLR groups (3-year DFS rate: 92.7% vs. 73.0% vs. 47.3%, for group A, B, and C, respectively, p = 0.018; 3-year OS rate: 96.0% vs. 85.5% vs. 59.8%, p = 0.034). Multivariate analysis revealed that the NLR was an independent prognostic factor for DFS (p = 0.028). Conclusion Both the pre-CRT NLR and the post-CRT NLR have a predictive value for the prognosis of patients with locally advanced rectal cancer treated with preoperative CRT followed by curative TME and adjuvant chemotherapy. A persistently elevated post-CRT NLR may be an indicator of an increased risk of distant metastasis. PMID:28291841

  13. The Role of Imaging in Patient Selection, Preoperative Planning, and Postoperative Monitoring in Human Upper Extremity Allotransplantation

    PubMed Central

    Roth, Eira S.; Buck, David G.; Gorantla, Vijay S.; Losee, Joseph E.; Foust, Daniel E.; Britton, Cynthia A.

    2014-01-01

    Objective. To describe the role of imaging in vascular composite allotransplantation based on one institution's experience with upper extremity allotransplant patients. Methods. The institutional review board approved this review of HIPAA-compliant patient data without the need for individual consent. A retrospective review was performed of imaging from 2008 to 2011 on individuals undergoing upper extremity transplantation. This demonstrated that, of the 19 patients initially considered, 5 patients with a mean age of 37 underwent transplantation. Reports were correlated clinically to delineate which preoperative factors lead to patient selection versus disqualification and what concerns dictated postoperative imaging. Findings were subdivided into musculoskeletal and vascular imaging criterion. Results. Within the screening phase, musculoskeletal exclusion criterion included severe shoulder arthropathy, poor native bone integrity, and marked muscular atrophy. Vascular exclusion criterion included loss of sufficient arterial or venous supply and significant distortion of the native vascular architecture. Postoperative imaging was used to document healing and hardware integrity. Postsurgical angiography and ultrasound were used to monitor for endothelial proliferation or thrombosis as signs of rejection and vascular complication. Conclusion. Multimodality imaging is an integral component of vascular composite allotransplantation surgical planning and surveillance to maximize returning form and functionality while minimizing possible complications. PMID:24800056

  14. Fast and accurate sensitivity analysis of IMPT treatment plans using Polynomial Chaos Expansion

    NASA Astrophysics Data System (ADS)

    Perkó, Zoltán; van der Voort, Sebastian R.; van de Water, Steven; Hartman, Charlotte M. H.; Hoogeman, Mischa; Lathouwers, Danny

    2016-06-01

    The highly conformal planned dose distribution achievable in intensity modulated proton therapy (IMPT) can severely be compromised by uncertainties in patient setup and proton range. While several robust optimization approaches have been presented to address this issue, appropriate methods to accurately estimate the robustness of treatment plans are still lacking. To fill this gap we present Polynomial Chaos Expansion (PCE) techniques which are easily applicable and create a meta-model of the dose engine by approximating the dose in every voxel with multidimensional polynomials. This Polynomial Chaos (PC) model can be built in an automated fashion relatively cheaply and subsequently it can be used to perform comprehensive robustness analysis. We adapted PC to provide among others the expected dose, the dose variance, accurate probability distribution of dose-volume histogram (DVH) metrics (e.g. minimum tumor or maximum organ dose), exact bandwidths of DVHs, and to separate the effects of random and systematic errors. We present the outcome of our verification experiments based on 6 head-and-neck (HN) patients, and exemplify the usefulness of PCE by comparing a robust and a non-robust treatment plan for a selected HN case. The results suggest that PCE is highly valuable for both research and clinical applications.

  15. Fast and accurate sensitivity analysis of IMPT treatment plans using Polynomial Chaos Expansion.

    PubMed

    Perkó, Zoltán; van der Voort, Sebastian R; van de Water, Steven; Hartman, Charlotte M H; Hoogeman, Mischa; Lathouwers, Danny

    2016-06-21

    The highly conformal planned dose distribution achievable in intensity modulated proton therapy (IMPT) can severely be compromised by uncertainties in patient setup and proton range. While several robust optimization approaches have been presented to address this issue, appropriate methods to accurately estimate the robustness of treatment plans are still lacking. To fill this gap we present Polynomial Chaos Expansion (PCE) techniques which are easily applicable and create a meta-model of the dose engine by approximating the dose in every voxel with multidimensional polynomials. This Polynomial Chaos (PC) model can be built in an automated fashion relatively cheaply and subsequently it can be used to perform comprehensive robustness analysis. We adapted PC to provide among others the expected dose, the dose variance, accurate probability distribution of dose-volume histogram (DVH) metrics (e.g. minimum tumor or maximum organ dose), exact bandwidths of DVHs, and to separate the effects of random and systematic errors. We present the outcome of our verification experiments based on 6 head-and-neck (HN) patients, and exemplify the usefulness of PCE by comparing a robust and a non-robust treatment plan for a selected HN case. The results suggest that PCE is highly valuable for both research and clinical applications.

  16. An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

    PubMed

    Pirlich, Markus; Tittmann, Mary; Franz, Daniela; Dietz, Andreas; Hofer, Mathias

    2017-02-01

    "CI-Wizard" is a new, three-dimensional software planning tool for cochlear implant surgery with manual and semi-automatic algorithms to visualize anatomical risk structures of the lateral skull base preoperatively. Primary endpoints of the study represented the evaluation of the CI-Wizards usability, accuracy, subjectively perceived and objectively measured time in clinical practice. In a period from January 2014 to March 2015, n = 36 participants were included in this study. These members were divided into three groups of equal number (n = 12), but different level of experience. Senior doctors and consultants (group 1), residents (group 2) and medical students (group 3) segmented 12 different CT-scan data sets of the CI-Wizard (four per participant). In total, n = 144 data sets were collected. The usability of the CI-Wizard was measured by the given questionnaire with an interval rating scale. The Jaccard coefficient (JT) was used to evaluate the accuracy of the anatomical structures segmented. The subjectively perceived time was measured with an interval rating scale in the questionnaire and was compared with the objectively mean measured time (time interact). Across all three groups, the usability of the CI-Wizard has been assessed between 1 ("very good") and 2 ("with small defects"). Subjectively, the time was stated as "appropriate" by questionnaire. Objective measurements of the required duration revealed averages of t = 9.8 min for creating a target view. Concerning the accuracy, semi-automatic anatomical structures such as the external acoustic canal (JT = 0.90), the tympanic cavity (JT = 0.87), the ossicles (JT = 0.63), the cochlea (JT = 0.66), and the semicircular canals (JT = 0.61) reached high Jaccard values, which describes a great match of the segmented structures between the partcipants and the gold standard. Facial nerve (JT = 0.39) and round window (JT = 0.37) reached lower Jaccard values. Very little overlap tendency was

  17. Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

    PubMed Central

    Schulz-Drost, Stefan; Oppel, Pascal; Grupp, Sina; Schmitt, Sonja; Carbon, Roman Th.; Mauerer, Andreas; Hennig, Friedrich F.; Buder, Thomas

    2015-01-01

    Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture’s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology. PMID

  18. Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling.

    PubMed

    Schulz-Drost, Stefan; Oppel, Pascal; Grupp, Sina; Schmitt, Sonja; Carbon, Roman Th; Mauerer, Andreas; Hennig, Friedrich F; Buder, Thomas

    2015-01-05

    Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture's morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology.

  19. Can radiation therapy treatment planning system accurately predict surface doses in postmastectomy radiation therapy patients?

    SciTech Connect

    Wong, Sharon; Back, Michael; Tan, Poh Wee; Lee, Khai Mun; Baggarley, Shaun; Lu, Jaide Jay

    2012-07-01

    Skin doses have been an important factor in the dose prescription for breast radiotherapy. Recent advances in radiotherapy treatment techniques, such as intensity-modulated radiation therapy (IMRT) and new treatment schemes such as hypofractionated breast therapy have made the precise determination of the surface dose necessary. Detailed information of the dose at various depths of the skin is also critical in designing new treatment strategies. The purpose of this work was to assess the accuracy of surface dose calculation by a clinically used treatment planning system and those measured by thermoluminescence dosimeters (TLDs) in a customized chest wall phantom. This study involved the construction of a chest wall phantom for skin dose assessment. Seven TLDs were distributed throughout each right chest wall phantom to give adequate representation of measured radiation doses. Point doses from the CMS Xio Registered-Sign treatment planning system (TPS) were calculated for each relevant TLD positions and results correlated. There were no significant difference between measured absorbed dose by TLD and calculated doses by the TPS (p > 0.05 (1-tailed). Dose accuracy of up to 2.21% was found. The deviations from the calculated absorbed doses were overall larger (3.4%) when wedges and bolus were used. 3D radiotherapy TPS is a useful and accurate tool to assess the accuracy of surface dose. Our studies have shown that radiation treatment accuracy expressed as a comparison between calculated doses (by TPS) and measured doses (by TLD dosimetry) can be accurately predicted for tangential treatment of the chest wall after mastectomy.

  20. Three-dimensional multidetector computed tomography may aid preoperative planning of the transmanubrial osteomuscular-sparing approach to completely resect superior sulcus tumor.

    PubMed

    Saji, Hisashi; Kato, Yasufumi; Shimada, Yoshihisa; Kudo, Yujin; Hagiwara, Masaru; Matsubayashi, Jun; Nagao, Toshitaka; Ikeda, Norihiko

    2015-11-01

    The anterior transcervical-thoracic approach clearly exposes the subclavian vessels and brachial plexus. We believe that this approach is optimal when a superior sulcus tumor (SST) invades the anterior part of the thoracic inlet. However, this approach is not yet widely applied because anatomical relationships in this procedure are difficult to visualize. Three-dimensional tomography can considerably improve preoperative planning, enhance the surgeon's skill and simplify the approach to complex surgical procedures. We applied preoperative 3-dimensional multidetector computed tomography to a case where an SST had invaded the anterior part of the thoracic inlet including the clavicle, sternoclavicular joint, first rib, subclavian vessels and brachial plexus. After the patient underwent induction chemotherapy, we performed the transmanubrial osteomuscular-sparing approach and added a third anterolateral thoracotomy with a hemi-clamshell incision and completely resected the tumor.

  1. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths.

    PubMed

    Natori, Yuhei; Yoshizawa, Hidekazu; Mizuno, Hiroshi; Hayashi, Ayato

    2015-12-01

    During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure.

  2. The Preoperative Neurological Evaluation

    PubMed Central

    Probasco, John; Sahin, Bogachan; Tran, Tung; Chung, Tae Hwan; Rosenthal, Liana Shapiro; Mari, Zoltan; Levy, Michael

    2013-01-01

    Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease. PMID:24198903

  3. SU-E-T-311: Dosimetric Comparison of Volumetric Modulated Arc Therapy Plans for Preoperative Radiotherapy Rectal Cancer Using Flattening Filter-Free and Flattening Filter Modes

    SciTech Connect

    Zhang, W; Zhang, J; Lu, J; Chen, C

    2015-06-15

    Purpose: To compare the dosimetric difference of volumetric modulated arc therapy(VMAT) for preoperative radiotherapy rectal cancer using 6MV X-ray flattening filter free(FFF) and flattening filter(FF) modes. Methods: FF-VMAT and FFF-VMAT plans were designed to 15 rectal cancer patients with preoperative radiotherapy by planning treatment system(Eclipse 10.0),respectively. Dose prescription was 50 Gy in 25 fractions. All plans were normalized to 50 Gy to 95% of PTV. The Dose Volume Histogram (DVH), target and risk organ doses, conformity indexes (CI), homogeneity indexes (HI), low dose volume of normal tissue(BP), monitor units(MU) and treatment time (TT) were compared between the two kinds of plans. Results: FF-VMAT provided the lower Dmean, V105, HI, and higher CI as compared with FFF-VMAT. The small intestine of D5, Bladder of D5, Dmean, V40, V50, L-femoral head of V40, R-femoral head of Dmean were lower in FF-VMAT than in FFF-VMAT. FF-VMAT had higher BP of V5, but no significantly different of V10, V15, V20, V30 as compared with FFF-VMAT. FF-VMAT reduceed the monitor units(MU) by 21%(P<0.05), as well as the treatment time(TT) was no significantly different(P>0.05), as compared with FFF-VMAT. Conclusion: The plan qualities of FF and FFF VMAT plans were comparable and both clinically acceptable. FF-VMAT as compared with FFF-VMAT, showing better target coverage, some of OARs sparing, the MUs of FFF-VMAT were higher than FF-VMAT, yet were delivered within the same time. This work was supported by the Medical Scientific Research Foundation of Guangdong Procvince (A2014455 to Changchun Ma)

  4. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy

    PubMed Central

    Yoon, Seong-Dae; Zhang, GuoFeng; Kim, Hee-June; Lee, Byoung-Joo; Kyung, Hee-Soo

    2016-01-01

    Purpose The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). Materials and Methods This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. Results The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. Conclusions In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method. PMID:27894175

  5. [Understanding and implementing the Party's policies on family planning accurately in an all-around way].

    PubMed

    Liang, J; Peng, Z

    1984-05-29

    Recently, the Party's Central Committee held numerous meetings to study the problem of family planning. The main goal of these meetings was to find a correct family planning policy, which should be based on common sense, support from the people, and reasonable work from the cadres. Family planning policies and regulations should be realistic and creative. In the implementation of policies, different methods should be adopted for varied situations, and there should also be appropriate guiding principles for different categories. To cope with a new situation, creative methods and approaches should be chosen in order to implement the family planning policy. The correct method will ensure complete implementation of the policy. In family planning work, the first step is the improvement of ideological education, so that the people may have a correct understanding of the need for family planning. In the technical management work of family planning, a constant improvement in the quality of service should be the goal. Through practical working experience in family planning, some rules and regulations will be found, and they should be used to promote the management level and the level of family planning work in general.

  6. Accurate combination of CT and MR data of the head: validation and applications in surgical and therapy planning.

    PubMed

    Hill, D L; Hawkes, D J; Hussain, Z; Green, S E; Ruff, C F; Robinson, G P

    1993-01-01

    A method is presented for the accurate combination of magnetic resonance (MR) and computed tomographic (CT) images of the head. Our technique is based on user identified 3D landmarks followed by data combination and display as adjacent slices, a single fused slice representation, colour overlay and three-dimensional (3D) rendered scenes. Validation with a point phantom and computer simulation has established the relationship of registration accuracy with point location accuracy, the number of points used and their spatial distribution. The technique is in clinical use in the planning of skull base surgery, transferring MR images acquired without a stereotaxic frame to stereotaxic space, and staging and planning therapy of nasopharyngeal tumours.

  7. Toward optimizing patient-specific IMRT QA techniques in the accurate detection of dosimetrically acceptable and unacceptable patient plans

    SciTech Connect

    McKenzie, Elizabeth M.; Balter, Peter A.; Stingo, Francesco C.; Jones, Jimmy; Followill, David S.; Kry, Stephen F.

    2014-12-15

    was no significant difference in the performance of any device between gamma criteria of 2%/2 mm, 3%/3 mm, and 5%/3 mm. Finally, optimal cutoffs (e.g., percent of pixels passing gamma) were determined for each device and while clinical practice commonly uses a threshold of 90% of pixels passing for most cases, these results showed variability in the optimal cutoff among devices. Conclusions: IMRT QA devices have differences in their ability to accurately detect dosimetrically acceptable and unacceptable plans. Field-by-field analysis with a MapCheck device and use of the MapCheck with a MapPhan phantom while delivering at planned rotational gantry angles resulted in a significantly poorer ability to accurately sort acceptable and unacceptable plans compared with the other techniques examined. Patient-specific IMRT QA techniques in general should be thoroughly evaluated for their ability to correctly differentiate acceptable and unacceptable plans. Additionally, optimal agreement thresholds should be identified and used as common clinical thresholds typically worked very poorly to identify unacceptable plans.

  8. The development and verification of a highly accurate collision prediction model for automated noncoplanar plan delivery

    SciTech Connect

    Yu, Victoria Y.; Tran, Angelia; Nguyen, Dan; Cao, Minsong; Ruan, Dan; Low, Daniel A.; Sheng, Ke

    2015-11-15

    Purpose: Significant dosimetric benefits had been previously demonstrated in highly noncoplanar treatment plans. In this study, the authors developed and verified an individualized collision model for the purpose of delivering highly noncoplanar radiotherapy and tested the feasibility of total delivery automation with Varian TrueBeam developer mode. Methods: A hand-held 3D scanner was used to capture the surfaces of an anthropomorphic phantom and a human subject, which were positioned with a computer-aided design model of a TrueBeam machine to create a detailed virtual geometrical collision model. The collision model included gantry, collimator, and couch motion degrees of freedom. The accuracy of the 3D scanner was validated by scanning a rigid cubical phantom with known dimensions. The collision model was then validated by generating 300 linear accelerator orientations corresponding to 300 gantry-to-couch and gantry-to-phantom distances, and comparing the corresponding distance measurements to their corresponding models. The linear accelerator orientations reflected uniformly sampled noncoplanar beam angles to the head, lung, and prostate. The distance discrepancies between measurements on the physical and virtual systems were used to estimate treatment-site-specific safety buffer distances with 0.1%, 0.01%, and 0.001% probability of collision between the gantry and couch or phantom. Plans containing 20 noncoplanar beams to the brain, lung, and prostate optimized via an in-house noncoplanar radiotherapy platform were converted into XML script for automated delivery and the entire delivery was recorded and timed to demonstrate the feasibility of automated delivery. Results: The 3D scanner measured the dimension of the 14 cm cubic phantom within 0.5 mm. The maximal absolute discrepancy between machine and model measurements for gantry-to-couch and gantry-to-phantom was 0.95 and 2.97 cm, respectively. The reduced accuracy of gantry-to-phantom measurements was

  9. The development and verification of a highly accurate collision prediction model for automated noncoplanar plan delivery

    PubMed Central

    Yu, Victoria Y.; Tran, Angelia; Nguyen, Dan; Cao, Minsong; Ruan, Dan; Low, Daniel A.; Sheng, Ke

    2015-01-01

    Purpose: Significant dosimetric benefits had been previously demonstrated in highly noncoplanar treatment plans. In this study, the authors developed and verified an individualized collision model for the purpose of delivering highly noncoplanar radiotherapy and tested the feasibility of total delivery automation with Varian TrueBeam developer mode. Methods: A hand-held 3D scanner was used to capture the surfaces of an anthropomorphic phantom and a human subject, which were positioned with a computer-aided design model of a TrueBeam machine to create a detailed virtual geometrical collision model. The collision model included gantry, collimator, and couch motion degrees of freedom. The accuracy of the 3D scanner was validated by scanning a rigid cubical phantom with known dimensions. The collision model was then validated by generating 300 linear accelerator orientations corresponding to 300 gantry-to-couch and gantry-to-phantom distances, and comparing the corresponding distance measurements to their corresponding models. The linear accelerator orientations reflected uniformly sampled noncoplanar beam angles to the head, lung, and prostate. The distance discrepancies between measurements on the physical and virtual systems were used to estimate treatment-site-specific safety buffer distances with 0.1%, 0.01%, and 0.001% probability of collision between the gantry and couch or phantom. Plans containing 20 noncoplanar beams to the brain, lung, and prostate optimized via an in-house noncoplanar radiotherapy platform were converted into XML script for automated delivery and the entire delivery was recorded and timed to demonstrate the feasibility of automated delivery. Results: The 3D scanner measured the dimension of the 14 cm cubic phantom within 0.5 mm. The maximal absolute discrepancy between machine and model measurements for gantry-to-couch and gantry-to-phantom was 0.95 and 2.97 cm, respectively. The reduced accuracy of gantry-to-phantom measurements was

  10. Considerations and Protocols in Virtual Surgical Planning of Reconstructive Surgery for More Accurate and Esthetic Neomandible with Deep Circumflex Iliac Artery Free Flap

    PubMed Central

    Kim, Nam-Kyoo; Kim, Hyun Young; Kim, Hyung Jun; Cha, In-Ho; Nam, Woong

    2014-01-01

    Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap. PMID:27489828

  11. Predicting Next Year's Resources--Short-Term Enrollment Forecasting for Accurate Budget Planning. AIR Forum Paper 1978.

    ERIC Educational Resources Information Center

    Salley, Charles D.

    Accurate enrollment forecasts are a prerequisite for reliable budget projections. This is because tuition payments make up a significant portion of a university's revenue, and anticipated revenue is the immediate constraint on current operating expenditures. Accurate forecasts are even more critical to revenue projections when a university's…

  12. Definitive, Preoperative, and Palliative Radiation Therapy of Esophageal Cancer

    PubMed Central

    Fokas, Emmanouil; Rödel, Claus

    2015-01-01

    Summary Background Long-term survival in patients with esophageal cancer remains dismal despite the recent improvements in surgery, the advances in radiotherapy (RT) technology, and the refinement of systemic treatments, including the advent of targeted therapies. Although surgery constitutes the treatment of choice for early-stage disease (stage I), a multimodal approach, including preoperative or definitive chemoradiotherapy (CRT) and perioperative chemotherapy, is commonly pursued in patients with locally advanced disease. Methods A review of the literature was performed to assess the role of RT, alone or in combination with chemotherapy, in the management of esophageal cancer. Results Evidence from large, randomized phase III trials and meta-analyses supports the application of perioperative chemotherapy alone or preoperative concurrent CRT in patients with lower esophageal and esophagogastric junction adenocarcinomas. Preoperative CRT but not preoperative chemotherapy alone is now routinely used in patients with locally advanced squamous cell carcinoma (SCC). Additionally, definitive CRT without surgery has also emerged as a valuable approach in the management of resectable esophageal SCC to avoid surgery-related morbidity and mortality, whereas salvage surgery is reserved for those with persistent disease. Furthermore, brachytherapy offers a valuable option in the palliative treatment of patients with locally advanced, unresponsive disease. Fluorodeoxyglucose-positron emission tomography (FDG-PET) can facilitate a more accurate treatment response assessment and patient selection. Finally, the development of modern RT techniques, such as intensity-modulated and image-guided RT as well as FDG-PET-based RT planning, could further increase the therapeutic ratio of CRT. Conclusion Altogether, CRT constitutes an important tool in the treatment armamentarium for esophageal cancer. Further optimization of CRT using modern technology and imaging, targeted therapies

  13. SU-E-T-273: Do Task Group External Beam QA Recommendations Guarantee Accurate Treatment Plan Dose Delivery?

    SciTech Connect

    Templeton, A; Liao, Y; Redler, G; Zhen, H

    2015-06-15

    Purpose: AAPM task groups 40/142 have provided an invaluable set of goals for physicists designing QA programs, attempting to standardize what would otherwise likely be a highly variable phenomenon across institutions. However, with the complexity of modalities such as VMAT, we hypothesize that following these guidelines to the letter might still allow unacceptable dose discrepancies. To explore this hypothesis we simulated machines bordering on QA acceptability, and calculated the effect on patient plans. Methods: Two errant machines were simulated in Aria/Eclipse, each just within task group criteria for output, percent depth dose, beam profile, gantry and collimator rotations, and jaw and MLC positions. One machine minimized dose to the PTV (machine A) and the other maximized dose to the OARs (machine B). Clinical treatment plans (3-phase prostate, n=3; hypofractionated lung, n=1) were calculated on these machines and the dose distributions compared. A prostate case was examined for contribution of error sources and evaluated using delivery QA data. Results: The prostate plans showed mean decreases in target D95 of 9.9% of prescription dose on machine A. On machine B, The rectal and bladder V70Gy each increased by 7.1 percentage points, while their V45Gy increased by 16.2% and 15.0% respectively. In the lung plan, the target D95 decreased by 12.8% and the bronchial tree Dmax increased by 21% of prescription dose, on machines A and B. One prostate plan showed target dose errors of 3.8% from MLC changes, 2% from output, ∼3% from energy and ∼0.5% from other factors. This plan achieved an 88.4% gamma passing rate using 3%/3mm using ArcCHECK. Conclusion: In the unlikely event that a machine exhibits all maximum errors allowed by TG 40/142, unacceptably large changes in dose delivered are possible especially in highly modulated VMAT plans, despite the machine passing routine QA.

  14. Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance.

    PubMed

    Schoenhagen, Paul; Numburi, Uma; Halliburton, Sandra S; Aulbach, Peter; von Roden, Martin; Desai, Milind Y; Rodriguez, Leonardo L; Kapadia, Samir R; Tuzcu, E Murat; Lytle, Bruce W

    2010-11-01

    The rapid expansion of less invasive surgical and transcatheter cardiovascular procedures for a wide range of cardiovascular conditions, including coronary, valvular, structural cardiac, and aortic disease has been paralleled by novel three-dimensional (3-D) approaches to imaging. Three-dimensional imaging allows acquisition of volumetric data sets and subsequent off-line reconstructions along unlimited 2-D planes and 3-D volumes. Pre-procedural 3-D imaging provides detailed understanding of the operative field for surgical/interventional planning. Integration of imaging modalities during the procedure allows real-time guidance. Because computed tomography routinely acquires 3-D data sets, it has been one of the early imaging modalities applied in the context of surgical and interventional planning. This review describes the continuum of applications from pre-operative planning to procedural integration, based on the emerging experience with computed tomography and rotational angiography, respectively. At the same time, the potential adverse effects of imaging with X-ray-based tomographic or angiographic modalities are discussed. It is emphasized that the role of imaging guidance in this context remains unclear and will need to be evaluated in clinical trials. This is in particular true, because data showing improved outcome or even non-inferiority for most of the emerging transcatheter procedures are still lacking.

  15. Digital subtraction angiography for preoperative evaluation of extremity tumors

    SciTech Connect

    Paushter, D.M.; Borkowski, G.R.; Buonocore, E.; Belhobek, G.H.; Marks, K.E.

    1983-07-01

    A retrospective study was undertaken to evaluate the role of digital subtraction angiography (DSA) in the surgical planning of musculoskeletal neoplasms. Thirteen patients with primary bone and soft-tissue tumors were examined by CT and DSA. Three patients also had conventional angiography. DSA yielded surgically useful information in 10 patients, comparable to that expected from conventional angiography. DSA was most helpful in demonstrating the presence or absence of major vessel involvement by tumor when this could not be ascertained definitely on CT. Demonstration of mass extent by CT was accurate in 11 patients. Results of this study suggest that the combination of CT and DSA is useful in the preoperative evaluation of selected extremity tumors and should diminish the need for conventional angiography.

  16. Using “Functional” Target Coordinates of the Subthalamic Nucleus to Assess the Indirect and Direct Methods of the Preoperative Planning: Do the Anatomical and Functional Targets Coincide?

    PubMed Central

    Rabie, Ahmed; Verhagen Metman, Leo; Slavin, Konstantin V.

    2016-01-01

    Objective: To answer the question of whether the anatomical center of the subthalamic nucleus (STN), as calculated indirectly from stereotactic atlases or by direct visualization on magnetic resonance imaging (MRI), corresponds to the best functional target. Since the neighboring red nucleus (RN) is well visualized on MRI, we studied the relationships of the final target to its different borders. Methods: We analyzed the data of 23 PD patients (46 targets) who underwent bilateral frame-based STN deep brain stimulation (DBS) procedure with microelectrode recording guidance. We calculated coordinates of the active contact on DBS electrode on postoperative MRI, which we referred to as the final “functional/optimal” target. The coordinates calculated by the atlas-based “indirect” and “direct” methods, as well as the coordinates of the different RN borders were compared to these final coordinates. Results: The mean ± SD of the final target coordinates was 11.7 ± 1.5 mm lateral (X), 2.4 ± 1.5 mm posterior (Y), and 6.1 ± 1.7 mm inferior to the mid-commissural point (Z). No significant differences were found between the “indirect” X, Z coordinates and those of the final targets. The “indirect” Y coordinate was significantly posterior to Y of the final target, with mean difference of 0.6 mm (p = 0.014). No significant differences were found between the “direct” X, Y, and Z coordinates and those of the final targets. Conclusions: The functional STN target is located in direct proximity to its anatomical center. During preoperative targeting, we recommend using the “direct” method, and taking into consideration the relationships of the final target to the mid-commissural point (MCP) and the different RN borders. PMID:28009826

  17. [Reducing postoperative morbidity and mortality with preoperative risk evaluation and with refined perioperative medical care].

    PubMed

    Uchida, Kanji

    2012-05-01

    Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.

  18. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    Wang, Li; Lee, Myeongjong; Zhang, Zhe; Moodie, Jessica; Cheng, Davy; Martin, Janet

    2016-01-01

    Objectives The clinical impact of preoperative physiotherapy on recovery after joint replacement remains controversial. This systematic review aimed to assess the clinical impact of prehabilitation before joint replacement. Design We searched PubMed, Embase and Cochrane CENTRAL up to November 2015 for randomised controlled trials comparing prehabilitation versus no prehabilitation before joint replacement surgery. Postoperative pain and function scores were converted to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales (0–100, high scores indicate worse outcome). Random effects meta-analysis was performed to calculate weighted mean differences (WMD, 95% CI), subgrouped by hip and knee surgery. Primary and secondary outcomes Postoperative pain and function scores, time to resume activities of daily living, quality of life, length of hospital stay, total cost, patient satisfaction, postoperative complications, any adverse events and discontinuations. Results Of 22 studies (1492 patients), 18 had high risk of bias. Prehabilitation slightly reduced pain scores within 4 weeks postoperatively (WMD −6.1 points, 95% CI −10.6 to −1.6 points, on a scale of 0–100), but differences did not remain beyond 4 weeks. Prehabilitation slightly improved WOMAC function score at 6–8 and 12 weeks (WMD −4.0, 95% CI −7.5 to −0.5), and time to climbing stairs (WMD −1.4 days, 95% CI −1.9 to −0.8 days), toilet use (−0.9 days, 95% CI −1.3 to −0.5 days) and chair use (WMD −1.2 days, 95% CI −1.7 to −0.8 days). Effects were similar for knee and hip surgery. Differences were not found for SF-36 scores, length of stay and total cost. Other outcomes of interest were inadequately reported. Conclusions Existing evidence suggests that prehabilitation may slightly improve early postoperative pain and function among patients undergoing joint replacement; however, effects remain too small and short

  19. Putting 3D modelling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects

    PubMed Central

    Tetsworth, Kevin; Block, Steve; Glatt, Vaida

    2017-01-01

    3D printing technology has revolutionized and gradually transformed manufacturing across a broad spectrum of industries, including healthcare. Nowhere is this more apparent than in orthopaedics with many surgeons already incorporating aspects of 3D modelling and virtual procedures into their routine clinical practice. As a more extreme application, patient-specific 3D printed titanium truss cages represent a novel approach for managing the challenge of segmental bone defects. This review illustrates the potential indications of this innovative technique using 3D printed titanium truss cages in conjunction with the Masquelet technique. These implants are custom designed during a virtual surgical planning session with the combined input of an orthopaedic surgeon, an orthopaedic engineering professional and a biomedical design engineer. The ability to 3D model an identical replica of the original intact bone in a virtual procedure is of vital importance when attempting to precisely reconstruct normal anatomy during the actual procedure. Additionally, other important factors must be considered during the planning procedure, such as the three-dimensional configuration of the implant. Meticulous design is necessary to allow for successful implantation through the planned surgical exposure, while being aware of the constraints imposed by local anatomy and prior implants. This review will attempt to synthesize the current state of the art as well as discuss our personal experience using this promising technique. It will address implant design considerations including the mechanical, anatomical and functional aspects unique to each case. PMID:28220752

  20. Putting 3D modelling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects.

    PubMed

    Tetsworth, Kevin; Block, Steve; Glatt, Vaida

    2017-01-01

    3D printing technology has revolutionized and gradually transformed manufacturing across a broad spectrum of industries, including healthcare. Nowhere is this more apparent than in orthopaedics with many surgeons already incorporating aspects of 3D modelling and virtual procedures into their routine clinical practice. As a more extreme application, patient-specific 3D printed titanium truss cages represent a novel approach for managing the challenge of segmental bone defects. This review illustrates the potential indications of this innovative technique using 3D printed titanium truss cages in conjunction with the Masquelet technique. These implants are custom designed during a virtual surgical planning session with the combined input of an orthopaedic surgeon, an orthopaedic engineering professional and a biomedical design engineer. The ability to 3D model an identical replica of the original intact bone in a virtual procedure is of vital importance when attempting to precisely reconstruct normal anatomy during the actual procedure. Additionally, other important factors must be considered during the planning procedure, such as the three-dimensional configuration of the implant. Meticulous design is necessary to allow for successful implantation through the planned surgical exposure, while being aware of the constraints imposed by local anatomy and prior implants. This review will attempt to synthesize the current state of the art as well as discuss our personal experience using this promising technique. It will address implant design considerations including the mechanical, anatomical and functional aspects unique to each case.

  1. Positioning control of the upper incisors in orthognathic surgery. Pre-operative planning with the Model Positioning Device and intra-operative application of the Sandwich Splint.

    PubMed

    Schwestka, R; Engelke, D; Zimmer, B; Kubein-Meesenburg, D

    1991-10-01

    In orthognathic surgery a three-dimensional positioning of the maxilla is possible by means of the Le Fort I osteotomy and subsequent maxillary movement. In treatment planning and at the time of surgery it is very important to achieve an exact positioning of the upper incisors in relation to the upper lip and the rest of the skull. The Model Positioning Device described here allows three-dimensional positioning of the upper incisors in one- or two-jaw surgery. The reference plane is the upper surface of the upper part of a semi-individually adjustable articulator. The application of the Sandwich Splint enables the three-dimensional positioning of the maxilla in relation to the rest of the skull. The Sandwich Splint ensures that the vertical position of the mandible in relation to the rest of the skull above the osteotomy plane is exactly reproducible in the pre- and post-operative situation in both model surgery and at time of surgery. To this mandibular position the maxilla is positioned in three dimensions, as preplanned. The vertical dimension, which is identically reproducible before and after surgery is measured with a caliper. After surgery the mandible can be rotated into the planned new intercuspidation.

  2. Reducing the Need for Accurate Stream Flow Forecasting for Water Supply Planning by Augmenting Reservoir Operations with Seawater Desalination and Wastewater Recycling

    NASA Astrophysics Data System (ADS)

    Bhushan, R.; Ng, T. L.

    2014-12-01

    Accurate stream flow forecasts are critical for reservoir operations for water supply planning. As the world urban population increases, the demand for water in cities is also increasing, making accurate forecasts even more important. However, accurate forecasting of stream flows is difficult owing to short- and long-term weather variations. We propose to reduce this need for accurate stream flow forecasts by augmenting reservoir operations with seawater desalination and wastewater recycling. We develop a robust operating policy for the joint operation of the three sources. With the joint model, we tap into the unlimited reserve of seawater through desalination, and make use of local supplies of wastewater through recycling. However, both seawater desalination and recycling are energy intensive and relatively expensive. Reservoir water on the other hand, is generally cheaper but is limited and variable in its availability, increasing the risk of water shortage during extreme climate events. We operate the joint system by optimizing it using a genetic algorithm to maximize water supply reliability and resilience while minimizing vulnerability subject to a budget constraint and for a given stream flow forecast. To compute the total cost of the system, we take into account the pumping cost of transporting reservoir water to its final destination, and the capital and operating costs of desalinating seawater and recycling wastewater. We produce results for different hydro climatic regions based on artificial stream flows we generate using a simple hydrological model and an autoregressive time series model. The artificial flows are generated from precipitation and temperature data from the Canadian Regional Climate model for present and future scenarios. We observe that the joint operation is able to effectively minimize the negative effects of stream flow forecast uncertainty on system performance at an overall cost that is not significantly greater than the cost of a

  3. Alignment of sparse freehand 3-D ultrasound with preoperative images of the liver using models of respiratory motion and deformation.

    PubMed

    Blackall, Jane M; Penney, Graeme P; King, Andrew P; Hawkes, David J

    2005-11-01

    We present a method for alignment of an interventional plan to optically tracked two-dimensional intraoperative ultrasound (US) images of the liver. Our clinical motivation is to enable the accurate transfer of information from three-dimensional preoperative imaging modalities [magnetic resonance (MR) or computed tomography (CT)] to intraoperative US to aid needle placement for thermal ablation of liver metastases. An initial rigid registration to intraoperative coordinates is obtained using a set of US images acquired at maximum exhalation. A preprocessing step is applied to both the preoperative images and the US images to produce evidence of corresponding structures. This yields two sets of images representing classification of regions as vessels. The registration then proceeds using these images. The preoperative images and plan are then warped to correspond to a single US slice acquired at an unknown point in the breathing cycle where the liver is likely to have moved and deformed relative to the preoperative image. Alignment is constrained using a patient-specific model of breathing motion and deformation. Target registration error is estimated by carrying out simulation experiments using resliced MR volumes to simulate real US and comparing the registration results to a "bronze-standard" registration performed on the full MR volume. Finally, the system is tested using real US and verified using visual inspection.

  4. Pediatric Patient with Incidental Os Odontoideum Safely Treated with Posterior Fixation Using Rod-Hook System and Preoperative Planning Using 3D Printer: A Case Report.

    PubMed

    Sakai, Toshinori; Tezuka, Fumitake; Abe, Mitsunobu; Yamashita, Kazuta; Takata, Yoichiro; Higashino, Kosaku; Nagamachi, Akihiro; Sairyo, Koichi

    2017-05-01

    Os odontoideum is often found incidentally. Surgical treatment is recommended for patients with atlantoaxial instability or neurologic deficits. Although various techniques have been used for C1-C2 fusion in adults, the use of these procedures in children is not widely accepted. We present a 12-year-old boy with incidental os odontoideum and obvious C1-C2 instability, in which bony union was achieved safely and successfully by posterior fixation using a rod-hook system and perioperative planning using a three-dimensional printer. At the 2-year follow-up, bone formation around the gap of the dens, which has been generally considered as pseudoarthrosis, was obtained after union of the posterior element of C1-C2.

  5. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  6. Fast and accurate Monte Carlo modeling of a kilovoltage X-ray therapy unit using a photon-source approximation for treatment planning in complex media

    PubMed Central

    Zeinali-Rafsanjani, B.; Mosleh-Shirazi, M. A.; Faghihi, R.; Karbasi, S.; Mosalaei, A.

    2015-01-01

    To accurately recompute dose distributions in chest-wall radiotherapy with 120 kVp kilovoltage X-rays, an MCNP4C Monte Carlo model is presented using a fast method that obviates the need to fully model the tube components. To validate the model, half-value layer (HVL), percentage depth doses (PDDs) and beam profiles were measured. Dose measurements were performed for a more complex situation using thermoluminescence dosimeters (TLDs) placed within a Rando phantom. The measured and computed first and second HVLs were 3.8, 10.3 mm Al and 3.8, 10.6 mm Al, respectively. The differences between measured and calculated PDDs and beam profiles in water were within 2 mm/2% for all data points. In the Rando phantom, differences for majority of data points were within 2%. The proposed model offered an approximately 9500-fold reduced run time compared to the conventional full simulation. The acceptable agreement, based on international criteria, between the simulations and the measurements validates the accuracy of the model for its use in treatment planning and radiobiological modeling studies of superficial therapies including chest-wall irradiation using kilovoltage beam. PMID:26170553

  7. Predictive Ability of Preoperative CT Scan in Determining Whether the Adrenal Gland is Spared at Radical Nephrectomy

    PubMed Central

    Nason, Gregory J.; Aslam, Asadullah; Giri, Subhasis K.

    2016-01-01

    Introduction The aim of this study was to assess whether preoperative multiple detector computed tomography (MDCT) accurately predicts adrenal involvement for patients undergoing non-adrenal sparing radical nephrectomy for renal cell carcinoma. Methods and Materials A retrospective observational study based on a composite patient population of two university teaching hospitals who underwent radical nephrectomy. Sensitivity, specificity, overall accuracy, positive and negative predictive values and likelihood ratios were calculated from radiological reports. Results Total 579 patients underwent radical nephrectomy, of which 199 (34.4%) patients underwent a non-adrenal sparing radical nephrectomy, in which 128 (64.3%) were male and 118 (59.3%) were left side tumors. Mean tumor size was 8.2 cm (range 1.4-20cm). MDCT was found to have a sensitivity of 100% and specificity of 95.2% for identifying adrenal invasion. Total 179 patients (89.9%) had a radiographically normal ipsilateral adrenal gland, of which none were found to have adrenal involvement. Therefore, the negative predictive value of preoperative cross-sectional imaging for identification of adrenal involvement was 100%. Conclusion Cross- sectional MDCT imaging accurately predicts adrenal involvement and the decision to remove or spare the adrenal gland should be made preoperative planning regardless of tumour size or location at the time of multi-disciplinary discussion unless there is intraoperative evidence of adrenal invasion. PMID:27867332

  8. Preoperative irradiation and cystectomy for bladder cancer.

    PubMed

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F

    1982-03-01

    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  9. Making safer preoperative arrangements for patients using vitamin K antagonists

    PubMed Central

    van Fessem, Joris; Willems, Jessica; Kruip, Marieke; Hoeks, Sanne; Jan Stolker, Robert

    2017-01-01

    Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework had not been implemented. Therefore, a quality-improvement project was started at the Anesthesia Department to improve perioperative safety. After exploration of barriers, multiple interventions were carried out to encourage co-workers at the preoperative screening department to take shared responsibility: distribution of prints, adjustments in electronic patient records, introduction of a protocol and education sessions. Efficacy was measured retrospectively performing a before-after study collecting perioperative data of patients using vitamin K antagonists. The primary outcome measure was the percentage of predefined safe preoperative plans. Secondary outcome measures were (1) incidence of postoperative bleeding and thrombo-embolic events within the first 24 hours after intervention and (2) necessity to preoperative correction of anticoagulation. Before intervention 72 (29%) safe, 93 (38%) partially unsafe and 83 (33%) unsafe arrangements were made. After the intervention these numbers were 105 (80%), 23 (17%) en 4 (3%), respectively: a significant 51% increase in safe preoperative plans (P<0.001). We observed no significant difference (P=0.369) regarding bleeding and thrombo-embolic events: pre-intervention 12 (5%) cases of postoperative bleeding were documented, vs. 6 (5%) post intervention and the number of thrombo-embolic events was 5 (2%) vs. 0. Also, no significant differences concerning preoperative correction of anticoagulation were observed: 11 (4%) vs. 8 (6%) (P=0.489). This quality improvement project demonstrates a major improvement in safer preoperative arrangements in our institution regarding vitamin K antagonists, using the described interventions

  10. Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt

    PubMed Central

    Fukushima, Kensuke; Takahira, Naonobu; Uchiyama, Katsufumi; Moriya, Mitsutoshi; Takaso, Masashi

    2017-01-01

    Introduction: Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. Methods: The model was prepared from the patient’s Digital Imaging and Communications in Medicine (DICOM) formatted data from computed tomography (CT), for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following the osteotomy. Results: Our models clearly reflected the anatomical shape of the patient’s hip. Our models allowed for surgical simulation, making realistic use of the chisel and drill. Our method of pre-operative simulation for PAO allowed for the assessment of accurate osteotomy line, determination of the position of the osteotomized fragment, and prevented anterior impingement after the operation. Conclusion: Our method of pre-operative simulation might improve the safety, accuracy, and results of PAO. PMID:28186873

  11. Can C.T. detect labyrinthine fistulae pre-operatively?

    PubMed

    Bates, G J; O'Donoghue, G M; Anslow, P; Houlding, T

    1988-01-01

    The aim of the study was to undertake a controlled prospective evaluation of high resolution computerized tomography in the pre-operative diagnosis of labyrinthine fistulae. Fifty consecutive patients with chronic suppurative otitis media were scanned prior to surgery, using a Siemens DRI scanner. The radiological predictions were then compared with the surgical findings. Five patients had labyrinthine erosions and these were predicted in 4 out of the 5 (80%). The one erosion that escaped radiological detection was less than 2 mm in length. The study shows that high resolution computerized tomography is a highly accurate method for demonstrating pre-operatively all but the smallest fistulae.

  12. [Preoperative fasting guidelines: an update].

    PubMed

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.

  13. Preoperative Psychological Preparation of Children

    PubMed Central

    Güleç, Ersel; Özcengiz, Dilek

    2015-01-01

    Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed. PMID:27366525

  14. Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction

    PubMed Central

    Angrigiani, Claudio; Hammond, Dennis; Nava, Maurizio; Gonzalez, Eduardo; Rostagno, Roman; Gercovich, Gustavo

    2016-01-01

    Background Digital mammography clearly distinguishes gland tissue density from the overlying non-glandular breast tissue coverage, which corresponds to the existing tissue between the skin and the Cooper’s ligaments surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning of the most adequate surgical techniques and reconstructive procedures for each case. Methods This study aimed to describe the results of a retrospective study of 352 digital mammograms in 176 patients with different breast volumes who underwent preoperative conservative mastectomies. The breast tissue coverage thickness and its relationship with the breast volume were evaluated. Results The breast tissue coverage thickness ranged from 0.233 to 4.423 cm, with a mean value of 1.952 cm. A comparison of tissue coverage and breast volume revealed a non-direct relationship between these factors. Conclusions Preoperative planning should not depend only on breast volume. Flap evaluations based on preoperative imaging measurements might be helpful when planning a conservative mastectomy. Accordingly, we propose a breast tissue coverage classification (BTCC). PMID:26855903

  15. [Cervical cancer staging - preoperative assessment of tumor extent (a review of the most recent ultrasound studies)].

    PubMed

    Fischerová, D

    2014-12-01

    For treatment planning of cervical cancer it is necessary preoperatively to determine the presence and size of residual tumour after the biopsy, the tumour topography within the cervix and the parametrial and lymph node status. According to current data, ultrasound is comparably accurate with magnetic resonance imaging in view of tumour presence and local extent assessment. Ultrasound, if compared with the magnetic resonance imaging, does not have known contraindications and it is a broadly available diagnostic test. Currently no advanced imaging technique exists that can reliably detect infiltrated lymph nodes in the clinically early stage of the disease, as it often manifests as micrometastatic involvement in non-enlarged lymph nodes. The sensitivity of lymph node detection using ultrasound in the early stage is around 40%, but the specificity is high (96%). For daily practice, this means that a negative ultrasound finding should be always verified by surgical staging based on systematic lymphadenectomy, while positive ultrasound finding usually changes the treatment strategy.

  16. The correlation between preoperative volumetry and real graft weight: comparison of two volumetry programs

    PubMed Central

    Mussin, Nadiar; Sumo, Marco; Choi, YoungRok; Choi, Jin Yong; Ahn, Sung-Woo; Yoon, Kyung Chul; Kim, Hyo-Sin; Hong, Suk Kyun; Yi, Nam-Joon; Suh, Kyung-Suk

    2017-01-01

    Purpose Liver volumetry is a vital component in living donor liver transplantation to determine an adequate graft volume that meets the metabolic demands of the recipient and at the same time ensures donor safety. Most institutions use preoperative contrast-enhanced CT image-based software programs to estimate graft volume. The objective of this study was to evaluate the accuracy of 2 liver volumetry programs (Rapidia vs. Dr. Liver) in preoperative right liver graft estimation compared with real graft weight. Methods Data from 215 consecutive right lobe living donors between October 2013 and August 2015 were retrospectively reviewed. One hundred seven patients were enrolled in Rapidia group and 108 patients were included in the Dr. Liver group. Estimated graft volumes generated by both software programs were compared with real graft weight measured during surgery, and further classified into minimal difference (≤15%) and big difference (>15%). Correlation coefficients and degree of difference were determined. Linear regressions were calculated and results depicted as scatterplots. Results Minimal difference was observed in 69.4% of cases from Dr. Liver group and big difference was seen in 44.9% of cases from Rapidia group (P = 0.035). Linear regression analysis showed positive correlation in both groups (P < 0.01). However, the correlation coefficient was better for the Dr. Liver group (R2 = 0.719), than for the Rapidia group (R2 = 0.688). Conclusion Dr. Liver can accurately predict right liver graft size better and faster than Rapidia, and can facilitate preoperative planning in living donor liver transplantation. PMID:28382294

  17. Pre-operative preparation for otologic surgery: temporal bone simulation

    PubMed Central

    Sethia, Rishabh; Wiet, Gregory J.

    2015-01-01

    Purpose of review The field of temporal bone simulation (TBS) has largely focused on the development and validation of simulators as training and assessment tools. However, as technology has progressed over the years, researchers have envisioned new clinical applications for simulators extending to pre-operative surgical planning and case rehearsal. The purpose of this article is to review the current state of the art in TBS and to highlight recent advancements in the field. Due to space limitations, we will limit our discussion to computer-based virtual reality (VR) simulators. Recent findings A review of the recent literature on TBS revealed very limited application of VR simulators for pre-operative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using VR simulation. Further investigation and clinical evaluation are required to validate its use outside of training and skill assessment. Summary This article provides an overview of the current use of VR simulators with emphasis on pre-operative planning. We evaluate the limitations of the technology, and discuss potential areas of improvement for the future. More studies are necessary to assess the value of VR simulation for pre-operative preparation. PMID:26339966

  18. MO-A-BRD-10: A Fast and Accurate GPU-Based Proton Transport Monte Carlo Simulation for Validating Proton Therapy Treatment Plans

    SciTech Connect

    Wan Chan Tseung, H; Ma, J; Beltran, C

    2014-06-15

    Purpose: To build a GPU-based Monte Carlo (MC) simulation of proton transport with detailed modeling of elastic and non-elastic (NE) protonnucleus interactions, for use in a very fast and cost-effective proton therapy treatment plan verification system. Methods: Using the CUDA framework, we implemented kernels for the following tasks: (1) Simulation of beam spots from our possible scanning nozzle configurations, (2) Proton propagation through CT geometry, taking into account nuclear elastic and multiple scattering, as well as energy straggling, (3) Bertini-style modeling of the intranuclear cascade stage of NE interactions, and (4) Simulation of nuclear evaporation. To validate our MC, we performed: (1) Secondary particle yield calculations in NE collisions with therapeutically-relevant nuclei, (2) Pencil-beam dose calculations in homogeneous phantoms, (3) A large number of treatment plan dose recalculations, and compared with Geant4.9.6p2/TOPAS. A workflow was devised for calculating plans from a commercially available treatment planning system, with scripts for reading DICOM files and generating inputs for our MC. Results: Yields, energy and angular distributions of secondaries from NE collisions on various nuclei are in good agreement with the Geant4.9.6p2 Bertini and Binary cascade models. The 3D-gamma pass rate at 2%–2mm for 70–230 MeV pencil-beam dose distributions in water, soft tissue, bone and Ti phantoms is 100%. The pass rate at 2%–2mm for treatment plan calculations is typically above 98%. The net computational time on a NVIDIA GTX680 card, including all CPU-GPU data transfers, is around 20s for 1×10{sup 7} proton histories. Conclusion: Our GPU-based proton transport MC is the first of its kind to include a detailed nuclear model to handle NE interactions on any nucleus. Dosimetric calculations demonstrate very good agreement with Geant4.9.6p2/TOPAS. Our MC is being integrated into a framework to perform fast routine clinical QA of pencil

  19. Pre-operative templating for trauma hemiarthroplasty (Thompson's)

    PubMed Central

    Green, Robert Nicholas; Rushton, Paul R.P.; Kramer, Derek; Inman, Dominic; Partington, Paul F.

    2015-01-01

    Introduction Surgical complications may be avoided by preoperative templating in trauma hemiarthroplasty. Materials and methods Digital templates for the Stryker™ range of Thompson's prostheses were created and fifty trauma patients that had undergone cemented hemiarthroplasty were retrospectively templated by 2 blinded surgeons. Results Templating for prosthesis size was highly accurate with excellent Inter and intra-observer reproducibility. Sensitivity for identifying femoral canals too narrow for a Thompsons was 100%. Conclusions Templating is a valuable tool and should be standard practice in trauma. We have demonstrated that it is possible to generate custom templates to allow accurate templating. PMID:26566327

  20. Do psychological interventions reduce preoperative anxiety?

    PubMed

    Renouf, Tessa; Leary, Alison; Wiseman, Theresa

    The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.

  1. A safe and accurate method to perform esthetic mandibular contouring surgery for Far Eastern Asians.

    PubMed

    Hsieh, A M-C; Huon, L-K; Jiang, H-R; Liu, S Y-C

    2017-05-01

    A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described.

  2. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    PubMed

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p < 0.02) and used less narcotic use (average 1.7 tablets, p < 0.02) for the first 36 hours compared with group 1. No statistically significant differences were identified between the two groups with regard to demographics, hours of postoperative cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction.

  3. Staging of renal cell carcinoma: cost-effectiveness of routine preoperative bone scans

    SciTech Connect

    Campbell, R.J.; Broaddus, S.B.; Leadbetter, G.W. Jr.

    1985-03-01

    The use of bone scans in the evaluation of renal cell carcinoma has become routine in many centers. In a retrospective analysis of 42 patients undergoing radical nephrectomy for renal cell carcinoma, the authors analyzed the cost-effectiveness of routine preoperative bone scans. Although these scans accurately predict metastatic disease to bone, they are not cost-effective as a routine preoperative tool because they do not alter outcome. In selected patients with bone pain and no other positive staging studies, preoperative bone scans may be of value in the decision to perform extirpative surgery.

  4. Preoperative Evaluation for Noncardiac Surgery.

    PubMed

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  5. Patterns of Response After Preoperative Treatment in Gastric Cancer

    SciTech Connect

    Diaz-Gonzalez, Juan A.; Rodriguez, Javier; Hernandez-Lizoain, Jose L.; Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier; Chopitea, Ana; Martinez-Regueira, Fernando; Valenti, Victor; Garcia-Foncillas, Jesus; Martinez-Monge, Rafael; Sola, Jesus J.

    2011-07-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  6. The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease.

    PubMed

    Stryckers, Marijke; Nagler, Evi V; Van Biesen, Wim

    2016-11-01

    As people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual's values and preferences. Accurate estimations of one's risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

  7. [Preoperative full-body magnetic resonance imaging is indicated on suspicion of multifocal infection in children].

    PubMed

    Al-Aubaidi, Zaid; Pedersen, Niels Wisbech

    2011-04-11

    Musculoskeletal infections in children present a challenge regarding diagnosis and treatment. Conventional radiographs guide the initial radiographic assessment. Additional imaging is often performed to improve the diagnosis of the abnormality. The modalities used are ultrasound, bone-scan, computed tomography or magnetic resonance imaging (MRI). On suspicion of multifocal musculoskeletal infections (MMI), MRI may save time and improve preoperative planning. We highly recommend the use of MRI for the preoperative assessment of children with MMI.

  8. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  9. Magnification rate of digital panoramic radiographs and its effectiveness for pre-operative assessment of dental implants

    PubMed Central

    Kim, Y-K; Park, J-Y; Kim, S-G; Kim, J-S; Kim, J-D

    2011-01-01

    Objectives The purpose of this study was to determine the accuracy and effectiveness of digital panoramic radiographs for pre-operative assessment of dental implants. Methods We selected 86 patients (221 implants) and calculated the length of the planned implant based on the distance between a selection of critical anatomical structures and the alveolar crest using the scaling tools provided in the digital panoramic system. We analysed the magnification rate and the difference between the actual inserted implant length and planned implant length according to the location of the implant placement and the clarity of anatomical structures seen in the panoramic radiographs. Results There was no significant difference between the planned implant length and actual inserted implant length (P > 0.05). The magnification rate of the width and length of the inserted implants, seen in the digital panoramic radiographs, was 127.28 ± 13.47% and 128.22 ± 4.17%, respectively. The magnification rate of the implant width was largest in the mandibular anterior part and there was a significant difference in the magnification rate of the length of implants between the maxilla and the mandible (P < 0.05). When the clarity of anatomical structures seen in the panoramic radiographs is low, the magnification rate of the width of the inserted implants is significantly higher (P < 0.05), but there is no significant difference between the planned implant length and actual inserted implant length according to the clarity of anatomical structures (P < 0.05). Conclusions Digital panoramic radiography can be considered a simple, readily available and considerably accurate pre-operative assessment tool in the vertical dimension for dental implant therapy. PMID:21239569

  10. Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty

    PubMed Central

    Noguchi, Hideo; Matsuda, Yoshikazu; Kiga, Hiroshi; Takeda, Mitsuhiro; Toyabe, Shin-ichi

    2007-01-01

    A preoperative quantitative evaluation of soft tissues is helpful for planning total knee arthroplasty, in addition to the conventional clinical examinations involved in moving the knee manually. We evaluated preoperative coronal laxity with osteoarthritis in patients undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. We examined a consecutive series of 120 knees in 102 patients. The median laxity was 0° in abduction and 8° in adduction. The femorotibial angle on non-weight-bearing standard anteroposterior radiographs was 180° and correlated with both abduction (r = −0.244, p = 0.007) and adduction (r = 0.205, p = 0.025) laxity. The results of a regression analysis suggested that the femorotibial angle is helpful for estimating both laxities. Considering the many reports on how to obtain well-balanced soft tissues, stress radiographs might help to improve the preoperative planning for gaining the optimal laxity deemed appropriate by surgeons. PMID:17938923

  11. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  12. Preoperative evaluation and workup of the cataract and intraocular lens implant patient.

    PubMed

    Hagan, J C; Wyatt, B

    1993-01-01

    1. Cataract and intraocular lens (IOL) implant surgery is the most common operation in ophthalmology. Much of the success of cataract and implant surgery depends on thorough and accurate preoperative patient counseling, testing, and biometric measurements. 2. The preoperative workup of cataract and implant surgery should include a complete ocular history and physical examination, patient education, preoperative testing, and informed consent. 3. Essential preoperative testing includes keratometric readings, ultrasound axial length of the eye (A-scan), and a calculation of implant power requirements using a modern implant formula. 4. In some circumstances, corneal endothelial cell counts, corneal pachymetry, and B-scan ultrasonographic scanning of the posterior segment will be needed. Optional testing also might include potential visual acuity (PVA) testing, ophthalmic photography, and corneal topographic scanning.

  13. Guideline implementation: preoperative patient skin antisepsis.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-01-01

    Performing preoperative skin antisepsis to remove soil and microorganisms at the surgical site may help prevent patients from developing a surgical site infection. The updated AORN "Guideline for preoperative skin antisepsis" addresses the topics of preoperative patient bathing and hair removal, selection and application of skin antiseptics, and safe handling, storage, and disposal of skin antiseptics. This article focuses on key points of the guideline to help perioperative personnel develop protocols for patient skin antisepsis. The key points include the need for the patient to take a preoperative bath or shower and the need for perioperative personnel to manage hair at the surgical site, select a safe and effective antiseptic for the individual patient, perform a safe preoperative surgical site prep, and appropriately store skin antiseptics. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  14. Preoperative staging of nodal status in gastric cancer

    PubMed Central

    Berlth, Felix; Chon, Seung-Hun; Chevallay, Mickael; Jung, Minoa Karin

    2017-01-01

    An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of false-positive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods. PMID:28217758

  15. The Importance of Preoperative Staging of Rectal Cancer Using Multiparametric MRI. A Systematic Review

    PubMed

    Bauer, Ferdinand

    2016-01-01

    A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an

  16. Achieving Accurate Ligament Balancing Using Robotic-Assisted Unicompartmental Knee Arthroplasty

    PubMed Central

    Plate, Johannes F.; Mofidi, Ali; Mannava, Sandeep; Smith, Beth P.; Lang, Jason E.; Poehling, Gary G.; Conditt, Michael A.; Jinnah, Riyaz H.

    2013-01-01

    Unicompartmental knee arthroplasty (UKA) allows replacement of a single compartment in patients with limited disease. However, UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics. This study examined the accuracy of dynamic, real-time ligament balancing using a robotic-assisted UKA system. Surgical data obtained from the computer system were prospectively collected from 51 patients (52 knees) undergoing robotic-assisted medial UKA by a single surgeon. Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place. Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan, with 83% of cases within 1 mm at 0°, 30°, 60°, 90°, and 110° of flexion. Ligamentous laxity of 1.31 ± 0.13 mm at 30° of flexion was corrected successfully to 0.78 ± 0.17 mm (P < 0.05). Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic, real-time soft-tissue balancing to help restore natural knee kinematics, potentially improving implant survival and functional outcomes. PMID:23634304

  17. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

    PubMed Central

    Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-01-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

  18. Pre-operative nutritional assessment.

    PubMed

    Corish, C A

    1999-11-01

    Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in surgical patients admitted to hospital. Nutritional status is known to deteriorate over the course of the hospital stay, with poor awareness by medical and nursing staff as to the deleterious effects of impaired nutritional status on clinical outcome and hospital costs. While there is no consensus on the best method for assessment of the nutritional status of surgical patients pre-operatively, there are a number of techniques available. These techniques can be divided into two types, those suitable for screening for nutrition risk on admission to hospital and those used to fully assess nutritional status. Both techniques have their limitations, but if used correctly, and their limitations recognized, should identify the appropriate degree of nutritional intervention for an individual patient in a timely and cost-effective manner. The techniques currently available for nutritional screening and nutritional assessment are reviewed, and their applicability to the Irish setting are discussed in the present paper.

  19. Preoperative imaging for hepatic resection of colorectal cancer metastasis.

    PubMed

    Frankel, Timothy L; Gian, Richard Kinh; Jarnagin, William R

    2012-03-01

    Despite recent advances in chemotherapeutic agents, the prognosis for metastatic colon cancer remains poor. Over the past two decades, hepatic metastasectomy has emerged as a promising technique for improving survival in patients with metastatic colon cancer and in some cases providing long-term cure. To maximize safety and efficacy of metastasectomy, appropriate pre-operative imaging is needed. Advancements in computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have led to improved detection of occult lesions and better definition of surgical anatomy. While CT, PET and MRI have a comparable sensitivity for detection of large liver metastases, MRI excels at detection of subcentimeter liver metastases compared to CT and FDG-PET, especially with the combination of diffusion weighted imaging (DWI) and hepatocyte-specific contrast agents. CT may be useful as a screening modality or in preoperative planning such as volumetric estimation of the remnant liver size or in defining preoperative arterial anatomy for hepatic artery infusion pump placement. While technologic advancements have led to unprecedented image quality and clarity, this does not replace the need for a dedicated, competent radiologist with experience in hepatic imaging.

  20. The value of preoperative functional cortical mapping using navigated TMS.

    PubMed

    Lefaucheur, Jean-Pascal; Picht, Thomas

    2016-04-01

    The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.

  1. Odontoma-associated tooth impaction: accurate diagnosis with simple methods? Case report and literature review.

    PubMed

    Troeltzsch, Matthias; Liedtke, Jan; Troeltzsch, Volker; Frankenberger, Roland; Steiner, Timm; Troeltzsch, Markus

    2012-10-01

    Odontomas account for the largest fraction of odontogenic tumors and are frequent causes of tooth impaction. A case of a 13-year-old female patient with an odontoma-associated impaction of a mandibular molar is presented with a review of the literature. Preoperative planning involved simple and convenient methods such as clinical examination and panoramic radiography, which led to a diagnosis of complex odontoma and warranted surgical removal. The clinical diagnosis was confirmed histologically. Multidisciplinary consultation may enable the clinician to find the accurate diagnosis and appropriate therapy based on the clinical and radiographic appearance. Modern radiologic methods such as cone-beam computed tomography or computed tomography should be applied only for special cases, to decrease radiation.

  2. Preoperative antisepsis: critiquing a research article.

    PubMed

    Lipp, Allyson; Edwards, Peggy

    2010-11-01

    A critique of a research article on preoperative skin antisepsis was undertaken using a recognised framework. This critique drew out issues which may be of use for clinicians in making a judgement regarding implementing change into their clinical practice.

  3. Analysing a family-centred preoperative intervention programme: a dismantling approach

    PubMed Central

    Fortier, M. A.; Blount, R. L.; Wang, S.-M.; Mayes, L. C.; Kain, Z. N.

    2011-01-01

    Background The goal of this project was to identify key effective components of ADVANCE, a family-centred preoperative intervention programme, through the use of a dismantling approach. ADVANCE was previously demonstrated to be more effective than parental presence and just as effective as midazolam in reducing children's preoperative anxiety. The total programme, however, may be difficult to implement in hospitals across the country. Methods Subjects in this follow-up dismantling report were 96 children aged 2–10 who were part of the original study and who underwent anaesthesia and surgery. Baseline characteristics, parental adherence to the components of ADVANCE, and child and parent anxiety were assessed. Results We found that greater parental adherence to the ADVANCE intervention was associated with lower child anxiety before surgery. The two components of ADVANCE that emerged as having a significant impact on children's anxiety were practising with the anaesthesia mask at home and parental planning and use of distraction in the preoperative holding area. In fact, not only did children experience significantly less preoperative anxiety when their parents were adherent to mask practise and use of distraction, their anxiety tended to remain stable and relatively low throughout the preoperative period. Conclusions Shaping and exposure (i.e. practise with the anaesthesia mask) and parental use of distraction in the surgical setting are two beneficial components that could be included in preoperative preparation programmes that will be designed in the future. PMID:21324929

  4. Study of Preoperative Predictive Signs in Management of Facial Nerve in Parotid Tumors

    PubMed Central

    CHIRILA, Magdalena; MURESAN, Mihaela; BOLBOACA, Sorana D.

    2014-01-01

    Objectives: To find preoperative predictive signs for better surgical planning of the facial nerve in parotid tumors. Methods: Prospective study in patients with primary parotid malignancies. Patients with primary parotid malignant tumor were investigated for preoperative clinical signs in correlation with histological findings and surgical management of the facial nerve. Outcomes: The study included 47 patients. Several clinical findings as facial pain, paresthesia, and rapid growth of tumor might suggest the risk of malignancy. Paresis/palsy of the facial nerve was correlates with direct neural involvement. Conclusion: There are several predictive clinical signs that might suggest malignancy of a parotid tumor. PMID:25553124

  5. Assisting vascular access surgery planning for hemodialysis by using MR, image segmentation techniques, and computer simulations.

    PubMed

    Merkx, M A G; Bode, A S; Huberts, W; Oliván Bescós, J; Tordoir, J H M; Breeuwer, M; van de Vosse, F N; Bosboom, E M H

    2013-08-01

    The surgical creation of a vascular access, used for hemodialysis treatment of renal patients, has considerable complication rates (30-50 %). Image-based computational modeling might assist the surgeon in planning by enhanced analysis of preoperative hemodynamics, and in the future might serve as platform for outcome prediction. The objective of this study is to investigate preoperative personalization of the computer model using magnetic resonance (MR). MR-angiography and MR-flow data were obtained for eight patients and eight volunteers. Blood vessels were extracted for model input by a segmentation algorithm. Windkessel elements were added at the ends to represent the peripheral beds. Monte Carlo-based calibration was used to estimate the most influential non-measurable parameters. The predicted flow waveforms were compared with the MR-flow measurements for framework evaluation. The vasculature of all subjects were segmented in on average <5 min. The Monte Carlo-calibrated simulations showed a deviation between measured and simulated flow waveforms of 9 and 10 % for volunteers and patients, respectively. The presented method accurately mimics the preoperative hemodynamic state. Furthermore, the surgeon can interactively explore the hemodynamics at any vascular tree position. This integration of measurements in a modeling approach can provide the surgeon with additional information for preoperative planning.

  6. [Preoperative correction of volemic disorders in thyrotoxicosis].

    PubMed

    Lukomskiĭ, G I; Ivanova, N A; Krivenko, N G

    1976-01-01

    The investigations conducted by the authors enabled them to pinpoint further the complex of symptoms determining a phase character of volemic disturbances in thyrotoxicosis. The phases somewhat reveal the volemic substrate of thyrotoxicosis, allowing an aimed management of some stages of the preoperative preparation. The latter is conventionally divided according to Sh. Milk into three periods: initial, intermediate and final. The main aim of the preoperative correction is to normalize hydration correlations, that is likely to be gained by excreting excessive sodium and replenishment of potassium deficit.

  7. Patient-tailored plate for bone fixation and accurate 3D positioning in corrective osteotomy.

    PubMed

    Dobbe, J G G; Vroemen, J C; Strackee, S D; Streekstra, G J

    2013-02-01

    A bone fracture may lead to malunion of bone segments, which gives discomfort to the patient and may lead to chronic pain, reduced function and finally to early osteoarthritis. Corrective osteotomy is a treatment option to realign the bone segments. In this procedure, the surgeon tries to improve alignment by cutting the bone at, or near, the fracture location and fixates the bone segments in an improved position, using a plate and screws. Three-dimensional positioning is very complex and difficult to plan, perform and evaluate using standard 2D fluoroscopy imaging. This study introduces a new technique that uses preoperative 3D imaging to plan positioning and design a patient-tailored fixation plate that only fits in one way and realigns the bone segments as planned. The method is evaluated using artificial bones and renders realignment highly accurate and very reproducible (d(err) < 1.2 ± 0.8 mm and φ(err) < 1.8° ± 2.1°). Application of a patient-tailored plate is expected to be of great value for future corrective osteotomy surgeries.

  8. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  9. Preoperational test report, vent building ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  10. A comparison between patient recall and concurrent measurement of preoperative quality of life outcome in total hip arthroplasty.

    PubMed

    Howell, Jonathan; Xu, Min; Duncan, Clive P; Masri, Bassam A; Garbuz, Donald S

    2008-09-01

    The objective is to evaluate the reliability of patients' recall of preoperative pain and function during the immediate postoperation period after total hip arthroplasty. A prospective cohort of 104 patients completed a survey about their quality of life before operation, and recalled preoperative status at 3 days, 6 weeks, and 12 weeks after operation. Quality of life was measured by the Western Ontario and McMaster University Osteoarthritis Index, the Oxford-12 hip score, and the 12-item Short-Form score. The intraclass correlation coefficient and Spearman correlation coefficient were used to compare preoperative quality of life scores to the scores recalled. The reliability of recall remained high up to 3 months postoperation. Patients are able to accurately recall their preoperative function for up to 3 months after total hip arthroplasty.

  11. Contemporary approach to preoperative preparation of patients with adrenal cortex hormones dysfunction.

    PubMed

    Kalezić, Nevena; Malenković, Vesna; Zivaljević, Vladan; Sabljak, Vera; Diklić, Aleksandar; Ivan, Paunović

    2011-01-01

    Preoperative preparation of the patients with adrenal cortex dysfunction is based on the careful preoperative evaluation of the type and the severity of the disturbance. The dysfunction involving adrenal glands may be: insufficiency (severe, mild, expressed) and hyperfunction (hypercorticism and/or hyperaldosteronism). If we speak about the patients with limited adrenal reserve (Addison's disease, therapeutic glucocorticoid application etc.) they need necessary corticosteroid supplementation, during preoperative preparation, as well as, during complete perioperative period. Doses needed for the substitution are adjusted according to the severity of adrenal insufficiency and according to the extent of the planned surgical procedure. Patients with Cushing's syndrome (or other form of hypercorticism), as well as, patients with Conn's syndrome (or other forms of hyperaldosteronism), do have numerous organ dysfunctions, that are significant in preoperative preparation, anesthesia and for the outcome of the surgical treatment. Common feature for both of the above syndromes is hydroelectrolyte disbalance, with hypokalemia, metabolic alkalosis and hypertension. Disturbances related to the adrenal cortex hyperfunction must be corrected preoperatively, in order to avoid complications. When we speak about hypokalemia it must be promptly corrected even before urgent/vital surgical procedure because it may cause severe intraoperative cardiac arrhythmia.

  12. Biochemical Diagnosis and Preoperative Imaging of GEP NETs

    PubMed Central

    Maxwell, Jessica E.; O’Dorisio, Thomas M.; Howe, James R.

    2015-01-01

    SYNOPSIS Neuroendocrine tumors (NETs) are a diverse group of neoplasms that can arise in a variety of locations throughout the body and often metastasize early. A patient’s only chance for cure is surgical removal of the primary tumor and all associated metastases, although even when surgical cure is unlikely, patients can benefit from surgical debulking of their disease. A thorough preoperative workup will often require multiple clinical tests and imaging studies to locate the primary tumor, delineate the extent of the disease, and assess tumor functionality. This review will discuss the biomarkers important for the diagnosis of these unique tumors and the imaging modalities that are most helpful for surgical planning. PMID:26610781

  13. Preoperative localization of the central sulcus by dipole source analysis of early somatosensory evoked potentials and three-dimensional magnetic resonance imaging.

    PubMed

    Buchner, H; Adams, L; Knepper, A; Rüger, R; Laborde, G; Gilsbach, J M; Ludwig, I; Reul, J; Scherg, M

    1994-05-01

    Surgery of lesions within or close to the central area of the brain always carries the risk of iatrogenic motor or sensory deficits. Functional localization by means of intraoperative direct stimulation of the motor area or by recording somatosensory evoked potentials (SSEP's) from the surface of the somatosensory cortex is believed to reduce the operative risk. The authors introduce the combination of dipole source analysis of scalp-recorded SSEP's with three-dimensional (3-D) magnetic resonance (MR) imaging as a tool for preoperative localization of the central sulcus. This provides information on both functional and structural localization for preoperative planning. Four repeated measurements of right and left median nerve SSEP's were obtained from 20 subjects. Dipole source analysis showed a retest reliability of the 3-D localization error of 2.9 +/- 2.0 mm. Compared to the MR evaluation, dipole source analysis was found to mark the central sulcus within 3 mm for 15 conditions (subjects x side of stimulation), while the 3-D MR measurement was accurate to within 6 mm for 10 conditions and 9 mm for 14 conditions. Dipole locations were confirmed in six patients who underwent surgery of the central region. With respect to this application, dipole source analysis combined with 3-D MR imaging appears to be a valuable tool for preoperative functional localization. The accuracy in localization will be further improved when realistic head models become available that can take into account individual head geometry. Further development of the proposed new method holds promise that evoked potentials and electroencephalography will gain greater use in presurgical functional localization.

  14. Preoperative blood transfusions for sickle cell disease

    PubMed Central

    Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

    2016-01-01

    Background Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Surgical interventions are more common in people with sickle cell disease, and occur at much younger ages than in the general population. Blood transfusions are frequently used prior to surgery and several regimens are used but there is no consensus over the best method or the necessity of transfusion in specific surgical cases. This is an update of a Cochrane review first published in 2001. Objectives To determine whether there is evidence that preoperative blood transfusion in people with sickle cell disease undergoing elective or emergency surgery reduces mortality and perioperative or sickle cell-related serious adverse events. To compare the effectiveness of different transfusion regimens (aggressive or conservative) if preoperative transfusions are indicated in people with sickle cell disease. Search methods We searched for relevant trials in The Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 23 March 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 18 January 2016. Selection criteria All randomised controlled trials and quasi-randomised controlled trials comparing preoperative blood transfusion regimens to different regimens or no transfusion in people with sickle cell disease undergoing elective or emergency surgery. There was no restriction by outcomes examined, language or publication status. Data collection and analysis Two authors independently assessed trial eligibility and the risk of bias and extracted data. Main results Three trials with 990 participants were eligible for inclusion in the review. There were no

  15. The Impact of Preoperative Magnetic Resonance Imaging on Surgical Treatment and Outcomes for Ductal Carcinoma In Situ

    PubMed Central

    Itakura, Kaoru; Lessing, Juan; Sakata, Theadora; Heinzerling, Amy; Vriens, Eline; Wisner, Dorota; Alvarado, Michael; Esserman, Laura; Ewing, Cheryl; Hylton, Nola; Hwang, E. Shelley

    2014-01-01

    Background Although magnetic resonance imaging (MRI) is a useful imaging modality for invasive cancer, its role in preoperative surgical planning for ductal carcinoma in situ (DCIS) has not been established. We sought to determine whether preoperative MRI affects surgical treatment and outcomes in women with pure DCIS. Patients and Methods We reviewed consecutive records of women diagnosed with pure DCIS on core biopsy between 2000 and 2007. Patient characteristics, surgical planning, and outcomes were compared between patients with and without preoperative MRI. Multivariable regression was performed to determine which covariates were independently associated with mastectomy or sentinel lymph node biopsy (SLNB). Results Of 149 women diagnosed with DCIS, 38 underwent preoperative MRI. On univariate analysis, patients undergoing MRI were younger (50 years vs. 59 years; P < .001) and had larger DCIS size on final pathology (1.6 cm vs. 1.0 cm; P = .007) than those without MRI. Mastectomy and SLNB rates were significantly higher in the preoperative MRI group (45% vs. 14%, P < .001; and 47% vs. 23%, P = .004, respectively). However, there were no differences in number of re-excisions, margin status, and margin size between the two groups. On multivariate analysis, preoperative MRI and age were independently associated with mastectomy (OR, 3.16, P = .018; OR, 0.95, P = .031, respectively), while multifocality, size, and family history were not significant predictors. Conclusion We found a strong association between preoperative MRI and mastectomy in women undergoing treatment for DCIS. Additional studies are needed to examine the increased rates of mastectomy as a possible consequence of preoperative MRI for DCIS. PMID:21421520

  16. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

    PubMed Central

    2016-01-01

    MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). PMID:26941984

  17. The importance of thorough preoperative diagnostics of maxillary ameloblastoma: report of three cases.

    PubMed

    Matijević, Marko; Leović, Dinko; Popić, Bruno; Zubcić, Vedran; Kopić, Vlatko; Prlić, Ante; Siber, Stjepan; Dinjar, Kristijan

    2010-12-01

    Ameloblastoma, especially maxillary, is a rare benign neoplasm of odontogenic origin. Diagnosis of significant number of lesions is usually established postoperatively, because ameloblastoma, especially the unicystic form, mimics wide range of more frequent jaw lesions. From January 1993 to December 2005, three cases of the maxillary ameloblastoma were surgically treated at our Department. The authors present clinical, radiological and pathohistological features of the ameloblastomas in this rare localization with special attention to need of accurate preoperative diagnostics.

  18. Accurate Finite Difference Algorithms

    NASA Technical Reports Server (NTRS)

    Goodrich, John W.

    1996-01-01

    Two families of finite difference algorithms for computational aeroacoustics are presented and compared. All of the algorithms are single step explicit methods, they have the same order of accuracy in both space and time, with examples up to eleventh order, and they have multidimensional extensions. One of the algorithm families has spectral like high resolution. Propagation with high order and high resolution algorithms can produce accurate results after O(10(exp 6)) periods of propagation with eight grid points per wavelength.

  19. Accurate monotone cubic interpolation

    NASA Technical Reports Server (NTRS)

    Huynh, Hung T.

    1991-01-01

    Monotone piecewise cubic interpolants are simple and effective. They are generally third-order accurate, except near strict local extrema where accuracy degenerates to second-order due to the monotonicity constraint. Algorithms for piecewise cubic interpolants, which preserve monotonicity as well as uniform third and fourth-order accuracy are presented. The gain of accuracy is obtained by relaxing the monotonicity constraint in a geometric framework in which the median function plays a crucial role.

  20. Preoperative Embolization of Cervical Spine Tumors

    SciTech Connect

    Vetter, Sylvia C.; Strecker, Ernst-Peter; Ackermann, Ludwig W.; Harms, Juergen

    1997-09-15

    Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.

  1. [Preoperative assessment of patients with diabetes mellitus].

    PubMed

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  2. Perineovulvovaginal preoperative preparation in minor gynecological surgery.

    PubMed

    Adeleye, J A

    1976-09-01

    Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

  3. Anaphylactic reaction secondary to topical preoperative moxifloxacin.

    PubMed

    Ullman, Michael A; Midgley, Kirsten J; Kim, Jocelyn; Ullman, Saul

    2016-12-01

    We report a case of anaphylactic shock following topical administration of moxifloxacin for endophthalmitis prophylaxis prior to cataract surgery. Immunoglobulin E (IgE) serology and IgE skin testing confirmed the anaphylactic etiology. Phacoemulsification with posterior chamber intraocular lens implantation was later performed with identical preoperative preparation except for the exclusion of moxifloxacin; no anaphylactic response occurred. To our knowledge, this is the first report of an anaphylactic response to topical moxifloxacin.

  4. Three-Dimensional Path Planning and Guidance of Leg Vascular Based on Improved Ant Colony Algorithm in Augmented Reality.

    PubMed

    Gao, Ming-ke; Chen, Yi-min; Liu, Quan; Huang, Chen; Li, Ze-yu; Zhang, Dian-hua

    2015-11-01

    Preoperative path planning plays a critical role in vascular access surgery. Vascular access surgery has superior difficulties and requires long training periods as well as precise operation. Yet doctors are on different leves, thus bulky size of blood vessels is usually chosen to undergo surgery and other possible optimal path is not considered. Moreover, patients and surgeons will suffer from X-ray radiation during the surgical procedure. The study proposed an improved ant colony algorithm to plan a vascular optimal three-dimensional path with overall consideration of factors such as catheter diameter, vascular length, diameter as well as the curvature and torsion. To protect the doctor and patient from exposing to X-ray long-term, the paper adopted augmented reality technology to register the reconstructed vascular model and physical model meanwhile, locate catheter by the electromagnetic tracking system and used Head Mounted Display to show the planning path in real time and monitor catheter push procedure. The experiment manifests reasonableness of preoperative path planning and proves the reliability of the algorithm. The augmented reality experiment real time and accurately displays the vascular phantom model, planning path and the catheter trajectory and proves the feasibility of this method. The paper presented a useful and feasible surgical scheme which was based on the improved ant colony algorithm to plan vascular three-dimensional path in augmented reality. The study possessed practical guiding significance in preoperative path planning, intraoperative catheter guiding and surgical training, which provided a theoretical method of path planning for vascular access surgery. It was a safe and reliable path planning approach and possessed practical reference value.

  5. Paraganglioma of the heart. The value of magnetic resonance imaging in the preoperative evaluation.

    PubMed

    Conti, V R; Saydjari, R; Amparo, E G

    1986-10-01

    Although the 131I-metaiodobenzylguanidine scan has proven reliable in identifying mediastinal paragangliomas, further localization has usually required dynamic computerized tomographic scanning which requires rapid bolus injection of contrast material. In the case presented herein, magnetic resonance imaging provided accurate preoperative localization and added important anatomic detail that was not appreciated with dynamic computerized tomograms or with other studies. Magnetic resonance imaging can accurately localize cardiac paragangliomas without injection of contrast material and may provide more detailed information for better guidance for surgical excision.

  6. Preoperative Medical Evaluation: Part 2: Pulmonary, Endocrine, Renal, and Miscellaneous Considerations

    PubMed Central

    Becker, Daniel E

    2009-01-01

    A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders. PMID:20020794

  7. Strategy for accurate liver intervention by an optical tracking system

    PubMed Central

    Lin, Qinyong; Yang, Rongqian; Cai, Ken; Guan, Peifeng; Xiao, Weihu; Wu, Xiaoming

    2015-01-01

    Image-guided navigation for radiofrequency ablation of liver tumors requires the accurate guidance of needle insertion into a tumor target. The main challenge of image-guided navigation for radiofrequency ablation of liver tumors is the occurrence of liver deformations caused by respiratory motion. This study reports a strategy of real-time automatic registration to track custom fiducial markers glued onto the surface of a patient’s abdomen to find the respiratory phase, in which the static preoperative CT is performed. Custom fiducial markers are designed. Real-time automatic registration method consists of the automatic localization of custom fiducial markers in the patient and image spaces. The fiducial registration error is calculated in real time and indicates if the current respiratory phase corresponds to the phase of the static preoperative CT. To demonstrate the feasibility of the proposed strategy, a liver simulator is constructed and two volunteers are involved in the preliminary experiments. An ex-vivo porcine liver model is employed to further verify the strategy for liver intervention. Experimental results demonstrate that real-time automatic registration method is rapid, accurate, and feasible for capturing the respiratory phase from which the static preoperative CT anatomical model is generated by tracking the movement of the skin-adhered custom fiducial markers. PMID:26417501

  8. Incidental sinonasal findings identified during preoperative evaluation for endoscopic transsphenoidal approaches

    PubMed Central

    Laury, Adrienne M.; Oyesiku, Nelson M.; Hadjipanayis, Costas G.; DelGaudio, John M.

    2013-01-01

    Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery–otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation

  9. Significance of preoperative calculation of uterine weight as an indicator for preserving the uterus in pelvic reconstructive surgery.

    PubMed

    Sheng, Qingsong; Ma, Ning; Huang, Huijuan; Xu, Bo; He, Chunni; Song, Yanfeng

    2015-01-01

    Recently, increasing evidence has shown that uterus preservation is beneficial for pelvic organ prolapse (POP) patients, both physiologically and psychologically. However, the preoperative indicators for uterus preservation have rarely been examined. The current study was designed to determine the relationship between the preoperative evaluated uterus weight and the operation selection (preserving the uterus or not) in pelvic reconstructive surgery (PRS) using vaginal meshes. First, in a series of 96 patients undergoing hysterectomy, the uterine weight was calculated by preoperative ultrasound measurements, and was then compared with the postoperative actual weight of the uterus. Subsequently, in a series of 65 patients undergone PRS using vaginal meshes and preserving the uterus, the uterine weight was calculated by preoperative ultrasound measurements. Lastly, in a series of 43 patients with a uterine weight > 56.12 g who had undergone PRS using vaginal meshes, the operation success rate in patients with a preserved uterus was compared to patients for whom the uterus was not preserved. The results showed that uterus weight can be evaluated by ultrasound and used as a preoperative indicator for whether the uterus should be preserved or not in PRS when using vaginal meshes. It was indicated that preoperative evaluation of uterine weight is beneficial for surgical planning and guidance.

  10. Accurate quantum chemical calculations

    NASA Technical Reports Server (NTRS)

    Bauschlicher, Charles W., Jr.; Langhoff, Stephen R.; Taylor, Peter R.

    1989-01-01

    An important goal of quantum chemical calculations is to provide an understanding of chemical bonding and molecular electronic structure. A second goal, the prediction of energy differences to chemical accuracy, has been much harder to attain. First, the computational resources required to achieve such accuracy are very large, and second, it is not straightforward to demonstrate that an apparently accurate result, in terms of agreement with experiment, does not result from a cancellation of errors. Recent advances in electronic structure methodology, coupled with the power of vector supercomputers, have made it possible to solve a number of electronic structure problems exactly using the full configuration interaction (FCI) method within a subspace of the complete Hilbert space. These exact results can be used to benchmark approximate techniques that are applicable to a wider range of chemical and physical problems. The methodology of many-electron quantum chemistry is reviewed. Methods are considered in detail for performing FCI calculations. The application of FCI methods to several three-electron problems in molecular physics are discussed. A number of benchmark applications of FCI wave functions are described. Atomic basis sets and the development of improved methods for handling very large basis sets are discussed: these are then applied to a number of chemical and spectroscopic problems; to transition metals; and to problems involving potential energy surfaces. Although the experiences described give considerable grounds for optimism about the general ability to perform accurate calculations, there are several problems that have proved less tractable, at least with current computer resources, and these and possible solutions are discussed.

  11. [Preoperative and surgical protocols for better implant integration].

    PubMed

    Takács, G

    1994-01-01

    In implant placement, different bone densities require different implant types in order to achieve maximum stability. Therefore, careful preoperative planning is essential to diagnose and/or augment the bone, to select the correct size and type of implant for each individual case, and to establish the appropriate surgical protocol. This paper and presentation discuss the essentials for establishing such protocol, ie, the quality and quantity of bone, type and size of implants, surgery, progressive loading, and shifting of the mastication forces. Serious errors in planning first appear as short-term failures, and they indicate inadequacy in osseointegration in the healing phase or overloading caused by the superstructure. Less grave errors occur later as long-term failures, due to the width, depth, and density of the bone and the angulation of the implant. Appropriate components have to be used for different types of bone: Uncoated screws are the best solution for D1 and D2 types of bone; coated screws should be used in the presinus area and after nerve transpositioning. Cylindrical implants are best suited for subantral augmentation, using a narrow drill; the bone bed is progressively widened by a conic osteotome, and the technique provides a good stability. Free gingival transplant is indicated in cases with insufficient keratinized gingiva. Masticatory overloading can be avoided by reducing the occlusal table, decreasing cusp inclination, and anteriorizing the upper mastication areas.

  12. Fundoplication for laryngopharyngeal reflux despite preoperative dysphagia.

    PubMed

    Falk, G L; Van der Wall, H; Burton, L; Falk, M G; O'Donnell, H; Vivian, S J

    2017-03-01

    INTRODUCTION Fundoplication for laryngopharyngeal disease with oesophageal dysmotility has led to mixed outcomes. In the presence of preoperative dysphagia and oesophageal dysmotility, this procedure has engendered concern in certain regards. METHODS This paper describes a consecutive series of laryngopharyngeal reflux (LPR) patients with a high frequency of dysmotility. Patients were selected for surgery with 24-hour dual channel pH monitoring, oesophageal manometry and standardised reflux scintigraphy. RESULTS Following careful patient selection, 33 patients underwent fundoplication by laparoscopy. Surgery had high efficacy in symptom control and there was no adverse dysphagia. CONCLUSIONS Evidence of proximal reflux can select a group of patients for good results of fundoplication for atypical symptoms.

  13. Preoperational test report, recirculation ventilation systems

    SciTech Connect

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  14. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  15. BIOACCESSIBILITY TESTS ACCURATELY ESTIMATE ...

    EPA Pesticide Factsheets

    Hazards of soil-borne Pb to wild birds may be more accurately quantified if the bioavailability of that Pb is known. To better understand the bioavailability of Pb to birds, we measured blood Pb concentrations in Japanese quail (Coturnix japonica) fed diets containing Pb-contaminated soils. Relative bioavailabilities were expressed by comparison with blood Pb concentrations in quail fed a Pb acetate reference diet. Diets containing soil from five Pb-contaminated Superfund sites had relative bioavailabilities from 33%-63%, with a mean of about 50%. Treatment of two of the soils with P significantly reduced the bioavailability of Pb. The bioaccessibility of the Pb in the test soils was then measured in six in vitro tests and regressed on bioavailability. They were: the “Relative Bioavailability Leaching Procedure” (RBALP) at pH 1.5, the same test conducted at pH 2.5, the “Ohio State University In vitro Gastrointestinal” method (OSU IVG), the “Urban Soil Bioaccessible Lead Test”, the modified “Physiologically Based Extraction Test” and the “Waterfowl Physiologically Based Extraction Test.” All regressions had positive slopes. Based on criteria of slope and coefficient of determination, the RBALP pH 2.5 and OSU IVG tests performed very well. Speciation by X-ray absorption spectroscopy demonstrated that, on average, most of the Pb in the sampled soils was sorbed to minerals (30%), bound to organic matter 24%, or present as Pb sulfate 18%. Ad

  16. Preoperative Preparation and Anesthesia for Trabeculectomy

    PubMed Central

    2016-01-01

    ABSTRACT Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35. PMID:27231416

  17. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    PubMed

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise

    2013-03-01

    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer.

  18. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery.

    PubMed

    Wang, Y Y; Zhang, H Q; Fan, S; Zhang, D M; Huang, Z Q; Chen, W L; Ye, J T; Li, J S

    2016-11-01

    This study evaluated the accuracy of mandibular reconstruction and assessed clinical outcomes in both virtual planning and conventional surgery patients. ProPlan CMF surgical planning software was used preoperatively in the virtual planning group. In the virtual planning group, fibula flaps were harvested and osteotomized, and the mandibles were resected and reconstructed assisted by the prefabricated cutting guides and templates. The main outcome measures included the operative time, postoperative computed tomography (CT) scans, facial appearance, and occlusal function. The ischemia time and total operation time were shorter in the virtual planning group than in the conventional surgery group. High precision with the use of the cutting guides and templates was found for both the fibula and mandible, and a good fit was noted among the pre-bent plate, mandible, and fibula segments in the virtual planning group. Postoperative CT scans also showed excellent mandibular contours of the fibula flaps in accordance with virtual plans in the virtual planning group. This study demonstrated that virtual surgical planning was able to achieve more accurate mandibular reconstruction than conventional surgery. The use of prefabricated cutting guides and plates makes fibula flap moulding and placement easier, minimizes the operating time, and improves clinical outcomes.

  19. Accurate spectral color measurements

    NASA Astrophysics Data System (ADS)

    Hiltunen, Jouni; Jaeaeskelaeinen, Timo; Parkkinen, Jussi P. S.

    1999-08-01

    Surface color measurement is of importance in a very wide range of industrial applications including paint, paper, printing, photography, textiles, plastics and so on. For a demanding color measurements spectral approach is often needed. One can measure a color spectrum with a spectrophotometer using calibrated standard samples as a reference. Because it is impossible to define absolute color values of a sample, we always work with approximations. The human eye can perceive color difference as small as 0.5 CIELAB units and thus distinguish millions of colors. This 0.5 unit difference should be a goal for the precise color measurements. This limit is not a problem if we only want to measure the color difference of two samples, but if we want to know in a same time exact color coordinate values accuracy problems arise. The values of two instruments can be astonishingly different. The accuracy of the instrument used in color measurement may depend on various errors such as photometric non-linearity, wavelength error, integrating sphere dark level error, integrating sphere error in both specular included and specular excluded modes. Thus the correction formulas should be used to get more accurate results. Another question is how many channels i.e. wavelengths we are using to measure a spectrum. It is obvious that the sampling interval should be short to get more precise results. Furthermore, the result we get is always compromise of measuring time, conditions and cost. Sometimes we have to use portable syste or the shape and the size of samples makes it impossible to use sensitive equipment. In this study a small set of calibrated color tiles measured with the Perkin Elmer Lamda 18 and the Minolta CM-2002 spectrophotometers are compared. In the paper we explain the typical error sources of spectral color measurements, and show which are the accuracy demands a good colorimeter should have.

  20. Preoperative functional MRI localization of language areas in Chinese patients with brain tumors

    PubMed Central

    Xia, Hechun; Huang, Wei; Wu, Liang; Ma, Hui; Wang, Xiaodong; Chen, Xuexin; Sun, Shengyu; Jia, Xiaoxiong

    2012-01-01

    Ten Chinese patients with brain tumors involving language regions were selected. Preoperative functional MRI was performed to locate Broca's or Wernicke's area, and the cortex that was essential for language function was determined by electrocortical mapping. A site-by-site comparison between functional MRI and electrocortical mapping was performed with the aid of a neuronavigation device. Results showed that the sensitivity and specificity of preoperative functional MRI were 80.0% and 85.0% in Broca's area and 66.6% and 85.2% in Wernicke's area, respectively. These experimental findings indicate that functional MRI is an accurate, reliable technique with which to identify the location of Wernicke's area or Broca's area in patients with brain tumors. PMID:25657694

  1. On accurate determination of contact angle

    NASA Technical Reports Server (NTRS)

    Concus, P.; Finn, R.

    1992-01-01

    Methods are proposed that exploit a microgravity environment to obtain highly accurate measurement of contact angle. These methods, which are based on our earlier mathematical results, do not require detailed measurement of a liquid free-surface, as they incorporate discontinuous or nearly-discontinuous behavior of the liquid bulk in certain container geometries. Physical testing is planned in the forthcoming IML-2 space flight and in related preparatory ground-based experiments.

  2. Comparison of pre/post-operative CT image volumes to preoperative digitization of partial hepatectomies: a feasibility study in surgical validation

    NASA Astrophysics Data System (ADS)

    Dumpuri, Prashanth; Clements, Logan W.; Li, Rui; Waite, Jonathan M.; Stefansic, James D.; Geller, David A.; Miga, Michael I.; Dawant, Benoit M.

    2009-02-01

    Preoperative planning combined with image-guidance has shown promise towards increasing the accuracy of liver resection procedures. The purpose of this study was to validate one such preoperative planning tool for four patients undergoing hepatic resection. Preoperative computed tomography (CT) images acquired before surgery were used to identify tumor margins and to plan the surgical approach for resection of these tumors. Surgery was then performed with intraoperative digitization data acquire by an FDA approved image-guided liver surgery system (Pathfinder Therapeutics, Inc., Nashville, TN). Within 5-7 days after surgery, post-operative CT image volumes were acquired. Registration of data within a common coordinate reference was achieved and preoperative plans were compared to the postoperative volumes. Semi-quantitative comparisons are presented in this work and preliminary results indicate that significant liver regeneration/hypertrophy in the postoperative CT images may be present post-operatively. This could challenge pre/post operative CT volume change comparisons as a means to evaluate the accuracy of preoperative surgical plans.

  3. Discordance Between Preoperative and Postoperative Bladder Cancer Location: Implications for Partial-Bladder Radiation

    SciTech Connect

    Goldsmith, Benjamin; Tucker, Kai; Conway, Robert Greg; He, Jiwei; Guzzo, Thomas; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha; Malkowicz, S. Bruce; Christodouleas, John

    2013-03-01

    Purpose: There is strong interest in partial-bladder radiation whether as a boost or definitive therapy to limit long-term toxicity. It is unclear that a standard preoperative examination can accurately identify all sites of disease within the bladder. The purpose of this study was to determine the correlation between preoperative localization of bladder tumors with postoperative findings to facilitate partial-bladder radiation techniques when appropriate. Methods and Materials: We examined patients with clinically staged T1-T4 invasive transitional cell carcinoma (TCC) or TCC with variant histology with no history of radiation or partial cystectomy undergoing radical cystectomy. Patients were scored as “under-detected” if a bladder site was involved with invasive disease (≥T1) at the time of cystectomy, but not identified preoperatively. Patients were additionally scored as “widely under-detected” if they had postoperative lesions that were not identified preoperatively in a given site, nor in any adjacent site. Rates of under-detected and widely under-detected lesions, as well as univariate and multivariate association between clinical variables and under-detection, were evaluated using logistic regression. Results: Among 222 patients, 96% (213/222) had at least 1 area of discordance. Fifty-eight percent of patients were under-detected in at least 1 location, whereas 12% were widely under-detected. Among 24 patients with a single site of disease on preoperative evaluation, 21/24 (88%) had at least 1 under-detected lesion and 14/24 (58%) were widely under-detected. On multivariate analysis, only solitary site of preoperative disease was associated with increased levels of under-detection of invasive disease (OR = 4.161, 95% CI, 1.368-12.657). Conclusion: Our study shows a stark discordance between preoperative and postoperative localization of bladder tumors. From a clinical perspective, incomplete localization of all sites of disease within the bladder

  4. Preoperative nuclear scans in patients with melanoma

    SciTech Connect

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-05-15

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

  5. Predictors of preoperative anxiety in children.

    PubMed

    Wollin, S R; Plummer, J L; Owen, H; Hawkins, R M F; Materazzo, F

    2003-02-01

    This study aimed to identify factors contributing to anxiety at induction of anaesthesia in children. One hundred and twenty children aged five to twelve years and scheduled for surgery requiring general anaesthesia were included. Children were interviewed and assessed prior to surgery. Parents completed anxiety measures prior to surgery and were interviewed after the induction of anaesthesia. The level of children's anxiety was determined at the time of induction of anaesthesia by the modified Yale Preoperative Anxiety Scale. Factors associated with increased levels of anxiety in the children included increased number of people in the room at induction of anaesthesia; longer waiting time between admission at the hospital and induction of anaesthesia; negative memories of previous hospital experiences; and having a mother who does not practise a religion. Suggestions for implementation of the findings and for future research are provided.

  6. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

    Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

    2014-01-01

    Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner’s syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as “Pancoast-Tobias syndrome”. Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

  7. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  8. Pre-operative respiratory evaluation and management of patients for upper abdominal surgery.

    PubMed Central

    Davies, J. M.

    1991-01-01

    Patients presenting for surgery, be it on an elective or emergency basis, do so in the hope that the anesthetic will be without risk. Yet complications which arise are not always due to anesthesia. More often, the surgical process and factors intrinsic to the patient are major determinants of outcome. Pre-operative assessment allows review of the patient and the proposed surgery, and formation of a plan of management for the pre-, intra-, and post-operative anesthetic care. This paper provides an overview of the pre-operative assessment and management of patients who are to undergo upper abdominal surgery, with the aim of minimizing their risk of post-operative pulmonary complications. In particular, factors which contribute to the development of post-operative respiratory problems are described. PMID:1814053

  9. Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy: A case report and literature review

    PubMed Central

    Takase, Nobuhisa; Yamashita, Kimihiro; Sumi, Yasuo; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Matsuda, Yoshiko; Matsuda, Takeru; Oshikiri, Taro; Nakamura, Tetsu; Suzuki, Satoshi; Koma, Yu-Ichiro; Komatsu, Masato; Sasaki, Ryohei; Kakeji, Yoshihiro

    2017-01-01

    Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT. PMID:28138443

  10. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

  11. Amyloid goiter: preoperative scintigraphic diagnosis using Tc-99m pyrophosphate

    SciTech Connect

    Lee, V.W.; Rubinow, A.; Pehrson, J.; Skinner, M.; Cohen, A.S.

    1984-04-01

    Amyloid goiter is a rare clinical entity. The diagnosis is rarely made preoperatively because clinical and laboratory findings are nonspecific. The authors report two cases of amyloid goiter in whom the diagnosis was made preoperatively using Tc-99m pyrophosphate scintigraphy.

  12. Plan to procedure: combining 3D templating with rapid prototyping to enhance pedicle screw placement

    NASA Astrophysics Data System (ADS)

    Augustine, Kurt E.; Stans, Anthony A.; Morris, Jonathan M.; Huddleston, Paul M.; Matsumoto, Jane M.; Holmes, David R., III; Robb, Richard A.

    2010-02-01

    Spinal fusion procedures involving the implantation of pedicle screws have steadily increased over the past decade because of demonstrated improvement in biomechanical stability of the spine. However, current methods of spinal fusion carries a risk of serious vascular, visceral, and neurological injury caused by inaccurate placement or inappropriately sized instrumentation, which may lead to patient paralysis or even fatality. 3D spine templating software developed by the Biomedical Imaging Resource (BIR) at Mayo Clinic allows the surgeon to virtually place pedicle screws using pre-operative 3D CT image data. With the template plan incorporated, a patient-specific 3D anatomic model is produced using a commercial rapid prototyping system. The pre-surgical plan and the patient-specific model then are used in the procedure room to provide real-time visualization and quantitative guidance for accurate placement of each pedicle screw, significantly reducing risk of injury. A pilot study was conducted at Mayo Clinic by the Department of Radiology, the Department of Orthopedics, and the BIR, involving seven complicated pediatric spine cases. In each case, pre-operative 3D templating was carried out and patient specific models were generated. The plans and the models were used intra-operatively, providing precise pedicle screw starting points and trajectories. Postoperative assessment by the surgeon confirmed all seven operations were successful. Results from the study suggest that patient-specific, 3D anatomic models successfully acquired from 3D templating tools are valuable for planning and conducting pedicle screw insertion procedures.

  13. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities

    PubMed Central

    van Bergen, Christiaan JA; Gerards, Rogier M; Opdam, Kim TM; Terra, Maaike P; Kerkhoffs, Gino MMJ

    2015-01-01

    This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available. PMID:26716090

  14. Preoperative management of anticoagulation and antiplatelet agents.

    PubMed

    Gleason, Lauren Jan; Friedman, Susan M

    2014-05-01

    This article describes current literature and treatment plans for managing anticoagulation and antiplatelet agents in patients presenting with hip fractures. Indications for anticoagulation and antiplatelet agents are discussed, and management techniques for when patients present with hip fractures are reviewed.

  15. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative

  16. [Effect of preoperative administration of Lugol's solution on thyroid blood flow in hyperthyroidism].

    PubMed

    Rodier, J F; Janser, J C; Petit, H; Schneegans, O; Ott, G; Kaissling, A; Grob, J C; Velten, M

    1998-01-01

    A study of 50 patients with hyperthyroidism was conducted to evaluate the effect of preoperative administration of Lugol's iodine solution on thyroid blood flow. Highly significant reductions in diameter, time-averaged velocity, and volume flow of the superior thyroid artery were demonstrated after administration of Lugol's solution. The Duplex ultrasound scanning used in this study is a noninvasive, inexpensive, accurate, and reproducible technique suitable for analysis of thyroid blood flow in hyperthyroidism. On the basis of current ultrasonographic results and low postoperative morbidity in patients, Lugol's solution is well tolerated and may be recommended for use before thyroidectomy, especially for diffuse toxic goiters and Graves disease.

  17. 3D volume assessment techniques and computer-aided design and manufacturing for preoperative fabrication of implants in head and neck reconstruction.

    PubMed

    Patel, Ashish; Otterburn, David; Saadeh, Pierre; Levine, Jamie; Hirsch, David L

    2011-11-01

    Cases in subdisciplines of craniomaxillofacial surgery--corrective jaw surgery, maxillofacial trauma, temporomandibular joint/skull base, jaw reconstruction, and postablative reconstruction-illustrate the ease of use, cost effectiveness, and superior results that can be achieved when using computer-assisted design and 3D volumetric analysis in preoperative surgical planning. This article discusses the materials and methods needed to plan cases, illustrates implementation of guides and implants, and describes postoperative analysis in relation to the virtually planned surgery.

  18. Evaluation of surgical outcome, complications, and mortality in dogs undergoing preoperative computed tomography angiography for diagnosis of an extrahepatic portosystemic shunt: 124 cases (2005–2014)

    PubMed Central

    Brunson, Benjamin W.; Case, J. Brad; Ellison, Gary W.; Fox-Alvarez, W. Alexander; Kim, Stanley E.; Winter, Matthew; Garcia-Pereira, Fernando L.; Farina, Lisa L.

    2016-01-01

    This study evaluated the safety of preoperative computed tomography angiography (CTA) and its effect on surgical time and clinical outcomes in dogs that underwent surgical correction of a single congenital extrahepatic portosystemic shunt (CEPSS). Patient data were retrospectively collected from medical records and owner communications for 124 dogs with single CEPSS, undergoing preoperative CTA (n = 43) or not (n = 81) which were surgically treated from 2005 to 2014. The frequency of major postoperative complications was 4.7% and 9.9% for the CTA and no CTA groups, respectively (P = 0.49). Mean ± standard deviation (SD) surgical time for the preoperative CTA group was 84 ± 40 min and 81 ± 31 min for the no CTA group (P = 0.28). We conclude that anesthetized preoperative CTA appears to be a safe method for diagnosis and surgical planning in dogs with single CEPSS, and does not appear to affect surgical procedure time, complication rate, or clinical outcome. PMID:26740699

  19. New strategies for preoperative skin antisepsis.

    PubMed

    Ulmer, Miriam; Lademann, Juergen; Patzelt, Alexa; Knorr, Fanny; Kramer, Axel; Koburger, Torsten; Assadian, Ojan; Daeschlein, Georg; Lange-Asschenfeldt, Bernhard

    2014-01-01

    During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

  20. A Pre-operative Risk Model for Post-operative Pneumonia following Coronary Artery Bypass Grafting

    PubMed Central

    Strobel, Raymond J.; Liang, Qixing; Zhang, Min; Wu, Xiaoting; Rogers, Mary A. M.; Theurer, Patricia F.; Fishstrom, Astrid B.; Harrington, Steven D.; DeLucia, Alphonse; Paone, Gaetano; Patel, Himanshu J.; Prager, Richard L.; Likosky, Donald S.

    2016-01-01

    Background Post-operative pneumonia is the most prevalent of all hospital-acquired infections following isolated coronary artery bypass grafting (CAB). Accurate prediction of a patient’s risk of this morbid complication is hindered by its low relative incidence. In an effort to support clinical decision-making and quality improvement, we developed a pre-operative prediction model for post-operative pneumonia following CAB. Methods We undertook an observational study of 16,084 patients undergoing CAB between Q3 2011 – Q2 2014 across 33 institutions participating in the Michigan Society of Thoracic and Cardiovascular Surgeons – Quality Collaborative. Variables related to patient demographics, medical history, admission status, comorbid disease, cardiac anatomy and the institution performing the procedure were investigated. Logistic regression via forwards stepwise selection (p < 0.05 threshold) was utilized to develop a risk prediction model for estimating the occurrence of pneumonia. Traditional methods were employed to assess the model’s performance. Results Post-operative pneumonia occurred in 3.30% of patients. Multivariable analysis identified 17 pre-operative factors, including: demographics, laboratory values, comorbid disease, pulmonary and cardiac function, and operative status. The final model significantly predicted the occurrence of pneumonia, and performed well (C-statistic: 0.74). These findings were confirmed via sensitivity analyses by center and clinically important sub-groups. Conclusions We identified 17 readily obtainable pre-operative variables associated with post-operative pneumonia. This model may be used to provide individualized risk estimation and to identify opportunities to reduce a patient’s pre-operative risk of pneumonia through pre-habilitation. PMID:27261082

  1. Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

    PubMed Central

    Choi, Seong Chan; Lee, Saem; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo

    2016-01-01

    Purpose To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). Methods We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. Results CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. Conclusions Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO. PMID:27478350

  2. Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern.

    PubMed

    Tashiro, Kensuke; Harima, Mitsunobu; Mito, Daisuke; Shibata, Takashi; Furuya, Megumi; Kato, Motoi; Yamamoto, Takumi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

    2015-06-01

    The anatomy of the lateral thoracic artery perforator flap remains controversial, but this region is extremely useful as a reconstructive donor site. In this report, we describe the usefulness of the preoperative color Doppler ultrasound evaluation for the harvesting of the lateral thoracic artery perforator flap, and we clarify its branching pattern. Twenty-seven patients underwent the preoperative color Doppler ultrasound assessment before perforator flaps were harvested. We evaluated the branching pattern and the diameter of the flaps by direct observation. All flaps were successfully transferred, and it was found that the branching pattern of the lateral thoracic perforator is divided into three groups: the superficial branch, the medial branch, and the deep branch. Their appearance ratios were 48.1% (13/27), 14.8% (4/27), and 81.5% (22/27), respectively. The lateral thoracic artery perforator flap has a great deal of anatomical variation, and vessels with relatively small diameters compared to those of other flaps. This is why flaps from this region are not currently popular. This study revealed the superiority of the color Doppler ultrasound for preoperative planning of the lateral thoracic artery perforator flap elevation. Furthermore, the branching pattern and the diameters of the different branches were specified.

  3. [Preoperative screening and nutritional support of nutritional deficiencies].

    PubMed

    Zazzo, J-F

    2004-01-01

    Nutritional deficiencies have to be considered as an independent risk factor for postoperative morbidity. Peri-operative nutritional support reduce this risk in elective abdominal surgery for cancer and cardiac surgery. Preoperative nutritional support for 7-10 days reduce postoperative complications in undernourished patients by 10% but is not operant when administered after surgery. Enteral route is as effective. Recent studies using immunonutrients conclude that a short preoperative oral intake is able to reduce complications even in well-nourished patients. Then, a preoperative nutritional screening must be routinely performed leading to a nutritional programme.

  4. Pre-operative investigations: yield and conformity to national guidelines.

    PubMed

    Juliana, H; Lim, T A; Inbasegaran, K

    2003-03-01

    Routine ordering of pre-operative investigations yields a low true positive rate and is not cost effective. In this study, case notes of 251 adults who underwent elective surgery were reviewed. Pre-operative investigations were classified as 'indicated' or 'not indicated', based on the national guidelines. Only 56% of all tests done were indicated. The overall rates of expected and unexpected abnormal values from pre-operative blood investigations were 51.1% and 34.4% respectively. This study found that selective testing based on guidelines was beneficial. However, the results also suggest that the local guidelines need to be reviewed.

  5. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    PubMed

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    OBJECTIVE The operative management of patients with adult spinal deformity (ASD) has a high complication rate and it remains unknown whether baseline patient characteristics and surgical variables can predict early complications (intraoperative and perioperative [within 6 weeks]). The development of an accurate preoperative predictive model can aid in patient counseling, shared decision making, and improved surgical planning. The purpose of this study was to develop a model based on baseline demographic, radiographic, and surgical factors that can predict if patients will sustain an intraoperative or perioperative major complication. METHODS This study was a retrospective analysis of a prospective, multicenter ASD database. The inclusion criteria were age ≥ 18 years and the presence of ASD. In total, 45 variables were used in the initial training of the model including demographic data, comorbidities, modifiable surgical variables, baseline health-related quality of life, and coronal and sagittal radiographic parameters. Patients were grouped as either having at least 1 major intraoperative or perioperative complication (COMP group) or not (NOCOMP group). An ensemble of decision trees was constructed utilizing the C5.0 algorithm with 5 different bootstrapped models. Internal validation was accomplished via a 70/30 data split for training and testing each model, respectively. Overall accuracy, the area under the receiver operating characteristic (AUROC) curve, and predictor importance were calculated. RESULTS Five hundred fifty-seven patients were included: 409 (73.4%) in the NOCOMP group, and 148 (26.6%) in the COMP group. The overall model accuracy was 87.6% correct with an AUROC curve of 0.89 indicating a very good model fit. Twenty variables were determined to be the top predictors (importance ≥ 0.90 as determined by the model) and included (in decreasing importance): age, leg pain, Oswestry Disability Index, number of decompression levels, number of

  6. Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy as Preoperative Treatment for Localized Gastric Adenocarcinoma

    SciTech Connect

    Chakravarty, Twisha; Crane, Christopher H.; Ajani, Jaffer A.; Mansfield, Paul F.; Briere, Tina M.; Beddar, A. Sam; Mok, Henry; Reed, Valerie K.; Krishnan, Sunil; Delclos, Marc E.; Das, Prajnan

    2012-06-01

    Purpose: The goal of this study was to evaluate dosimetric parameters, acute toxicity, pathologic response, and local control in patients treated with preoperative intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for localized gastric adenocarcinoma. Methods: Between November 2007 and April 2010, 25 patients with localized gastric adenocarcinoma were treated with induction chemotherapy, followed by preoperative IMRT and concurrent chemotherapy and, finally, surgical resection. The median radiation therapy dose was 45 Gy. Concurrent chemotherapy was 5-fluorouracil and oxaliplatin in 18 patients, capecitabine in 3, and other regimens in 4. Subsequently, resection was performed with total gastrectomy in 13 patients, subtotal gastrectomy in 7, and other surgeries in 5. Results: Target coverage, expressed as the ratio of the minimum dose received by 99% of the planning target volume to the prescribed dose, was a median of 0.97 (range, 0.92-1.01). The median V{sub 30} (percentage of volume receiving at least 30 Gy) for the liver was 26%; the median V{sub 20} (percentage of volume receiving at least 20 Gy) for the right and left kidneys was 14% and 24%, respectively; and the median V{sub 40} (percentage of volume receiving at least 40 Gy) for the heart was 18%. Grade 3 acute toxicity developed in 14 patients (56%), including dehydration in 10, nausea in 8, and anorexia in 5. Grade 4 acute toxicity did not develop in any patient. There were no significant differences in the rates of acute toxicity, hospitalization, or feeding tube use in comparison to those in a group of 50 patients treated with preoperative three-dimensional conformal radiation therapy with concurrent chemotherapy. R0 resection was obtained in 20 patients (80%), and pathologic complete response occurred in 5 (20%). Conclusions: Preoperative IMRT for gastric adenocarcinoma was well tolerated, accomplished excellent target coverage and normal structure sparing, and led to appropriate

  7. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

    PubMed Central

    Arumugam, Sudha; Lau, Christine SM; Chamberlain, Ronald S

    2016-01-01

    Objectives Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. Materials and methods A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. Results A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. Conclusion The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment

  8. Comparison of navigated transcranial magnetic stimulation and functional magnetic resonance imaging for preoperative mapping in rolandic tumor surgery.

    PubMed

    Coburger, Jan; Musahl, Christian; Henkes, Hans; Horvath-Rizea, Diana; Bittl, Markus; Weissbach, Claudia; Hopf, Nikolai

    2013-01-01

    Navigated transcranial magnetic stimulation (nTMS) is a novel tool for preoperative functional mapping. It detects eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the advantage of nTMS in comparison with functional magnetic resonance imaging (fMRI) in the clinical setting. Special focus was placed on accuracy of motor cortex localization in patients with rolandic lesions. Thirty consecutive patients were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Feasibility of the technique and spatial resolution of upper and lower extremity cortical mapping were compared with fMRI. Consistency of preoperative mapping with intraoperative DCS was assessed via the neuronavigation system. nTMS was feasible in all 30 patients. fMRI was impossible in 7 out of 30 patients with special clinical conditions, pediatric patients, central vascular lesions, or compliance issues. The mean accuracy to localize motor cortex of nTMS was higher than in fMRI. In the subgroup of intrinsic tumors, nTMS produced statistically significant higher accuracy scores of the lower extremity localization than fMRI. fMRI failed to localize hand or leg areas in 6 out of 23 cases. Using nTMS, a preoperative localization of the central sulcus was possible in all patients. Verification of nTMS motor cortex localization with DCS was achieved in all cases. The fMRI localization of the hand area proved to be postcentral in one case. nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance. nTMS scores higher on the accuracy scale than fMRI. nTMS represents a highly valuable supplement for the preoperative functional planning in the clinical routine.

  9. Pre-operative visits by ITU nurses: recommendations for practice.

    PubMed

    Cheetham, D

    1993-12-01

    Pre-operative visiting by theatre nurses is now policy in many hospitals, following an explosion of research studies outlining the benefits to the patient. However, the author could find very little available literature on pre-operative visiting by intensive therapy unit (ITU) nurses, to patients electively admitted to ITU following surgery. The purpose of this project is to explore the need for patient information, outline the aims of an ITU nurse's pre-operative visit, and discuss the timing of the proposed visit, the information to give the patient, the inclusion of the patient's family and the provision of printed literature. Finally, recommendations are made for implementing a pre-operative visiting service by ITU nurses.

  10. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  11. Appraisal of guidelines for pre-operative body wash.

    PubMed

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

    The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection.

  12. Benefits of preoperative education for adult elective surgery patients.

    PubMed

    Kruzik, Nancy

    2009-09-01

    Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

  13. Connectome analysis for pre-operative brain mapping in neurosurgery

    PubMed Central

    Hart, Michael G.; Price, Stephen J.; Suckling, John

    2016-01-01

    Abstract Object: Brain mapping has entered a new era focusing on complex network connectivity. Central to this is the search for the connectome or the brains ‘wiring diagram’. Graph theory analysis of the connectome allows understanding of the importance of regions to network function, and the consequences of their impairment or excision. Our goal was to apply connectome analysis in patients with brain tumours to characterise overall network topology and individual patterns of connectivity alterations. Methods: Resting-state functional MRI data were acquired using multi-echo, echo planar imaging pre-operatively from five participants each with a right temporal–parietal–occipital glioblastoma. Complex networks analysis was initiated by parcellating the brain into anatomically regions amongst which connections were identified by retaining the most significant correlations between the respective wavelet decomposed time-series. Results: Key characteristics of complex networks described in healthy controls were preserved in these patients, including ubiquitous small world organization. An exponentially truncated power law fit to the degree distribution predicted findings of general network robustness to injury but with a core of hubs exhibiting disproportionate vulnerability. Tumours produced a consistent reduction in local and long-range connectivity with distinct patterns of connection loss depending on lesion location. Conclusions: Connectome analysis is a feasible and novel approach to brain mapping in individual patients with brain tumours. Applications to pre-surgical planning include identifying regions critical to network function that should be preserved and visualising connections at risk from tumour resection. In the future one could use such data to model functional plasticity and recovery of cognitive deficits. PMID:27447756

  14. The role of preoperative prophylactic antibiotics in hypospadias repair

    PubMed Central

    Baillargeon, Emilie; Duan, Kai; Brzezinski, Alex; Jednak, Roman; El-Sherbiny, Mohamed

    2014-01-01

    Introduction: We sought to determine whether the use of preoperative antibiotics is effective in reducing postoperative wound infections and urinary tract infections (UTI) in hypospadias repair. Methods: We retrospectively reviewed all hypospadias repairs performed at the Montreal Children’s Hospital between March 2009 and September 2012. All types of primary hypospadias repairs and redo cases were included. Patients with no adequate follow-up or with missing records of antibiotics were excluded. Preoperative antibiotics were given in the form of cefazolin (50 mg/kg intravenously) when appropriate. Postoperative oral antibiotics were administered as decided by the pediatric urologist. Primary outcomes included postoperative wound infection and UTI. Secondary outcomes included the need for reoperation of hypospadias due to urethrocutaneous fistula, meatal stenosis, urethral stricture and wound dehiscence. Results: In total, 157 cases of hypospadias repair were reviewed; of these 7 were excluded due to lack of follow-up. Of the remaining 150 patients, 62 received preoperative antibiotics and 88 did not. The groups were well-matched for age, hypospadias characteristics, type of repair and repair of curvature. The group that received preoperative antibiotics had a significantly higher number of stented cases (82% vs. 52% of the non-preoperative antibiotic group). Two cases of wound infection were reported (1 in the pre-operative antibiotic group and 1 in the non-preoperative antibiotic group). There was no symptomatic UTI or culture-demonstrated UTI in either group. Moreover, there was no statistically significant difference between the 2 groups in terms of primary outcomes. The complication rate was 11% (17/150 repairs) and all patients needed reoperation. This study’s important limitations include the rarity of studied end points combined with the small sample and the retrospective nature of our study. Conclusion: Our findings do not support the routine use of

  15. Preoperative Assessment of Adult Patients for Intracranial Surgery

    PubMed Central

    Sivanaser, Vanitha; Manninen, Pirjo

    2010-01-01

    The preoperative assessment of the patient for neurosurgical and endovascular procedures involves the understanding of the neurological disease and its systemic presentation, and the requirements of the procedure. There is a wide spectrum of different neurosurgical disorders and procedures. This article provides an overview of the preoperative evaluation of these patients with respect to general principles of neuroanesthesia, and considerations for specific intracranial and vascular neurosurgical and interventional neuroradiological procedures. PMID:20700431

  16. An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information

    PubMed Central

    Chuy, Katherine; Yan, Zhe; Fleisher, Lee; Liu, Renyu

    2013-01-01

    Background A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. Methods The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. Results Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). Conclusions A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety. PMID:23853741

  17. Evaluating the effects of preoperative fasting and fluid limitation.

    PubMed

    Tosun, Betül; Yava, Ayla; Açıkel, Cengizhan

    2015-04-01

    The aim of the study was to evaluate the effects of preoperative fasting and fluid limitation in patients undergoing laparoscopic cholecystectomy. Although traditional long-term fasting is not recommended in current preoperative guidelines, this is still a common intervention. Visual analogue scale was used to assess hunger, thirst, sleepiness, exhaustion, nausea and pain; State and Trait Anxiety Inventory was used to assess the preoperative anxiety of 99 patients undergoing elective laparoscopic cholecystectomy. Mean time of preoperative fasting and fluid limitation were, respectively, 14.70 ± 3.14 and 11.25 ± 3.74 h. Preoperatively, 58.60% of the patients experienced moderate anxiety. Patients fasting 12 h or longer had higher hunger, thirst, nausea and pain scores. The mean trait anxiety score of patients fasting 12 h or longer was statistically significantly higher. Receiving nothing by mouth after midnight preoperatively is a persisted intervention and results in discomfort of patients. Clinical protocols should be revised and nurses should be trained in current fasting protocols.

  18. Accurate Evaluation of Quantum Integrals

    NASA Technical Reports Server (NTRS)

    Galant, D. C.; Goorvitch, D.; Witteborn, Fred C. (Technical Monitor)

    1995-01-01

    Combining an appropriate finite difference method with Richardson's extrapolation results in a simple, highly accurate numerical method for solving a Schrodinger's equation. Important results are that error estimates are provided, and that one can extrapolate expectation values rather than the wavefunctions to obtain highly accurate expectation values. We discuss the eigenvalues, the error growth in repeated Richardson's extrapolation, and show that the expectation values calculated on a crude mesh can be extrapolated to obtain expectation values of high accuracy.

  19. Electrode Localization for Planning Surgical Resection of the Epileptogenic Zone in Pediatric Epilepsy

    PubMed Central

    Taimouri, Vahid; Akhondi-Asl, Alireza; Tomas-Fernandez, Xavier; Peters, Jurriaan M.; Prabhu, Sanjay P.; Poduri, Annapurna; Takeoka, Masanori; Loddenkemper, Tobias; Bergin, Ann Marie R.; Harini, Chellamani; Madsen, Joseph R.; Warfield, Simon K.

    2014-01-01

    Purpose In planning for a potentially curative resection of the epileptogenic zone in patients with pediatric epilepsy, invasive monitoring with intracranial EEG is often used to localize the seizure onset zone and eloquent cortex. A precise understanding of the location of subdural strip and grid electrodes on the brain surface, and of depth electrodes in the brain in relationship to eloquent areas is expected to facilitate pre-surgical planning. Methods We developed a novel algorithm for the alignment of intracranial electrodes, extracted from post-operative CT, with pre-operative MRI. Our goal was to develop a method of achieving highly accurate localization of subdural and depth electrodes, in order to facilitate surgical planning. Specifically, we created a patient-specific 3D geometric model of the cortical surface from automatic segmentation of a pre-operative MRI, automatically segmented electrodes from post-operative CT, and projected each set of electrodes onto the brain surface after alignment of the CT to the MRI. Also, we produced critical visualization of anatomical landmarks, e.g. vasculature, gyri, sulci, lesions or eloquent cortical areas, which enables the epilepsy surgery team to accurately estimate the distance between the electrodes and the anatomical landmarks, which might help for better assessment of risks and benefits of surgical resection. Results Electrode localization accuracy was measured using knowledge of the position of placement from 2D intra-operative photographs in ten consecutive subjects who underwent intracranial EEG for pediatric epilepsy. Average spatial accuracy of localization was 1.31±0.69mm for all 385 visible electrodes in the photos. Conclusions In comparison to previously reported approaches, our algorithm is able to achieve more accurate alignment of strip and grid electrodes with minimal user input. Unlike manual alignment procedures, our algorithm achieves excellent alignment without time consuming and difficult

  20. Superconducting Super Collider site environmental report for calendar year 1991. Pre-operational

    SciTech Connect

    1995-05-01

    This is the first annual SER prepared for the SSC project. It is a pre-operational report, intended primarily to describe the baseline characterization of the Ellis County, Texas site that has been developed subsequent to the Environmental Impact Statement (EIS) and the Supplemental Environmental impact Statement (SEIS). As such, the emphasis will be on environmental compliance efforts, including monitoring and mitigation programs. The SER also reports on the measures taken to meet the commitments made in the EIS and SEIS. These measures are detailed in the Mitigation Action Plan (MAP) (Department of Energy (DOE), 1991), which was prepared following the signing of the Record of Decision (ROD) to construct the SSC in Texas. The SER will continue to be preoperational until the first high-energy (20 trillion electron volt or TeV) protons collisions are observed, at which point the SSC will become operational. At that time, the SER will place more emphasis on the radiological monitoring program. This SER will report on actions taken in 1991 or earlier and briefly mention some of those planned for calendar year 1992. AU actions completed in 1992 will be addressed in the SER for calendar year 1992.

  1. Adaptive planning using megavoltage fan-beam CT for radiation therapy with testicular shielding

    SciTech Connect

    Yadav, Poonam; Kozak, Kevin; Tolakanahalli, Ranjini; Ramasubramanian, V.; Paliwal, Bhudatt R.; Welsh, James S.; Rong, Yi

    2012-07-01

    This study highlights the use of adaptive planning to accommodate testicular shielding in helical tomotherapy for malignancies of the proximal thigh. Two cases of young men with large soft tissue sarcomas of the proximal thigh are presented. After multidisciplinary evaluation, preoperative radiation therapy was recommended. Both patients were referred for sperm banking and lead shields were used to minimize testicular dose during radiation therapy. To minimize imaging artifacts, kilovoltage CT (kVCT) treatment planning was conducted without shielding. Generous hypothetical contours were generated on each 'planning scan' to estimate the location of the lead shield and generate a directionally blocked helical tomotherapy plan. To ensure the accuracy of each plan, megavoltage fan-beam CT (MVCT) scans were obtained at the first treatment and adaptive planning was performed to account for lead shield placement. Two important regions of interest in these cases were femurs and femoral heads. During adaptive planning for the first patient, it was observed that the virtual lead shield contour on kVCT planning images was significantly larger than the actual lead shield used for treatment. However, for the second patient, it was noted that the size of the virtual lead shield contoured on the kVCT image was significantly smaller than the actual shield size. Thus, new adaptive plans based on MVCT images were generated and used for treatment. The planning target volume was underdosed up to 2% and had higher maximum doses without adaptive planning. In conclusion, the treatment of the upper thigh, particularly in young men, presents several clinical challenges, including preservation of gonadal function. In such circumstances, adaptive planning using MVCT can ensure accurate dose delivery even in the presence of high-density testicular shields.

  2. Adaptive planning using megavoltage fan-beam CT for radiation therapy with testicular shielding.

    PubMed

    Yadav, Poonam; Kozak, Kevin; Tolakanahalli, Ranjini; Ramasubramanian, V; Paliwal, Bhudatt R; Welsh, James S; Rong, Yi

    2012-01-01

    This study highlights the use of adaptive planning to accommodate testicular shielding in helical tomotherapy for malignancies of the proximal thigh. Two cases of young men with large soft tissue sarcomas of the proximal thigh are presented. After multidisciplinary evaluation, preoperative radiation therapy was recommended. Both patients were referred for sperm banking and lead shields were used to minimize testicular dose during radiation therapy. To minimize imaging artifacts, kilovoltage CT (kVCT) treatment planning was conducted without shielding. Generous hypothetical contours were generated on each "planning scan" to estimate the location of the lead shield and generate a directionally blocked helical tomotherapy plan. To ensure the accuracy of each plan, megavoltage fan-beam CT (MVCT) scans were obtained at the first treatment and adaptive planning was performed to account for lead shield placement. Two important regions of interest in these cases were femurs and femoral heads. During adaptive planning for the first patient, it was observed that the virtual lead shield contour on kVCT planning images was significantly larger than the actual lead shield used for treatment. However, for the second patient, it was noted that the size of the virtual lead shield contoured on the kVCT image was significantly smaller than the actual shield size. Thus, new adaptive plans based on MVCT images were generated and used for treatment. The planning target volume was underdosed up to 2% and had higher maximum doses without adaptive planning. In conclusion, the treatment of the upper thigh, particularly in young men, presents several clinical challenges, including preservation of gonadal function. In such circumstances, adaptive planning using MVCT can ensure accurate dose delivery even in the presence of high-density testicular shields.

  3. Preoperative psychological testing--another form of prejudice.

    PubMed

    Ashton, David; Favretti, Franco; Segato, Gianni

    2008-10-01

    Preoperative psychological screening of bariatric surgery candidates has become routine, and a significant proportion of patients have their surgery deferred as a consequence. If psychological testing is being used as a form of preoperative triage, both patients and surgeons are entitled to know whether there is sufficient evidence to justify its use in this way. We define the argument for psychological screening as consisting of four premises (p1-p4) and a conclusion (C) as follows: (p1) A significant minority of obese patients will not be successful in losing weight following bariatric surgery-the "failure" group; (p2) A significant minority of patients will exhibit abnormal psychological profiles during preoperative testing; (p3) The majority of individuals referred to in (p2) will be found in group (p1) i.e., abnormal psychological profiles identified preoperatively predict less favorable weight loss outcomes postoperatively; (p4) Identifying patients with adverse psychological profiles preoperatively would allow either exclusion of those at high risk of failure or provide a more secure rationale for targeted pre- and postoperative support; (C) Psychological screening should be part of the routine preoperative assessment for patients undergoing obesity surgery. We reviewed the literature to find evidence to support the premises and show that (p1) can be justified but that (p2) is problematic and can only be accepted in a heavily qualified version. We find no evidence for (p3) and since (p4) and (C) are predicated on (p3), the argument clearly fails. There is no evidence to suggest that preoperative psychological screening can predict postoperative outcomes and no justification for using such testing as a means of discriminating between candidates presenting themselves for bariatric surgery.

  4. Preoperative Body Mass Index, Blood Albumin and Triglycerides Predict Survival for Patients with Gastric Cancer

    PubMed Central

    Liu, Bin Zheng; Tao, Lin; Chen, Yun Zhao; Li, Xu Zhe; Dong, Yu Ling; Ma, Ya Jing; Li, Shu Gang; Li, Feng; Zhang, Wen Jie

    2016-01-01

    GC patients superior to postoperative TNM system in terms of timing for management. As potential survival-predictors, preoperative tests of BMI, albumin and triglyceride, combined with clinical imaging, may help personalized management for GC patients including planning surgical strategy, optimal radio-chemotherapy and appropriate follow-up intervals after surgery. PMID:27309531

  5. Preoperative Nutritional Status of the Surgical Patients in Jeju

    PubMed Central

    Moon, Myung-Sang; Lee, Sang-Yup; Jeon, Dal-Jae; Yoon, Min-Geun; Kim, Sung-Sim; Moon, Hanlim

    2014-01-01

    Background To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. Methods In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1. Results In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g

  6. Effect of acupressure on preoperative anxiety: a clinical trial.

    PubMed

    Valiee, Sina; Bassampour, Shiva Sadat; Nasrabadi, Alireza Nikbakht; Pouresmaeil, Zahra; Mehran, Abbas

    2012-08-01

    Preoperative anxiety, as an emotional reaction, is common among patients undergoing surgery. The purpose of this study was to examine the effect of acupressure on preoperative anxiety before abdominal surgery. The 70 subjects of this clinical trial were randomly assigned into the acupressure group (n=35), which received acupressure at the true points, or the placebo group (n=35), which received acupressure at sham (false) points. Preoperative anxiety and vital signs before and after the intervention were measured in both groups. The findings demonstrated a reduction in the level of preoperative anxiety for both groups (P<.001). Furthermore, they showed a statistically significant difference between the mean of vital signs before and after the intervention in the acupressure group (P<.001) and only statistically significant results for cardiovascular (P=.016) and respiratory rates (P=.007) in the placebo group. Overall, findings revealed that acupressure at true points (third eye and Shen men) can reduce higher preoperative anxiety of patients before abdominal surgery and that it has had a more clinically beneficial effect than sham points.

  7. Validation of a virtual preoperative evaluation clinic: a pilot study.

    PubMed

    Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

    2011-01-01

    Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

  8. Measuring preoperative anxiety in patients with breast cancer using the visual analog scale.

    PubMed

    Aviado-Langer, Jennifer

    2014-10-01

    Preoperative anxiety is a prevalent concern with deleterious effects in patient recovery and is not routinely assessed in the preoperative screening process. When it is assessed, it may prompt an increase in the use of anesthetic agents, heightened postoperative pain, and prolonged hospitalization. Preoperative women with breast cancer face anxiety as it relates to anesthesia, surgery, and recovery. The preoperative anxiety visual analog scale may identify and quantify anxiety in this population, provide advocacy and support, and improve the preoperative screening process.

  9. Short-Term Enrollment Forecasting for Accurate Budget Planning.

    ERIC Educational Resources Information Center

    Salley, Charles D.

    1979-01-01

    Reliance on enrollment trend models for revenue projections has led to a scenario of alternating overbudgeted and underbudgeted years. A study of a large, public university indicates that time series analysis should be used instead to anticipate the orderly seasonal and cyclical patterns that are visible in a period of moderate trend growth.…

  10. Over-expression of Skp2 is associated with resistance to preoperative doxorubicin-based chemotherapy in primary breast cancer

    PubMed Central

    Davidovich, Shirly; Ben-Izhak, Ofer; Shapira, Ma'anit; Futerman, Boris; Hershko, Dan D

    2008-01-01

    Introduction Preoperative chemotherapy is often used in patients with locally advanced breast cancer. However, commonly used clinical and pathological parameters are poor predictors of response to this type of therapy. Recent studies have suggested that altered regulation of the cell cycle in cancer may be involved in resistance to chemotherapy. Over-expression of the ubiquitin ligase Skp2 results in loss of the cell cycle inhibitor p27Kip1 and is associated with poor prognosis in early breast cancer. The purpose of the present study was to examine the role of these proteins as predictors of clinical outcome and response to chemotherapy in locally advanced breast cancer. Methods The expression levels of Skp2 and p27Kip1 were determined by immunohistochemistry both before and after preoperative chemotherapy in 40 patients with locally advanced breast cancer. All patients were treated with cyclophosphamide/doxorubicin (adriamycin)/5-fluorouracil (CAF) and some patients received additional treatment with docetaxel. Expression data were compared with patients' clinical and pathological features, clinical outcome, and response to chemotherapy. Results Skp2 expression before preoperative chemotherapy was inversely related to p27Kip1 levels, tumor grade, and expression of estrogen and progesterone receptors. Both Skp2 and p27Kip1 were found to be accurate prognostic markers for disease-free and overall survival. High preoperative expression of Skp2 was associated with resistance to CAF therapy in 94% of patients (P < 0.0001) but not with resistance to docetaxel. Conclusion Skp2 expression may be a useful marker for predicting response to doxorubicin-based preoperative chemotherapy and clinical outcome in patients with locally advanced breast cancer. PMID:18644126

  11. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds.

    PubMed

    John, Honeymol; Nimeri, Abdelrahman; Ellahham, Samer

    2015-01-01

    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) best practice guidelines as a guide. ACS NSQIP is a clinical registry that provides risk-adjusted clinical outcome reports every six months. The rates of SSI are reported in an observed/expected ratio. The expected ratio is calculated based on the risk factors of the patients which include wound classification. We established a multidisciplinary SSI taskforce. The members of the SSI taskforce included the ACS NSQIP team members, quality, surgeons, nurses, infection control, IT, pharmacy, microbiology, and it was chaired by a colorectal surgeon. The taskforce focused on five areas: pre-op showering and hair removal, skin antisepsis, prophylactic antibiotics, peri-operative maintenance of glycaemia, and normothermia. We planned audits to evaluate our wound classification and our SSI rates based on the SAR. Our expected SSI rates in general surgery and the whole department were 2.52% and 1.70% respectively, while our observed SSI rates were 4.68% and 3.57% respectively, giving us a high outlier status with an odd's ratio of 1.72 and 2.03. Wound classifications were identified as an area of concern. For example, wound classifications were preoperatively selected based on the default wound classification of the booked procedure in the Electronic Medical Record (EMR) which led to under classifying wounds in many occasions. A total of 998 cases were reviewed, our rate of incorrect wound classification

  12. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds

    PubMed Central

    John, Honeymol; Nimeri, Abdelrahman; ELLAHHAM, SAMER

    2015-01-01

    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) best practice guidelines as a guide. ACS NSQIP is a clinical registry that provides risk-adjusted clinical outcome reports every six months. The rates of SSI are reported in an observed/expected ratio. The expected ratio is calculated based on the risk factors of the patients which include wound classification. We established a multidisciplinary SSI taskforce. The members of the SSI taskforce included the ACS NSQIP team members, quality, surgeons, nurses, infection control, IT, pharmacy, microbiology, and it was chaired by a colorectal surgeon. The taskforce focused on five areas: pre-op showering and hair removal, skin antisepsis, prophylactic antibiotics, peri-operative maintenance of glycaemia, and normothermia. We planned audits to evaluate our wound classification and our SSI rates based on the SAR. Our expected SSI rates in general surgery and the whole department were 2.52% and 1.70% respectively, while our observed SSI rates were 4.68% and 3.57% respectively, giving us a high outlier status with an odd's ratio of 1.72 and 2.03. Wound classifications were identified as an area of concern. For example, wound classifications were preoperatively selected based on the default wound classification of the booked procedure in the Electronic Medical Record (EMR) which led to under classifying wounds in many occasions. A total of 998 cases were reviewed, our rate of incorrect wound classification

  13. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

    PubMed Central

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care. PMID:27812286

  14. Preoperational practices for steam generators and secondary-system components

    SciTech Connect

    Not Available

    1991-09-01

    PWR operating experience has shown that proper control of steam generator and secondary plant cleanliness during construction will prevent corrosion of critical components, minimize impurity transport to the steam generators, and minimize startup delays. This volume contains the following guidelines which address preoperational practices: Preoperational Flushing, Cleaning, and Layup of PWR Steam/Feedwater/Condensate Systems, Revision 1; and Guidelines to Minimize Contamination of PWR Steam Generators during Plant Construction, Revision 1. The guidelines provide specific recommendations and associated justifications for maintaining steam generator cleanliness during shipment, storage, and installation; and secondary plant cleanliness during construction. Recommendations for preoperational cleaning and flushing of secondary systems are also provided. 1 ref., 9 figs., 2 tabs.

  15. Preoperative IABP in high risk patients undergoing CABG.

    PubMed

    Theologou, T; Field, M L

    2011-01-01

    A recent international consensus conference on the reduction in mortality in cardiac anesthesia and intensive care included intraoperative aortic balloon pump among the ancillary (i.e. non-surgical) drugs/techniques/strategies that might influence survival rates in patients undergoing cardiac surgery. The consensus conferences state that "Pre-operative intraoperative aortic balloon pump might reduce 30-day mortality in elective high risk patients undergoing coronary artery bypass surgery unless specifically contraindicated". The authors of this "expert opinion" presents their insights into the use of the preoperative intraoperative aortic balloon pump and conclude that based on available limited randomized controlled trials and clinical experience preoperative intraoperative aortic balloon pump saves lives in unstable patients.

  16. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic.

    PubMed

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care.

  17. Preoperative localization of distal colorectal tumours.

    PubMed

    Bayrak, Savas; Kinaci, Erdem; Ozakay, Abdulkerim; Bektas, Ceyda Turan; Yardimci, Aytul Hande; Arslan, Esra; Sevinc, Mert Mahsuni; Bektas, Hasan

    2016-01-01

    L’identificazione della reale sede del tutmore è essenziale per la formulazione di un adatto algoritmo nei cancri localizzati distalmente nel colon-retto (CTC). In questo studio è stata indagata l’efficacia della localizzazione di tumori distali del colon-retto di quattro metodologia: la colonscopia, la TAC, l’imaging della RMN, e la PET con fluoro-18-desossi-glicosio tomografia computerizzata (CT), analizzando retrospettivamente le cartelle cliniche di 156 pazienti affetti, Fluorodeoxyglucose -positron emission tomography scan da tumore del colon-sigma, della giunzione retto sigmoidea e del retto sottoposti a trattamento chirurgico. Per quanto riguarda l’accuratezza delle quattro metodologie essa è risultata simile: 74% per la clolonscopia, 67% per la TAC, 75% per la RMN e 74% con la PET. La colonscopia è risultata meno sensibile nei tumori retto-sigmoidei (33%) mentre la TAC è risultata meno sensibile (26%) e la RMN meno specifica (33%) per i tumori del retto. In conclusione, confermando l’importanza di poter localizzare correttamente i tumori distali del colon retto al fine di determinare le strategia più accurate del trattamento, le indagini preoperatorie non forniscono dati di adeguata accuratezza per i tumori colon rettali distali, e solo l’uso combinato di esse può accrescere il risultato cercato.

  18. Virtual Surgical Planning in Craniofacial Surgery

    PubMed Central

    Chim, Harvey; Wetjen, Nicholas; Mardini, Samir

    2014-01-01

    The complex three-dimensional anatomy of the craniofacial skeleton creates a formidable challenge for surgical reconstruction. Advances in computer-aided design and computer-aided manufacturing technology have created increasing applications for virtual surgical planning in craniofacial surgery, such as preoperative planning, fabrication of cutting guides, and stereolithographic models and fabrication of custom implants. In this review, the authors describe current and evolving uses of virtual surgical planning in craniofacial surgery. PMID:25210509

  19. Functional connectivity networks for preoperative brain mapping in neurosurgery.

    PubMed

    Hart, Michael G; Price, Stephen J; Suckling, John

    2016-08-26

    OBJECTIVE Resection of focal brain lesions involves maximizing the resection while preserving brain function. Mapping brain function has entered a new era focusing on distributed connectivity networks at "rest," that is, in the absence of a specific task or stimulus, requiring minimal participant engagement. Central to this frame shift has been the development of methods for the rapid assessment of whole-brain connectivity with functional MRI (fMRI) involving blood oxygenation level-dependent imaging. The authors appraised the feasibility of fMRI-based mapping of a repertoire of functional connectivity networks in neurosurgical patients with focal lesions and the potential benefits of resting-state connectivity mapping for surgical planning. METHODS Resting-state fMRI sequences with a 3-T scanner and multiecho echo-planar imaging coupled to independent component analysis were acquired preoperatively from 5 study participants who had a right temporoparietooccipital glioblastoma. Seed-based functional connectivity analysis was performed with InstaCorr. Network identification focused on 7 major functional connectivity networks described in the literature and a putative language network centered on Broca's area. RESULTS All 8 functional connectivity networks were identified in each participant. Tumor-related topological changes to the default mode network were observed in all participants. In addition, each participant had at least 1 other abnormal network, and each network was abnormal in at least 1 participant. Individual patterns of network irregularities were identified with a qualitative approach and included local displacement due to mass effect, loss of a functional network component, and recruitment of new regions. CONCLUSIONS Resting-state fMRI can reliably and rapidly detect common functional connectivity networks in patients with glioblastoma and also has sufficient sensitivity for identifying patterns of network alterations. Mapping of functional

  20. Caregivers' reactions to preoperative procedures in outpatient pediatric surgery

    PubMed Central

    Velhote, André Bohomol; Bohomol, Elena; Velhote, Manoel Carlos Prieto

    2016-01-01

    ABSTRACT Objective: To identify pediatric caregivers' reactions in outpatient surgery settings. Methods: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. Results: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. Conclusion: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels. PMID:27759831

  1. Mammary analogue secretory carcinoma of parotid: Is preoperative cytological diagnosis possible?

    PubMed

    Oza, Nikita; Sanghvi, Kintan; Shet, Tanuja; Patil, Asawari; Menon, Santosh; Ramadwar, Mukta; Kane, Shubhada

    2016-06-01

    Mammary analogue secretory carcinoma is a recently recognized tumor of salivary gland with characteristic t(12;15)(q13;q25) that results in ETV6-NTRK3 fusion product. Distinguishing mammary analogue secretory carcinoma from other salivary gland tumors is important. Present study highlights cytologic findings in three cases of mammary analogue secretory carcinoma of parotid which facilitate preoperative diagnosis with the aid of ancillary diagnostic techniques. Fine needle aspiration cytology of parotid was performed on three cases after clinical examination. Immunocytochemistry for mammoglobin and S100 were performed. Parotidectomy was done in all cases. The corresponding hematoxylin and eosin stained slides and blocks of all cases were studied. Molecular analysis was done in one of the cases. Cases 1 and 3 revealed uniform atypical epithelial cells arranged in branching papillary pattern with few cells in microcystic pattern. Case 2 showed atypical cells arranged mainly in loose clusters and few singly dissociated. Individual cells revealed round nuclei, vesicular chromatin, prominent nucleoli and abundant finely vacuolated cytoplasm with metachromasia prominent in May-Grunwald-Giemsa smear (case 3). Characteristic hob-nail cells covering papillae were observed in cases 1 and 3. Immunocytochemistry showed strong positivity for mammoglobin and S100 thereby confirming the diagnosis of mammary analogue secretory carcinoma preoperatively. The diagnosis was in concordance with surgical specimen. Also, characteristic ETV6-NTRK3 translocation was confirmed in case 1. Increased awareness and high index of suspicion is necessary for the upfront diagnosis, more so for the papillary variant of mammary analogue secretory carcinoma. Immunocytochemistry aids in confirming this preoperative diagnosis, based on which treatment can be planned. Diagn. Cytopathol. 2016;44:519-525. © 2016 Wiley Periodicals, Inc.

  2. Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study

    PubMed Central

    2013-01-01

    Background To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer. Methods Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared. Results Mean age of the patients was 64.5 years (range 28–88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone. Conclusion The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification. PMID:24286200

  3. Patterns of Response After Preoperative Intensity-Modulated Radiation Therapy and Capecitabine/Oxaliplatin in Rectal Cancer: Is There Still a Place for Ecoendoscopic Ultrasound?

    SciTech Connect

    Arbea, Leire; Diaz-Gonzalez, Juan A.; Subtil, Jose Carlos; Sola, Josu; Hernandez-Lizoain, Jose Luis; Martinez-Monge, Rafael; Moreno, Marta; Aristu, Javier

    2011-10-01

    Purpose: The main goals of preoperative chemoradiotherapy (CHRT) in rectal cancer are to achieve pathological response and to ensure tumor control with functional surgery when possible. Assessment of the concordance between clinical and pathological responses is necessary to make decisions regarding alternative conservative procedures. The present study evaluates the patterns of response after a preoperative CHRT regimen, and the value of endoscopic ultrasound (EUS) in assessing response. Methods and Materials: A total of 51 EUS-staged T3 to T4 and/or N0 to N+ rectal cancer patients received preoperative CHRT (intensity-modulated radiation therapy and capecitabine/oxaliplatin (XELOX) followed by radical resection. Clinical response was assesed by EUS. Rates of pathological tumor regression grade (TRG) and lymph node (LN) involvement were determined in the surgical specimen. Clinical and pathological responses were compared, and the accuracy of EUS in assessing response was calculated. Results: Twenty-four patients (45%) achieved a major pathological response (complete or >95% pathological response (TRG 3+/4)). Sensitivity, specificity, negative predictive value, and positive predictive value of EUS in predicting pathological T response after preoperative CHRT were 77.8%, 37.5%, 60%, and 58%, respectively. The EUS sensitivity, specificity, negative predictive value, and positive predictive value for nodal staging were 44%, 88%, 88%, and 44%, respectively. Furthermore, EUS after CHRT accurately predicted the absence of LN involvement in 7 of 7 patients (100%) with major pathological response of the primary tumor. Conclusion: Preoperative IMRT with concomitant XELOX induces favorable rates of major pathological response. EUS has a limited ability to predict primary tumor response after preoperative CHRT, but it is useful for accurately determining LN status. EUS may have a potential value in identifying patients with a very low risk of LN involvement in association

  4. Rectal Motion in Patients Receiving Preoperative Radiotherapy for Carcinoma of the Rectum

    SciTech Connect

    Brierley, James D.; Dawson, Laura A.; Sampson, Elliott; Bayley, Andrew; Scott, Sandra; Moseley, Joanne L.; Craig, Timothy; Cummings, Bernard; Dinniwell, Robert; Kim, John J.; Ringash, Jolie; Wong, Rebecca; Brock, Kristy K.

    2011-05-01

    Purpose: To assess the movement of rectum, mesorectum, and rectal primary during a course of preoperative chemoradiotherapy. Methods and Materials: Seventeen patients with Stage II or III rectal cancer had a planning CT scan with rectal contrast before commencement of preoperative chemoradiation. The scan was repeated during Weeks 1, 3, and 5 of chemoradiation. The rectal primary (gross tumor volume), rectum, mesorectum, and bladder were contoured on all four scans. An in-house biomechanical model-based deformable image registration technique, Morfeus, was used to measure the three-dimensional spatial change in these structures after bony alignment. The required planning target volume margin for this spatial change, after bone alignment, was also calculated. Results: Rectal contrast was found to introduce a systematic error in the position of all organs compared with the noncontrast state. The largest change in structures during radiotherapy was in the anterior and posterior directions for the mesorectum and rectum and in the superior and inferior directions for the gross tumor volume. The planning target volume margins required for internal movement for the mesorectum based on the three scans acquired during treatment are 4 mm right, 5 mm left, 7 mm anterior, and 6 mm posterior. For the rectum, values were 8 mm right, 8 mm left, 8 mm anterior, and 9 mm posterior. The greatest movement of the rectum occurred in the upper third. Conclusions: Contrast is no longer used in CT simulation. Assuming bony alignment, a nonuniform margin of 8 mm anteriorly, 9 mm posteriorly, and 8 mm left and right is recommended.

  5. Evaluation of a CT-based technique to measure the transfer accuracy of a virtually planned osteotomy.

    PubMed

    Dobbe, J G G; Kievit, A J; Schafroth, M U; Blankevoort, L; Streekstra, G J

    2014-08-01

    Accurate transfer of a preoperatively planned osteotomy plane to the bone is of significance for corrective surgery, tumor resection, implant positioning and evaluation of new osteotomy techniques. Methods for comparing a preoperatively planned osteotomy plane with a surgical cut exist but the accuracy of these techniques are either limited or unknown. This paper proposes and evaluates a CT-based technique that enables comparing virtual with actual osteotomy planes. The methodological accuracy and reproducibility of the technique is evaluated using CT-derived volume data of a cadaver limb, which serves to plan TKA osteotomies in 3-D space and to simulate perfect osteotomies not hampered by surgical errors. The methodological variability of the technique is further investigated with repeated CT scans after actual osteotomy surgery of the same cadaver specimen. Plane displacement (derr) and angulation errors in the sagittal and coronal plane (βerr, γerr) are measured with high accuracy and reproducibility (derr=-0.11±0.06mm; βerr=0.08±0.04°, γerr=-0.03±0.03°). The proposed method for evaluating an osteotomy plane position and orientation has a high intrinsic accuracy and reproducibility. The method can be of great value for measuring the transfer accuracy of new techniques for positioning and orienting a surgical cut in 3-D space.

  6. Imaging Modality of Choice for Pre-Operative Cochlear Imaging: HRCT vs. MRI Temporal Bone

    PubMed Central

    Solanki, Rajendra N.; Shah, Dipali C.; Vishwakarma, Rajesh; Kumar, Sandeep

    2016-01-01

    Introduction Congenital inner ear malformations occur as a result of the arrest or aberrance of inner ear development due to the heredity, gene mutation or other factors. Ever since the availability of cochlear implants, pre-operative evaluation by imaging of temporal bone has gained much attention. Precise selection of the candidate for cochlear implant dependent on preoperative radiological investigations. Only CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) can provide a better picture of anatomy and pathology. Aim To compare pre-operative imaging findings of both MRI and High Resolution Computed Tomography (HRCT) temporal bone and to find the best modality of choice in patients with bilateral profound Sensorineural Hearing Loss (SNHL). Materials and Methods This was a prospective, longitudinal, observational study conducted between June 2010 to November 2012. A total of 144 temporal bones were evaluated in 72 children with bilateral profound SNHL with congenital inner ear malformations. Each temporal bone was considered as a single case (144 cases). All the patients underwent HRCT and high field MRI study. MRI study included T2 W axial 3D FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence. Anatomic abnormalities in each temporal bone were described and noted. For complete and better evaluation of Vestibulo-Cochlear Nerve (VCN) additional 3D oblique parasagittal view was taken perpendicular to the internal auditory canal with a small Field Of View (FOV). Results HRCT and MRI allowed accurate detection of inner ear malformations in children with bilateral SNHL. Majority of the patients presented with multiple structural abnormalities of inner ear. The common pathologies detected in the study were semicircular canal abnormality (89/144) followed by cochlear abnormalities (39/144). Most common cochlear abnormality was Mondini’s deformity (14/144). MRI demonstrated absent of vestibulo-cochlear nerve in 15 cases. Conclusion Few

  7. State-of-the-art preoperative staging of gastric cancer by MDCT and magnetic resonance imaging

    PubMed Central

    Choi, Joon-Il; Joo, Ijin; Lee, Jeong Min

    2014-01-01

    Gastric cancer is one of the most common and fatal cancers. The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment options, such as endoscopic mucosal resection or laparoscopic surgery. The tumor-node-metastasis staging system is the generally accepted staging system for predicting the prognosis of patients with gastric cancer. Multidetector row computed tomography (MDCT) is a widely accepted imaging modality for the preoperative staging of gastric cancer that can simultaneously assess locoregional staging, including the gastric mass, regional lymph nodes, and distant metastasis. The diagnostic performance of MDCT for T- and N-staging has been improved by the technical development of isotropic imaging and 3D reformation. Although magnetic resonance imaging (MRI) was not previously used to evaluate gastric cancer due to the modality’s limitations, the development of high-speed sequences has made MRI a feasible tool for the staging of gastric cancer. PMID:24782607

  8. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    PubMed

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  9. The effect of preoperative exercise on total knee replacement outcomes.

    PubMed

    D'Lima, D D; Colwell, C W; Morris, B A; Hardwick, M E; Kozin, F

    1996-05-01

    This study compared the effects of preoperative physical therapy of general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement. Thirty patients were randomly assigned to 1 of 3 groups. Group 1 was the control group. Group 2 participated in a physical therapy program designed to strengthen the upper and lower limbs and improve knee range of motion. Group 3 participated in a cardiovascular conditioning program, consisting of arm ergometry, cycle ergometry, aquatic exercises, and aerobic activity. All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale, and the Quality of Well Being instrument. Both experimental groups tolerated their respective exercise protocols extremely well. All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales. However, neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations.

  10. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J.; Callaway, M.P. Alderson, D.

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  11. The Concept of Death in Preoperational Retarded Children.

    ERIC Educational Resources Information Center

    Sternlicht, Manny

    1980-01-01

    Fourteen preoperational retarded boys and girls were interviewed for their concepts of death. Subjects did not have realistic concepts of when they would die, or of the permanence of death, but did have knowledge of how things die. Types of replies subjects made were significantly related to subjects' cognitive level. (Author/RH)

  12. Intrathyroidal parathyroid adenoma: preoperative identification and localization by parathyroid imaging

    SciTech Connect

    Al-Suhaili, A.R.; Lynn, J.; Lavender, J.P.

    1988-07-01

    The authors report, probably for the first time, a successful pre-operative localization of 7 mm intrathyroidal parathyroid adenoma which was successfully removed by using parathyroid imaging using a dual tracer (T1-201 and Tc-99m) and subtraction technique.

  13. [The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

    PubMed

    Grande, M; Danza, F M

    1999-01-01

    The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

  14. Images in plastic surgery: digital thermographic photography ("thermal imaging") for preoperative perforator mapping.

    PubMed

    Chubb, Daniel; Rozen, Warren M; Whitaker, Iain S; Ashton, Mark W

    2011-04-01

    Preoperative imaging to identify the location of individual perforators has been shown to improve operative outcomes, and while computed tomographic angiography (CTA) and magnetic resonance angiography are currently the most widely used modalities, these have substantial limitations. Such limitations include the need for intravenous access, the need for iodinated contrast media, radiation exposure with CTA, and long scanning times with magnetic resonance angiography. Complications from the use of contrast media are also noteworthy, and can include anaphylactoid reactions and renal toxicity. In a move to avoid these problems, we have recently introduced a technique that is readily available and easy to implement for preoperative imaging, and may show an accuracy that matches the more advanced imaging modalities. Thermal imaging is a readily performed technique, and can be undertaken by the reconstructive surgeon themselves at the initial consultation, enabling prompt operative planning, and avoiding the need for delays in imaging, confusion in the interpretation of a radiologist report, and the need for an intermediary radiologist altogether. In our experience thus far, the technique matches the accuracy for location of CTA, and a larger clinical trial of the technique is underway.

  15. Image-guided preoperative prediction of pyramidal tract side effect in deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Baumgarten, C.; Zhao, Y.; Sauleau, P.; Malrain, C.; Jannin, P.; Haegelen, C.

    2016-03-01

    Deep brain stimulation of the medial globus pallidus is a surgical procedure for treating patients suffering from Parkinson's disease. Its therapeutic effect may be limited by the presence of pyramidal tract side effect (PTSE). PTSE is a contraction time-locked to the stimulation when the current spreading reaches the motor fibers of the pyramidal tract within the internal capsule. The lack of side-effect predictive model leads the neurologist to secure an optimal electrode placement by iterating clinical testing on an awake patient during the surgical procedure. The objective of the study was to propose a preoperative predictive model of PTSE. A machine learning based method called PyMAN (for Pyramidal tract side effect Model based on Artificial Neural network) that accounted for the current of the stimulation, the 3D electrode coordinates and the angle of the trajectory, was designed to predict the occurrence of PTSE. Ten patients implanted in the medial globus pallidus have been tested by a clinician to create a labeled dataset of the stimulation parameters that trigger PTSE. The kappa index value between the data predicted by PyMAN and the labeled data was .78. Further evaluation studies are desirable to confirm whether PyMAN could be a reliable tool for assisting the surgeon to prevent PTSE during the preoperative planning.

  16. Pre-operative laboratory testing: A prospective study on comparison and cost analysis

    PubMed Central

    Keshavan, Venkatesh H; Swamy, Chidananda MN

    2016-01-01

    Background and Aims: Pre-operative investigations are performed before any surgical intervention under anaesthesia. Many are considered as routine. However, there are no clear guidelines regarding these in India. We aim to look at the relevance of the laboratory investigations ordered routinely and their cost implications compared with the National Institute of Clinical Excellence (NICE) guidelines. Methods: This prospective study was carried out at a tertiary care hospital. A total of 163 patients scheduled for elective surgical procedures were included in this study. Neither the surgeons nor anaesthesiologists involved in the case were aware of the study. The laboratory investigations of the patients who underwent surgery were noted. All values were categorised as normal or abnormal and they were assessed as indicated or unindicated based on NICE guidelines. Results: One hundred and sixty-three patients were subjected to a total of 984 tests. Forty three patients (26%) were subjected to tests as per NICE guidelines. Of the 984 tests, 515 tests were unindicated (52%). Out of the 515 unindicated tests, 7 (1.3%) were abnormal. None of these seven tests required any intervention or change of anaesthetic plan. The most common unindicated tests done were cardiac echocardiography and chest X-ray (92.5% and 93% respectively). The additional cost incurred towards unindicated tests was 63% of the total cost for the tests. Conclusion: Pre-operative laboratory investigations add to cost significantly. Patient premorbid conditions and surgical grade should guide the clinician to request for the relevant laboratory tests. PMID:27942058

  17. Preoperative Optimization of the Heart Failure Patient Undergoing Cardiac Surgery.

    PubMed

    Pichette, Maxime; Liszkowski, Mark; Ducharme, Anique

    2017-01-01

    Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning preoperative optimization of these patients. Salient findings are that end-organ dysfunction and medication should be optimized before surgery. Specifically: (1) reversible causes of anemia should be treated and a preoperative hemoglobin level of 100 g/L obtained; (2) renal function and volume status should be optimized; (3) liver function must be carefully evaluated; (4) nutritional status should be assessed and cachexia treated to achieve a preoperative albumin level of at least 30 g/L and a body mass index > 20; and (5) medication adjustments performed, such as withholding inhibitors of the renin-angiotensin-aldosterone system before surgery and continuing, but not starting, β-blockers. Levels of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP) provide additional prognostic value and therefore should be measured. In addition, individual patient's risk should be objectively assessed using standard formulas such as the EuroSCORE-II or Society of Thoracic Surgeons risk scores, which are simple and validated for various cardiac surgeries, including left ventricular assist device implantation. When patients are identified as high risk, preoperative hemodynamic optimization might be achieved with the insertion of a pulmonary artery catheter and hemodynamic-based tailored therapy. Finally, a prophylactic intra-aortic balloon pump might be considered in certain circumstances to decrease morbidity and even mortality, like in some high risk heart failure patients who undergo cardiac surgery, whereas routine preoperative inotropes are not recommended and should be reserved for patients in shock, except maybe for levosimendan.

  18. [The Helsinki Declaration for Patient Safety in Anaesthesiology--preoperative assessment and preparation].

    PubMed

    Fischer, Dania; Byhahn, Christian; Reyher, Christian; Wilke, Hans-Joachim

    2013-06-01

    The Helsinki Declaration offers guidelines for the warranty and improvement of patient safety in Anaesthesiology. The assessment of elective patients and their preoperative optimization plays a key role herein. Individual risk factors and preexisting pathologies have to be identified in order to initiate specific pre- and aftercare and an appropriate monitoring. The measures need to be evidence-based, goal-oriented and efficient. Our recommendations aim at elective adult patients planned for non-cardiac and non-lung-resecting surgery and stress the importance of gathering information from patients, performing physical examinations and arranging further diagnostic customized upon these findings only in contrast to routine testing. They shall spark the formulation or improvement of center-based, interdisciplinary standards of procedure in order to fulfill our great responsibility for the perioperative care of our patients.

  19. Aorta-Left Renal Vein Fistula Complicating an Aortic Aneurysm: Preoperative and Postoperative Multislice CT Findings

    SciTech Connect

    Barrier, Pierre Otal, Philippe; Garcia, Olivier; Vahdat, Olivier; Domenech, Brice; Lannareix, Valerie; Joffre, Francis; Rousseau, Herve

    2007-06-15

    Fistulas complicating an abdominal aortic aneurysm (AAA) are rare, and fistulas involving the left renal vein are particularly uncommon. We highlight here a fistula between an infrarenal aortic aneurysm and a retroaortic left renal vein, revealed by left flank pain associated with hematuria and acute renal failure. The multislice CT angiography performed in this 68-year-old patient revealed communication and equal enhancement between the aorta and the left gonadic vein, suggesting the presence of a fistula. The three-dimensional VRT reconstructions presented in this case were of great value in the preoperative planning, enabling immediate visualization of this unusual feature. Alternative diagnoses to consider when encountering this clinical presentation are reviewed.

  20. 77 FR 71804 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Antiseptic Patient Preoperative Skin Preparation Products...). The document announced a public hearing entitled ``Antiseptic Patient Preoperative Skin...

  1. On numerically accurate finite element

    NASA Technical Reports Server (NTRS)

    Nagtegaal, J. C.; Parks, D. M.; Rice, J. R.

    1974-01-01

    A general criterion for testing a mesh with topologically similar repeat units is given, and the analysis shows that only a few conventional element types and arrangements are, or can be made suitable for computations in the fully plastic range. Further, a new variational principle, which can easily and simply be incorporated into an existing finite element program, is presented. This allows accurate computations to be made even for element designs that would not normally be suitable. Numerical results are given for three plane strain problems, namely pure bending of a beam, a thick-walled tube under pressure, and a deep double edge cracked tensile specimen. The effects of various element designs and of the new variational procedure are illustrated. Elastic-plastic computation at finite strain are discussed.

  2. Interacting with image hierarchies for fast and accurate object segmentation

    NASA Astrophysics Data System (ADS)

    Beard, David V.; Eberly, David H.; Hemminger, Bradley M.; Pizer, Stephen M.; Faith, R. E.; Kurak, Charles; Livingston, Mark

    1994-05-01

    Object definition is an increasingly important area of medical image research. Accurate and fairly rapid object definition is essential for measuring the size and, perhaps more importantly, the change in size of anatomical objects such as kidneys and tumors. Rapid and fairly accurate object definition is essential for 3D real-time visualization including both surgery planning and Radiation oncology treatment planning. One approach to object definition involves the use of 3D image hierarchies, such as Eberly's Ridge Flow. However, the image hierarchy segmentation approach requires user interaction in selecting regions and subtrees. Further, visualizing and comprehending the anatomy and the selected portions of the hierarchy can be problematic. In this paper we will describe the Magic Crayon tool which allows a user to define rapidly and accurately various anatomical objects by interacting with image hierarchies such as those generated with Eberly's Ridge Flow algorithm as well as other 3D image hierarchies. Preliminary results suggest that fairly complex anatomical objects can be segmented in under a minute with sufficient accuracy for 3D surgery planning, 3D radiation oncology treatment planning, and similar applications. Potential modifications to the approach for improved accuracy are summarized.

  3. Computed Tomographic Angiography as an Adjunct to Digital Subtraction Angiography for the Pre-Operative Assessment of Cerebral Aneurysms

    PubMed Central

    Farsad, Khashayar; Mamourian, Alexander C; Eskey, Clifford J; Friedman, Jonathan A

    2009-01-01

    Objectives: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery. Patients and Methods: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning. Results: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments. Conclusion: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed. PMID:19452029

  4. The impact of focused transthoracic echocardiography in the pre-operative clinic.

    PubMed

    Canty, D J; Royse, C F; Kilpatrick, D; Bowman, L; Royse, A G

    2012-06-01

    Patients with suspected or symptomatic cardiac disease, associated with increased peri-operative risk, are often seen by anaesthetists in the pre-assessment clinic. The use of transthoracic echocardiography in this setting has not been reported. This prospective observational study investigated the effect of echocardiography on the anaesthetic management plan in 100 patients who were older than 65 years or had suspected cardiac disease. Echocardiography was performed by an anaesthetist, and was validated by a cardiologist. Overall, the anaesthetic plan was changed in 54 patients. Haemodynamically significant cardiac disease was revealed in 31 patients, resulting in a step-up of treatment in 20 patients, including: cardiology referral (four patients); altered surgical (two) and anaesthetic (four) technique; use of invasive monitoring (13); planned use of vasopressor infusion (10); and postoperative high dependency care (five). Reassuring negative findings in 69 patients led to a step-down in treatment in 34 patients: altered anaesthetic technique (six); procedure not cancelled (10); cardiology referral not made (10); use of invasive monitoring not required (seven); and high dependency care not booked (11). We conclude that focused transthoracic echocardiography in the pre-operative clinic is feasible and frequently alters management in patients with suspected cardiac disease.

  5. The Prognostic Importance of Patient Pre-Operative Expectations of Surgery for Lumbar Spinal Stenosis.

    ERIC Educational Resources Information Center

    Iversen, Maura D.; Daltroy, Lawren H.; Fossel, Anne H.; Katz, Jeffrey N.

    1998-01-01

    Examines patients (N=257) with lumbar spinal stenosis preoperatively and at six months to relate patient expectation to baseline function and pain and to determine how patient expectations and preoperative function interact to predict postoperative outcomes. Results show that patients with many preoperative expectations, particularly those with…

  6. Preoperative diagnosis of carcinoma within fibroadenoma on screening mammograms.

    PubMed

    Borecky, N; Rickard, M

    2008-02-01

    Three cases of fibroadenoma associated with carcinoma are reported. These cases were diagnosed within a screening programme as a result of suspicious mammographic findings, and the diagnosis of malignancy was confirmed preoperatively by core biopsy in all cases. The mammographic findings suggestive of carcinoma within fibroadenoma were irregularity of margins in one case and associated new suspicious pleomorphic and linear calcifications in the two other cases. The preoperative diagnosis of carcinoma within fibroadenoma was provided by ultrasound-guided core biopsy in two cases and core biopsy under stereotactic guidance in one case. Whereas asymptomatic fibroadenoma with benign imaging appearances usually does not require further investigation, fibroadenoma with atypical imaging features requires a triple test investigation.

  7. Preoperative staging of primary breast cancer. A multicentric study.

    PubMed

    Ciatto, S; Pacini, P; Azzini, V; Neri, A; Jannini, A; Gosso, P; Molino, A; Capelli, M C; di Costanzo, F; Pucciatti, M A

    1988-03-01

    This article reports on a consecutive series of 3627 breast cancer (BC) patients undergoing preoperative staging by chest x-ray (CXR), bone x-ray (BXR) or bone scintigraphy (BS), and liver ecography (LE) or liver scintigraphy (LS). The detection rate (DR) of preclinical asymptomatic distant metastases depended on the T and N category (TNM classification system), and was very low (CXR: 0.30%, BXR: 0.64%, BS: 0.90%, LE: 0.24%, LS: 0.23%). The sensitivity, determined after a 6-month follow-up, was below 0.50% for all tests. The highest value (0.48%) was recorded for BS, which also had the lowest specificity (0.95%). The entire preoperative staging policy using the studied tests seems questionable due to poor sensitivity and an extremely low DR of distant metastases.

  8. Cervical disk arthroplasty versus ACDF for preoperative reducible kyphosis.

    PubMed

    Chen, Yu; Wang, Xinwei; Lu, Xuhua; Yang, Haisong; Chen, Deyu

    2013-07-01

    Cervical total disk arthroplasty has proven to be an effective and safe alternative for anterior cervical diskectomy and fusion (ACDF) for the treatment of cervical disk degenerative disease. However, whether and when cervical disk arthroplasty is indicated for preoperative cervical spine kyphosis is unclear. In the authors' clinical experiences, preoperative kyphosis can generally be divided into reducible and irreducible forms according to the results of dynamic flexion-extension lateral radiographs. Reducible kyphosis is mostly related to local disk prolapse, clinical symptoms, and musculature weakness, but irreducible kyphosis is always associated with significant cervical degeneration or congenital bone malformation. In this study, 32 patients with preoperative reducible kyphosis were randomized in a 1:1 ratio to either single-level total cervical arthroplasty with the Discover cervical disk prosthesis (DePuy Spine, Raynham, Massachusetts) (arthroplasty group) or single-level ACDF with a polyetheretherketone cage and plate (ACDF group). No significant differences existed in clinical and radiological results at 2-year follow-up between the arthroplasty and ACDF groups. The global and functional spinal unit angles of the arthroplasty group were significantly lower than those of the ACDF group 6 months postoperatively, which was consistent with the result of the comparison in Neck Disability Index score. However, the sagittal alignment of the overall cervical spine and the treated segment and the Neck Disability Index score significantly improved after 6 months in the arthroplasty group but not in the ACDF group. Therefore, preoperative reducible kyphosis is not a contraindication for cervical total disk arthroplasty. However, neck strength-building exercises should be emphasized for the postoperative rehabilitation after cervical total disk arthroplasty.

  9. [Preoperative magnetic resonance imaging of children with multifocal musculoskeletal infections].

    PubMed

    Al-Aubaidi, Zaid

    2011-04-11

    We describe the case of a three-week-old female, who presented with fever and swelling of the left thigh. Initial examination revealed signs of infection in both hips, which was confirmed at surgery. However, as the child did not recover despite relevant antibiotics, a full body MRI was performed, revealing multiple abscesses, some of which had to be managed surgically. We emphasize the benefit of MRI as part of the preoperative assessment of multifocal musculoskeletal infections in children.

  10. Prognostic value of preoperative serum tumor markers in gastric cancer

    PubMed Central

    Huang, Ze-Bo; Zhou, Xin; Xu, Jun; Du, Yi-Ping; Zhu, Wei; Wang, Jian; Shu, Yong-Qian; Liu, Ping

    2014-01-01

    AIM: To evaluate the prognostic value of preoperative carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, and CA50 in patients undergoing D2 resection. METHODS: We evaluated 363 patients with gastric cancer who underwent gastrectomy at our hospital from January 2006 to December 2009. Blood samples were obtained from each patient within 1 wk before surgery. The cut-off values for serum CEA, CA19-9, and CA50 were 5 ng/mL, 37 U/mL, and 20 U/mL, respectively. The correlation between preoperative tumor marker levels and prognosis was studied by means of univariate and multivariate analyses. RESULTS: The preoperative serum positive rates of CEA, CA19-9 and CA50 were 24.0%, 18.9% and 24.5%, respectively. The positivity rate of serum CEA was significantly correlated with age (P < 0.001), sex (P = 0.022), tumor size (P = 0.007) and depth of invasion (P = 0.018); CA19-9 with tumor size (P = 0.042) and lymph node metastasis (P < 0.001); and CA50 only with lymph node metastasis (P = 0.001). In multivariate analysis, tumor size, T category, N category, vascular or neural invasion, and adjuvant chemotherapy were independent prognostic factors for overall survival. CA19-9 had an independent prognostic significance in patients without adjuvant chemotherapy (P = 0.027). CONCLUSION: Preoperative serum CEA, CA19-9 and CA50 are prognostic in patients with gastric cancer. Only CA19-9 is an independent prognostic factor after surgery without adjuvant chemotherapy. PMID:24829865

  11. Operational Environmental Monitoring Program Quality Assurance Project Plan

    SciTech Connect

    Perkins, C.J.

    1994-08-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and operational environmental monitoring performed by Westinghouse Hanford Company as it implements the Operational Environmental Monitoring program. This plan applies to all sampling and monitoring activities performed by Westinghouse Hanford Company in implementing the Operational Environmental Monitoring program at the Hanford Site.

  12. Psychologists in preoperative programmes for children undergoing surgery.

    PubMed

    Cuzzocrea, Francesca; Costa, Sebastiano; Gugliandolo, Maria Cristina; Larcan, Rosalba

    2016-06-01

    This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist.

  13. Preoperative Chemotherapy for Gastric Cancer: Personal Interventions and Precision Medicine

    PubMed Central

    Xu, Wei; Beeharry, Maneesh K.; Yan, Min; Zhu, Zhenggang

    2016-01-01

    In spite of the declining incidence of gastric cancer (GC) in recent years, the mortality rate is still high. The asymptomatic nature and nonspecific clinical manifestations combined with the lack of efficient screening programs delay the diagnosis of GC. Therefore, the prevalence of advanced gastric cancer (AGC) has prompted the need for aggressive and intensive treatment options. Among the various treatment options for AGC, surgery is still the mainstay. However, the efficacy of surgery alone is not established. Results from multiple randomized controlled trials suggest that preoperative chemotherapy is promising intervention for the treatment and management of AGC. The main objective of neoadjuvant chemotherapy is to downstage or control micrometastasis in resectable tumor before surgery. On the other hand, conversion chemotherapy refers to surgical treatment aiming at R0 resection after chemotherapy for originally nonresectable or marginally resectable tumors. Nevertheless, preoperative chemoradiotherapy is considered beneficial for AGC patients. Over the last few decades, the combination of chemotherapy and targeted therapy prior to surgery demonstrated great results for the treatment of AGC. The rapid developments in genomics and proteomics have heralded the era of precision medicine. The combination of preoperative chemotherapy and precision medicine may enhance survival in AGC patients. PMID:28105420

  14. [Comparison of four protocols for preoperative preparation in cattle].

    PubMed

    Bédard, S; Desrochers, A; Fecteau, G; Higgins, R

    2001-03-01

    This study was designed to evaluate 4 preoperative skin preparations, that is, more specifically, to compare the efficacy of chlorhexidine gluconate (CG) and povidone-iodine (PI), as well as 2 hair removal techniques (clipper alone or clipper followed by razor) for preoperative skin preparation in cattle. The 4 protocols resulted in a significant decrease in the number of bacterial colony-forming units (cfu). Group 4 (clipping + shaving + CG) had a significantly lower number of preoperative cfu per gel plate compared with groups 1 (clipping + PI) and 3 (clipping + shaving + PI). Skin reaction frequency was significantly higher in groups 3 and 4 (47.8% for both protocols) than in groups 1 and 2 (clipping + PI or CG) (8.7% for both). Wound infection frequency was 4.3% (4/92) and no significant difference was observed between the 4 treatment groups. The 4 protocols tested were equivalent as to efficacy and satisfactorily decreased skin microflora. Clipping alone was shown to be preferable to clipping plus shaving as a method of hair removal in cattle, with fewer skin reactions and no more wound infections.

  15. Adenosquamous carcinoma of the pancreas: preoperative diagnosis and molecular alterations.

    PubMed

    Murakami, Yoshiaki; Yokoyama, Takashi; Yokoyama, Yujiro; Kanehiro, Tetsuya; Uemura, Kenichiro; Sasaki, Masaru; Morifuji, Masahiko; Sueda, Taijiro

    2003-01-01

    Adenosquamous carcinoma of the pancreas is a rare tumor which has a less favorable prognosis than common ductal cell carcinoma of the pancreas, and a definite preoperative diagnosis of this tumor is quite difficult. We herein report two cases of this rare variant. The patients were a 41-year-old man (patient 1) and a 67-year-old woman (patient 2). Patient 1 had a hypoechoic mass measuring 3 cm in the uncus of the pancreas, while patient 2 had a huge mass, measuring 8 cm, in the tail of the pancreas. Patient 2 was successfully diagnosed preoperatively as having an adenosquamous carcinoma, by cytological examination of the pure pancreatic juice obtained by endoscopic retrograde pancreatic juice aspiration. A pylorus-preserving pancreatoduodenectomy was performed for patient 1, and a distal pancreatectomy with resection of the spleen and the left kidney was performed for patient 2. Subsequent pathological findings of these two tumors revealed adenosquamous carcinoma of the pancreas. K- ras point mutation, p53 overexpression, and telomerase activity in both tumor specimens were detected by the mutant allele specific amplification method, immunohistochemical staining, and telomeric repeat amplification protocol assay, respectively. The two patients died of recurrent disease 5 and 4 months, respectively, after surgery. Cytological examination of pure pancreatic juice is a useful modality for the preoperative diagnosis of this tumor, and frequent molecular alterations may be associated with the poor prognosis of adenosquamous carcinoma of the pancreas.

  16. Total ankle arthroplasty with severe preoperative varus deformity.

    PubMed

    Hanselman, Andrew E; Powell, Brian D; Santrock, Robert D

    2015-04-01

    Advancements in total ankle arthroplasty (TAA) over the past several decades have led to improved patient outcomes and implant survivorship. Despite these innovations, many implant manufacturers still consider a preoperative coronal plane deformity greater than 10° a relative contraindication to TAA. Without proper intraoperative alignment, these implants may experience abnormal wear and hardware failure. Correcting these deformities, often through the use of soft tissue procedures and/or osteotomies, not only increases the difficulty of a case, but also the intraoperative time and radiation exposure. The authors report a case in which a 54-year-old man with a severe right ankle varus deformity of 29° underwent successful TAA using the INBONE II Prophecy total ankle system (Wright Medical Technology, Inc, Memphis, Tennessee) and additional soft tissue reconstruction. Intraoperatively, the patient's coronal deformity was corrected to 1.8°. At 8 months postoperatively, the patient ambulated without restriction and had substantial improvement in validated patient outcome scores, specifically the Academy of Orthopaedic Surgeons Foot and Ankle Module and the Short Form Health Survey-12 This unique report documents the first time that this particular implant, with an exclusive preoperative computed tomography-derived patient-specific guide, has been used effectively for a severe preoperative varus deformity greater than 20° without the need for an osteotomy. Future studies should be directed toward the prospective evaluation of different total ankle implant systems and their outcomes with severe coronal plane deformity, specifically computed tomography-derived patient-specific guided implants.

  17. Clostridium difficile colonization in preoperative colorectal cancer patients.

    PubMed

    Zheng, Yi; Luo, Yun; Lv, Yinxiang; Huang, Chen; Sheng, Qinsong; Zhao, Peng; Ye, Julian; Jiang, Weiqin; Liu, Lulu; Song, Xiaojun; Tong, Zhou; Chen, Wenbin; Lin, Jianjiang; Tang, Yi-Wei; Jin, Dazhi; Fang, Weijia

    2017-01-02

    The entire process of Clostridium difficile colonization to infection develops in large intestine. However, the real colonization pattern of C. difficile in preoperative colorectal cancer patients has not been studied. In this study, 33 C. difficile strains (16.1%) were isolated from stool samples of 205 preoperative colorectal cancer patients. C. difficile colonization rates in lymph node metastasis patients (22.3%) were significantly higher than lymph node negative patients (10.8%) (OR=2.314, 95%CI=1.023-5.235, P =0.025). Meanwhile, patients positive for stool occult blood had lower C. difficile colonization rates than negative patients (11.5% vs. 24.0%, OR=0.300, 95%CI=0.131-0.685, P =0.019). A total of 16 sequence types were revealed by multilocus sequence typing. Minimum spanning tree and time-space cluster analysis indicated that all C. difficile isolates were epidemiologically unrelated. Antibiotic susceptibility testing showed all isolates were susceptible to vancomycin and metronidazole. The results suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital. Since lymph node metastasis colorectal cancer patients inevitably require adjuvant chemotherapy and C. difficile infection may halt the ongoing treatment, the call for sustained monitoring of C. difficile in those patients is apparently urgent.

  18. Accurate ab Initio Spin Densities.

    PubMed

    Boguslawski, Katharina; Marti, Konrad H; Legeza, Ors; Reiher, Markus

    2012-06-12

    We present an approach for the calculation of spin density distributions for molecules that require very large active spaces for a qualitatively correct description of their electronic structure. Our approach is based on the density-matrix renormalization group (DMRG) algorithm to calculate the spin density matrix elements as a basic quantity for the spatially resolved spin density distribution. The spin density matrix elements are directly determined from the second-quantized elementary operators optimized by the DMRG algorithm. As an analytic convergence criterion for the spin density distribution, we employ our recently developed sampling-reconstruction scheme [J. Chem. Phys.2011, 134, 224101] to build an accurate complete-active-space configuration-interaction (CASCI) wave function from the optimized matrix product states. The spin density matrix elements can then also be determined as an expectation value employing the reconstructed wave function expansion. Furthermore, the explicit reconstruction of a CASCI-type wave function provides insight into chemically interesting features of the molecule under study such as the distribution of α and β electrons in terms of Slater determinants, CI coefficients, and natural orbitals. The methodology is applied to an iron nitrosyl complex which we have identified as a challenging system for standard approaches [J. Chem. Theory Comput.2011, 7, 2740].

  19. Value of rest-stress myocardial positron tomography using nitrogen-13 ammonia for the preoperative prediction of reversible asynergy

    SciTech Connect

    Tamaki, N.; Yonekura, Y.; Yamashita, K.; Senda, M.; Saji, H.; Konishi, Y.; Hirata, K.; Ban, T.; Konishi, J. )

    1989-08-01

    To determine the predictive value of stress (13N)ammonia positron emission tomography (PET) for reversible ischemia, 31 patients with coronary artery disease underwent rest-stress (13N)ammonia PET before and after coronary artery bypass surgery. The circumferential profile analysis was applied to determine the presence of transient defect (TD) and persistent defect (PD) preoperatively, and the fate of perfusion abnormality and asynergy after the surgery was assessed. Preoperative PET demonstrated 100 segments with perfusion abnormalities, including 69 TD and 31 PD. Fifty-six of the 69 TD (81%) improved in regional perfusion, while only four of 31 PD (13%) improved in perfusion postoperatively (p less than 0.001). Of 75 segments showing regional asynergy on contrast or radionuclide ventriculography preoperatively, 34 of 48 segments with TD (71%) improved in asynergy, while only five of 27 segments with PD (19%) improved in asynergy postoperatively (p less than 0.001). Stress-delayed 201TI tomography was performed in 22 of them. The predictive values for improvement in perfusion (77%) and asynergy (65%) were similar as those by (13N)ammonia PET (81% and 71%, respectively). However, the predictive values for no improvement in perfusion and asynergy by 201TI tended to be low (66% and 58%, respectively), as compared to those in 13N ammonia PET (87%; p less than 0.05 and 81%; p = 0.09, respectively). We conclude that an accurate prediction of reversible ischemia and asynergy can be achieved with rest-stress (13N)ammonia PET. Particularly, it can identify irreversible areas more accurately than the commonly performed stress-delayed 201TI imaging.

  20. Early prediction of histopathological response of rectal tumors after one week of preoperative radiochemotherapy using 18 F-FDG PET-CT imaging. A prospective clinical study

    PubMed Central

    2012-01-01

    Background Preoperative radiochemotherapy (RCT) is standard in locally advanced rectal cancer (LARC). Initial data suggest that the tumor’s metabolic response, i.e. reduction of its 18 F-FDG uptake compared with the baseline, observed after two weeks of RCT, may correlate with histopathological response. This prospective study evaluated the ability of a very early metabolic response, seen after only one week of RCT, to predict the histopathological response to treatment. Methods Twenty patients with LARC who received standard RCT regimen followed by radical surgery participated in this study. Maximum standardized uptake value (SUV-MAX), measured by PET-CT imaging at baseline and on day 8 of RCT, and the changes in FDG uptake (ΔSUV-MAX), were compared with the histopathological response at surgery. Response was classified by tumor regression grade (TRG) and by achievement of pathological complete response (pCR). Results Absolute SUV-MAX values at both time points did not correlate with histopathological response. However, patients with pCR had a larger drop in SUV-MAX after one week of RCT (median: -35.31% vs −18.42%, p = 0.046). In contrast, TRG did not correlate with ΔSUV-MAX. The changes in FGD-uptake predicted accurately the achievement of pCR: only patients with a decrease of more than 32% in SUV-MAX had pCR while none of those whose tumors did not show any decrease in SUV-MAX had pCR. Conclusions A decrease in ΔSUV-MAX after only one week of RCT for LARC may be able to predict the achievement of pCR in the post-RCT surgical specimen. Validation in a larger independent cohort is planned. PMID:22853868

  1. Value of pre-operative breast MRI for the size assessment of ductal carcinoma in situ

    PubMed Central

    Proulx, Francesca; Correa, José A; Ferré, Romuald; Omeroglu, Atilla; Aldis, Ann; Meterissian, Sarkis

    2016-01-01

    Objective: To retrospectively evaluate the accuracy of pre-operative breast MRI and mammography in determining the size of ductal carcinoma in situ (DCIS) compared with the histopathological results. Methods: 79 patients [mean age: 56.5 (standard deviation 10.2) years] with pathologically proven DCIS (79 lesions) obtained a bilateral mammogram and a pre-operative contrast-enhanced MRI. The accuracy of MRI and mammography to detect tumour size were estimated and compared, using histopathological size as the gold standard, on the subjects with measurements with both modalities (n = 60). Results: MRI detected 67 (85%) lesions, mammography detected 72 (91%) and both modalities detected 60 (76%). Median DCIS size detected by mammography vs MRI was smaller (1.55 vs 1.65 cm). Out of these 60 cases, compared with the histopathological size, the accuracy of MRI and mammography was 0.66 and 0.56, respectively (p = 0.045). MRI showed better accuracy than mammography for younger patients (age ≤ 50 years, p = 0.003). For tumour nuclear grade, there was a statistically significant difference for the intermediate level, with higher accuracy for MRI (p = 0.03). Conclusion: MRI was more accurate than mammography in DCIS size assessment when visible, particularly in lesions of intermediate grade and in patients less than 50 years of age. Advances in knowledge: Breast MRI may help in management of DCIS of intermediate grade and in females less than 50 years of age. PMID:26568438

  2. 3D liver surgery simulation: computer-assisted surgical planning with 3D simulation software and 3D printing.

    PubMed

    Oshiro, Yukio; Ohkohchi, Nobuhiro

    2017-03-27

    To perform accurate hepatectomy without injury, it is necessary to understand the anatomical relationship among the branches of Glisson's sheath, hepatic veins, and tumor. In Japan, three-dimensional (3D) preoperative simulation for liver surgery is becoming increasingly common, and liver 3D modeling and 3D hepatectomy simulation by 3D analysis software for liver surgery have been covered by universal healthcare insurance since 2012. Herein, we review the history of virtual hepatectomy using computer-aided surgery (CAS) and our research to date, and we discuss the future prospects of CAS. We have used the SYNAPSE VINCENT medical imaging system (Fujifilm Medical, Tokyo, Japan) for 3D visualization and virtual resection of the liver since 2010. We developed a novel fusion imaging technique combining 3D computed tomography (CT) with magnetic resonance imaging (MRI). The fusion image enables us to easily visualize anatomic relationships among the hepatic arteries, portal veins, bile duct, and tumor in the hepatic hilum. In 2013, we developed an original software, called Liversim, that enables real-time deformation of the liver using physical simulation, and a randomized control trial has recently been conducted to evaluate the use of Liversim and SYNAPSE VINCENT for preoperative simulation and planning. Furthermore, we developed a novel hollow 3D-printed liver model whose surface is covered with frames. This model is useful for safe liver resection, has better visibility, and the production cost is reduced to one-third of a previous model. Preoperative simulation and navigation with CAS in liver resection are expected to help planning and conducting a surgery and surgical education. Thus, a novel CAS system will contribute to not only the performance of reliable hepatectomy but also to surgical education.

  3. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    ERIC Educational Resources Information Center

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The…

  4. Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

    PubMed Central

    Itagaki, Michael W.

    2015-01-01

    Three-dimensional (3D) printing applications in medicine have been limited due to high cost and technical difficulty of creating 3D printed objects. It is not known whether patient-specific, hollow, small-caliber vascular models can be manufactured with 3D printing, and used for small vessel endoluminal testing of devices. Manufacture of anatomically accurate, patient-specific, small-caliber arterial models was attempted using data from a patient’s CT scan, free open-source software, and low-cost Internet 3D printing services. Prior to endovascular treatment of a patient with multiple splenic artery aneurysms, a 3D printed model was used preoperatively to test catheter equipment and practice the procedure. A second model was used intraoperatively as a reference. Full-scale plastic models were successfully produced. Testing determined the optimal puncture site for catheter positioning. A guide catheter, base catheter, and microcatheter combination selected during testing was used intraoperatively with success, and the need for repeat angiograms to optimize image orientation was minimized. A difficult and unconventional procedure was successful in treating the aneurysms while preserving splenic function. We conclude that creation of small-caliber vascular models with 3D printing is possible. Free software and low-cost printing services make creation of these models affordable and practical. Models are useful in preoperative planning and intraoperative guidance. PMID:26027767

  5. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  6. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  7. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  8. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  9. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  10. Percutaneous vertebroplasty guided by preoperative computed tomography measurements

    PubMed Central

    Tan, Zhongbao; Di, Zhenhai; Mao, Xuequn; Zhang, Jian; Zou, Rong; Wang, Qingqing

    2016-01-01

    Background: Percutaneous vertebroplasty (PVP) is now widely performed to treat painful vertebral compression fractures. Previous researches have reported numerous advantages. However, it rarely reported that how to determine the feasibility of the unilateral or bilateral approach and how to decide the puncture angle, the skin insertion site before the procedure. The aim of this study was to discuss the feasibility of PVP using unilateral pedicular approach by the three-dimensional positioning of computed tomography (CT) image. Materials and Methods: Under fluoroscopic guidance, 108 patients with 115 diseased vertebral bodies underwent PVP. The study was divided in two groups. Group A, fifty patients with 52 vertebrae received PVP without using preoperative CT measurements and puncture simulation. Group B, 58 patients with 63 vertebrae received PVP using preoperative CT measurements and puncture simulation. The skin needle entry point and puncture angle of the transverse plane and sagittal plane were determined by the software of PACS on preoperative CT image. The choice of unilateral or bilateral pedicular approach was decided based on the CT image before the procedure. PVP was carried out according to the measurement result above. The average time for a single vertebra operation, the success rate of single puncture and complications was evaluated and compared between Group A and Group B. Results: In Group A, technical success of unilateral PVP was 63.5% (33/52 vertebrae), and 92% (58/63 vertebrae) in Group B. The average time of operation in Groups A and B were (37.5 ± 5.5) and (28.5 ± 5.5) min, respectively. There was a significant difference in the time of single-vertebra operation and the success rates of unilateral PVP between Groups A and B. No serious complications developed during the followup period. Conclusions: The CT three-dimensional positioning measurement for PVP can increase the success rate of unilateral PVP. PMID:27904217

  11. [Valvular heart disease: preoperative assessment and postoperative care].

    PubMed

    Nägele, Reto; Kaufmann, Beat A

    2013-10-30

    Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

  12. Preoperative fasting: current practice and areas for improvement.

    PubMed

    Falconer, R; Skouras, C; Carter, T; Greenway, L; Paisley, A M

    2014-03-01

    Preoperative fasting aims to increase patient safety by reducing the risk of adverse events during general anaesthesia. However, prolonged fasting may be associated with dehydration, hypoglycaemia and electrolyte imbalance as well as patient discomfort. We aimed to examine compliance with the current best practice guidelines in a large surgical unit and to identify areas for improvement. Adult patients undergoing elective and emergency general, orthopaedic, gynaecology and vascular surgery procedures in the Royal Infirmary of Edinburgh were surveyed over a 3-month period commencing November 2011. A standardised questionnaire was used to collect information on the duration of preoperative fasting and the advice administered by medical and nursing staff. 292 patients were included. Median fast from solids was 13.5 h for elective patients (IQR 11.5-16) and 17.38 h for emergency patients (IQR 13.68-28.5 h). Similarly, the median fast from fluids was 9.36 h for elective patients (IQR 5.38-12.75 h) and 12.97 h for emergency patients (IQR 8.5-16.22 h). The instructions that elective patients received contributed to prolonged fasting times. The median fast for elective patients fully compliant with fasting advice would be 10 h for solids (IQR 8.75-12 h) and 6.25 h (IQR 3.83-9.25 h) for clear fluids. Elective patients fasted for longer than recommended confirming that clinical practice is slow to change. The use of universal fasting instructions and patient choice are factors that unnecessarily prolong preoperative fasting, which however appears to be multifactorial. Service improvement by abbreviation of the observed fasting periods will rely on targeted staff education and effective clinical communication by provision of written information for both elective and emergency surgical patients. The routine use of preoperative nutritional supplements may need to be re-examined when further evidence is available.

  13. [Chronic medications in the preoperative period: should they be stopped?].

    PubMed

    López-Álvarez, A; Román-Fernández, A; Fernández-Vieitez, M B; Fossati-Puertas, S

    2014-03-01

    As different specialists are becoming increasingly involved in the preoperative management of our patients (for two main reasons; Primary Care doctors have to perform minor surgical procedures, and as coordination between Primary Care and In-hospital Care is more and more necessary in order to improve their outcomes), we believe that an update is needed as regards the management of chronic medications in this period. We will try to review the current literature dealing with the recommendations about withdrawing or continuing these drugs.

  14. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis.

    PubMed

    Miranda, L; Settembre, A; Capasso, P; Piccolboni, D; De Rosa, N; Corcione, F

    2001-03-01

    Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irreducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile woman with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.

  15. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications.

  16. Sinonasal glomangiopericytoma treated with preoperative embolisation and endoscopic sinus surgery

    PubMed Central

    Psoma, Elizabeth; Karkos, Petros D; Dova, Stamatia; Gavriilidis, Michail; Markou, Konstantinos; Kouskouras, Constantinos; Haritanti, Afroditi; Finitsis, Stefanos

    2016-01-01

    Sinonasal glomangiopericytoma is a benign rare tumour of pericytes that accounts for less than 0.5% of all sinonasal tumours. It is an indolent tumour with a macroscopic appearance of common inflammatory polyps. We report the case of a 55-year-old male who presented with right nasal obstruction. CT and MRI examinations demonstrated a soft-tissue mass that obstructed mainly the right nasal cavity. Biopsy revealed glomangiopericytoma. The tumour was treated with preoperative embolisation followed by complete endoscopic resection. Very few cases have been reported to be treated in this way. PMID:27994648

  17. [Preoperative tests recommendations in adult patients for ambulatory surgery].

    PubMed

    Zaballos, M; López-Álvarez, S; Argente, P; López, A

    2015-01-01

    Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status gradei and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA gradei and grade ii patients undergoing ambulatory surgery.

  18. Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy.

    PubMed

    Ogasawara, Yasushi; Sato, Yuiko; Narumi, Shinsuke; Sasaki, Makoto; Fujiwara, Shunrou; Kobayashi, Masakazu; Yoshida, Kenji; Terayama, Yasuo; Ogasawara, Kuniaki

    2016-10-27

    The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)-used to discriminate between the presence and absence of microembolic signals-was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.

  19. Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy

    PubMed Central

    Ogasawara, Yasushi; Sato, Yuiko; Narumi, Shinsuke; Sasaki, Makoto; Fujiwara, Shunrou; Kobayashi, Masakazu; Yoshida, Kenji; Terayama, Yasuo; Ogasawara, Kuniaki

    2016-01-01

    The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA. PMID:27801780

  20. Preoperative nutritional assessment and prognosis in patients with foregut tumors.

    PubMed

    Poziomyck, Aline Kirjner; Weston, Antonio Carlos; Lameu, Edson Braga; Cassol, Ornella Sari; Coelho, Luisa Jussara; Moreira, Luis Fernando

    2012-01-01

    Malnourished patients with gastrointestinal tumours are at risk for postoperative complications and death. The aim of this study was to determine which nutritional assessment method better predicts outcome. Seventy-four patients, 45 men and 29 women; mean (SD) age of 63 (102) yr (range = 34 to 83), undergoing surgical resections for esophageal (n = 19) gastric (n = 43) and pancreatic (n = 12) tumors were preoperatively assessed by Patient Generated Subjective Global Assessment, anthropometry, and by laboratory sampling. Forty-three (58%) of them were unnourished; 25 Subjective Global Assessment (SGA)-A, 34 SGA-B, and 15 SGA-C cases. Mean (SD) of dominant hand adductor pollicis muscle thickness (DAPM) was 13 (3.5) mm and mean (SD) serum albumin was 3.8 (0.5) g/dL. Mean (SD) hospital staying for patients who complicated and died was 34 (29) days and 23 (13) days for survivors (not significant); SGA-B cases were significantly associated with higher mortality (n = 12, P<0.001). Patients with a mean (SD) DAPM below 10.8 (3.7) mm died more frequently than those with a mean (SD) greater than 14 (3) mm (P < 0.001). None of the methods was significantly related to hospital stay, but receiver operating characteristic curves (95% confidence interval) for PG-SGA and DAPM thickness (0.75 and 0.74) reliably predicted mortality (P<0.001) and these methods may be used as preoperative parameter.

  1. Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

    PubMed

    Wolfe, Robert M; Pomerantz, Jonathan; Miller, Deborah E; Weiss-Coleman, Rebecca; Solomonides, Tony

    2016-01-01

    The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period.

  2. Preoperative pain management education: a quality improvement project.

    PubMed

    O'Donnell, Katherine F

    2015-06-01

    The management of pain is one of the greatest clinical challenges for nurses who care for patients during the postoperative period. It can be even more challenging for patients who must manage their own pain after discharge from the health care facility. Research shows that postoperative pain continues to be undermanaged despite decades of education and evidence-based guidelines. Ineffective management of postoperative pain can negatively impact multiple patient outcomes. The purpose of this quality improvement project was to evaluate the effectiveness of a preoperative pain management patient education intervention on improving patients' postoperative pain management outcomes. The project was conducted with patients undergoing same-day laparoscopic cholecystectomy in an outpatient general surgery service at a teaching institution. Patients in the intervention and comparison groups completed the American Pain Society Patient Outcome Questionnaire-Revised during their first postoperative clinic visit 2 weeks after surgery. Results showed that patients who received the preoperative education intervention reported less severe pain during the first 24 hours postoperatively, experienced fewer and less severe pain medication side effects, returned to normal activities sooner, and used more nonpharmacologic pain management methods postoperatively compared with those who did not receive the education.

  3. Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy

    PubMed Central

    Wang, Na; Wang, Lei; Gao, Yang; Zhou, Honglan

    2016-01-01

    Objective: To assess whether preoperative pentazocine can reduce intraoperative hemodynamic changes and postoperative pain. Methods: Fifty patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group P received intravenous 0.5 mg/kg pentazocine 10 min before surgery, and Group C received normal saline as a placebo. A standardized general anesthesia was conducted in all patients. Mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) scores at various time points were recorded. The tramadol consumption during the study period was recorded. Results: Group P had lower VAS scores at two, four, and eight hours postoperatively compared with Group C. MBP and HR rose significantly because of pneumoperitoneum within Group C, and no significant changes were detected in MBP and HR within Group P. Tramadol doses given were statistically fewer in Group P. Conclusion: Preoperative intravenous pentazocine can decrease intraoperative hemodynamic changes and postoperative pain. PMID:28168126

  4. Preoperative versus postoperative initiation of dalteparin thromboprophylaxis in THA.

    PubMed

    Borgen, Pål O; Dahl, Ola E; Reikeras, Olav

    2010-01-01

    Chemical thromboprophylaxis in total hip arthroplasty (THA) may increase surgical site bleeding. The drug dose and timing of such therapy is therefore important. We studied two cohorts of 298 and 301 patients undergoing THA. The first group received their first dose of dalteparin sodium 5000 IU subcutaneously the evening before surgery and the second group a half dose six hours postoperatively, followed by 5000 units daily in both groups. Blood loss was reduced by 146 ml from 1230 ml to 1084 ml (p<0.001) with postoperative prophylaxis alone. The number of patients receiving blood transfusion decreased from 53% to 35% (p=0.001), and the use of transfused packed red blood cells was reduced from 1.25 to 0.83 units per patient (p=0.001). The overall rates of non-vascular complications 6 months after surgery were 12% and 11%, bleeding related events 6.0% and 4.0%, and thromboembolic related events were 2.0% and 2.3% in the preoperative and the postoperative cohorts. Two patients died in the preoperative group and one in the postoperative group due to venous and arterial thromboembolism. This study show that 2500 IU dose of dalteparin started 6 hours after surgery significantly reduced blood loss and transfusions compared to 5000 IU dalteparin injected 12 hours before surgery. Few thromboembolic events occurred, and these were equally distributed.

  5. Preoperative Uterine Artery Embolization (PUAE) Before Uterine Fibroid Myomectomy

    SciTech Connect

    Dumousset, E.; Chabrot, P.; Rabischong, B.; Mazet, N.; Nasser, S.; Darcha, C.; Garcier, J.M.; Mage, G.; Boyer, L.

    2008-05-15

    Purpose. To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. Methods. This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. Results. No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. Conclusion. Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.

  6. [Preoperative fasting 2008: medical behaviour between empiricism and science].

    PubMed

    Weiss, G; Jacob, M

    2008-09-01

    Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle "nil per os from midnight on", is based on insufficient data, overinterpretation and expert opinion. In fact, the total perioperative risk of a clinically relevant regurgitation of gastric content is low. Clear liquids are not stored within the stomach for a long time and in the healthy, a fasting period of 6 h allows the total passage of solid food. Identifying those patients with an increased risk of perioperative aspiration is still difficult. In particular, the impact of pregnancy, adipositas and diabetes, trauma, smoking, opioids and renal insufficiency has not been clarified. This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the "patient at risk" without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.

  7. Preoperative FDG-PET/CT Is an Important Tool in the Management of Patients with Thick (T4) Melanoma

    PubMed Central

    Arrangoiz, Rodrigo; Papavasiliou, Pavlos; Stransky, Carrie A.; Yu, Jian Q.; Tianyu, Li; Sigurdson, Elin R.; Berger, Adam C.; Farma, Jeffrey M.

    2012-01-01

    The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in 11% of the cases based on PET/CT findings. PET/CT was negative 60% of the time, in 35% of the cases; it identified incidental findings that required further evaluation. Conclusion. Patients with T4 lesions, PET/CT changed the treatment plan 18% of the time. Regional findings changed the surgical treatment plan in 11% and the adjuvant plan in 7% of our cases due to the finding of metastatic disease. Additionally 20 patients had incidental findings that required further workup. In this subset of patients, we feel there is a benefit to PET/CT, and further studies should be performed to validate our findings. PMID:22654898

  8. Total autogenous mandibular reconstruction using virtual surgical planning.

    PubMed

    Winters, Ryan; Saad, Adam; Beahm, Donald David; Wise, Matthew Whitten; St Hilaire, Hugo

    2012-09-01

    Free fibula transfer has become the workhorse in mandibular reconstruction. Total mandibular reconstruction is an uncommon procedure with added complexity. Numerous techniques have been described for such reconstruction, many requiring a temporomandibular joint prosthesis. We present a novel method where simultaneous bilateral free fibula transfer utilizing preoperative virtual surgical planning was used to produce a total autogenous reconstruction. The virtual surgical planning allows to effectively quantify the bone stock required preoperatively and facilitates intraoperative modeling of the fibula. Therefore, a more anatomically correct reconstruction is obtained resulting in improved functional and aesthetic outcomes.

  9. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction

    PubMed Central

    Kim, Do Kyung; Hwang, Ji Hye; Park, Won Hah

    2015-01-01

    [Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability. PMID:26504270

  10. Pre-operational environmental monitoring plan for the Device Assembly Facility at the Nevada Test Site

    SciTech Connect

    Ferate, F.D.

    1995-01-01

    Nuclear explosives operations have been and may continue to be an important component of the DOE mission at the NTS. This mission has been to conduct the nation`s nuclear testing program in a safe, secure, and efficient manner while assuring full compliance with state and federal regulations, and DOE order`s and directives. These operations have generally included assembly, disassembly or modification, staging, transportation, and tesbng of nuclear explosive devices. They may also include maintenance, repair, retrofit, and surveillance. The Device Assembly Facility (DAF) was constructed to provide a dedicated facility in which to prepare nuclear explosives assemblies for their intended disposition. This facility will provide for combined operations (replacing two separate facilities) and incorporates state-of-the-art safety and security features while minimizing the risks of environmental impacts. The facility has been completed but not yet operated, so the impacts to be considered will b e based on normal operations and not on the impacts of construction activities. The impacts will arise from nuclear explosives operations that require the handling of high explosives in combination with special nuclear materials. Wastes from operation of the earlier device assembly facilities have included grams of epoxies, pints of solvents, and small quantities of waste explosives. These are hazardous (includes radioactive) wastes and are disposed of in accordance with state and federal regulations. Assuming similar operations at the DAF, non-hazardous (includes non-radioactive) solid waste would be transported to a permitted landfill. Waste explosives would be sent to the Area 11 Explosive Ordnance Disposal Unit. Other hazardous waste would be sent to the Area 5 Radioactive Waste.Management Site for shipment or burial.

  11. Use of preoperative embolization prior to Transplant nephrectomy

    PubMed Central

    Yeast, Carrie; Riley, Julie M.; Holyoak, Joshua; Ross, Gilbert; Weinstein, Stephen; Wakefield, Mark

    2016-01-01

    ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with

  12. Preoperative pulmonary rehabilitation for marginal-function lung cancer patients.

    PubMed

    Hashmi, Asra; Baciewicz, Frank A; Soubani, Ayman O; Gadgeel, Shirish M

    2017-01-01

    Background This study aimed to evaluate the impact of preoperative pulmonary rehabilitation in lung cancer patients undergoing pulmonary resection surgery with marginal lung function. Methods Short-term outcomes of 42 patients with forced expiratory volume in 1 s < 1.6 L who underwent lung resection between 01/2006 and 12/2010 were reviewed retrospectively. They were divided into group A (no preoperative pulmonary rehabilitation) and group B (receiving pulmonary rehabilitation). In group B, a second set of pulmonary function tests was obtained. Results There were no significant differences in terms of sex, age, race, pathologic stage, operative procedure, or smoking years. Mean forced expiratory volume in 1 s and diffusing capacity for carbon monoxide in group A was 1.40 ± 0.22 L and 10.28 ± 2.64 g∙dL(-1) vs. 1.39 ± 0.13 L and 10.75 ± 2.08 g∙dL(-1) in group B. Group B showed significant improvement in forced expiratory volume in 1 s from 1.39 ± 0.13 to 1.55 ± 0.06 L ( p = 0.02). Mean intensive care unit stay was 6 ± 5 days in group A vs. 9 ± 9 days in group B ( p = 0.22). Mean hospital stay was 10 ± 4 days in group A vs. 14 ± 9 days in group B ( p = 0.31). There was no significant difference in morbidity or mortality between groups. Conclusion Preoperative pulmonary rehabilitation can significantly improve forced expiratory volume in 1 s in some marginal patients undergoing lung cancer resection. However, it does not improve length of stay, morbidity, or mortality.

  13. Role of adjunctive radiotherapy for stage I endometrial carcinoma: preoperative vs postoperative irradiation

    SciTech Connect

    Chung, C.K.; Stryker, J.A.; Nahhas, W.A.; Mortel, R.

    1981-10-01

    Eighty-five patients with clinical State I endometrial carcinoma were reviewed: 81% of patients had either pre-operative or post-operative radiotherapy (RT). The incidence of deep myometrial invasion (outer 1/3 of thickness) of pre-op RT vs. post-op RT group was 6% and 28% respectively; the pre-op irradiation seemed to alter the depth of myometrial invasion. Eleven patients (13%) developed recurrences: 9 of these patients (82%) had recurrences in the extrapelvis. The incidence of extrapelvic recurrence of patients with Grade 3 tumors was 29% 4/14); those with deep myometrial invasion was 33% (4/12). The overall 5 year survival and complication rate was 89% and 4% respectively: these results were comparable between pre-op RT and post-op RT groups. However, post-op RT offers the advantage of accurate surgical-pathologic staging and optimal individualization of adjuvant therapy. In addition, those who have deep myometrial invasion and/or Grade 3 tumors may require systemic therapy in view of high incidence of distant failures.

  14. Incorporating a Gaussian model at the catheter tip for improved registration of preoperative surface models

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R., III; Packer, D. L.; Robb, R. A.

    2011-03-01

    Atrial fibrillation is a common cardiac arrhythmia in which aberrant electrical activity cause the atria to quiver which results in irregular beating of the heart. Catheter ablation therapy is becoming increasingly popular in treating atrial fibrillation, a procedure in which an electrophysiologist guides a catheter into the left atrium and creates radiofrequency lesions to stop the arrhythmia. Typical visualization tools include bi-plane fluoroscopy, 2-D ultrasound, and electroanatomic maps, however, recently there has been increased interest in incorporating preoperative surface models into the procedure. Typical strategies for registration include landmark-based and surface-based methods. Drawbacks of these approaches include difficulty in accurately locating corresponding landmark pairs and the time required to sample surface points with a catheter. In this paper, we describe a new approach which models the catheter tip as a Gaussian kernel and eliminates the need to collect surface points by instead using the stream of continuosly tracked catheter points. We demonstrate the feasibility of this technique with a left atrial phantom model and compare the results with a standard surface based approach.

  15. Small pancreatic cancer with pancreas divisum preoperatively diagnosed by pancreatic juice cytology.

    PubMed

    Obana, Takashi; Fujita, Naotaka; Noda, Yutaka; Kobayashi, Go; Ito, Kei; Horaguchi, Jun; Takasawa, Osamu; Tsuchiya, Takashi; Sawai, Takashi

    2009-01-01

    We present a case of small pancreatic head cancer with pancreas divisum preoperatively diagnosed by pancreatic juice cytology. A 60-year-old woman was referred to our hospital for evaluation of a dilated main pancreatic duct (MPD). A small and poorly reproducible low-echoic lesion in the pancreas was suspected by ultrasonography (US) and endoscopic ultrasonography (EUS). Magnetic resonance cholangiopancreatography (MRCP) failed to visualize the ventral pancreatic duct, and the upstream dorsal pancreatic duct was dilated. Endoscopic retrograde cholangiopancreatography (ERCP) was indicative of pancreas divisum, and complete obstruction of the MPD in the pancreatic head was seen. Cytology of pancreatic juice obtained from the dorsal pancreas after minor papilla sphincterotomy revealed the presence of adenocarcinoma cells. Pancreatoduodenectomy was performed under the diagnosis of pancreatic head cancer with pancreas divisum. Histological examination revealed moderately-differentiated tubular adenocarcinoma 20 mm in diameter, located in the pancreatic head. Dilatation of the dorsal pancreatic duct is sometimes observed in cases with pancreas divisum without the presence of tumors. When pancreatic duct stenosis also exists in such cases, even if a tumor is not clearly visualized by diagnostic imaging, vigorous examinations such as pancreatic juice cytology are recommended to establish an accurate diagnosis.

  16. Pre-operative detection of thyroid pyramidal lobes by ultrasound and computed tomography.

    PubMed

    Ryu, Ji Hwa; Kim, Dong Wook; Kang, Taewoo

    2014-07-01

    This study aimed to assess the diagnostic accuracy of pre-operative ultrasound (US) and computed tomography (CT) for detecting thyroid pyramidal lobe (TPL). A single radiologist prospectively performed thyroid US and retrospectively reviewed neck CT to detect TPLs in 135 consecutive patients scheduled for thyroid surgery. The location, size and superior extent of each TPL and its separation or continuity with the main thyroid gland were assessed by thyroid US, neck CT and surgery. The prevalence of TPLs as diagnosed by thyroid US, neck CT and surgery was 58.5% (79/135), 56.3% (76/135) and 60% (81/135), respectively. We compared US and CT detection of TPLs with surgical data to determine their sensitivity (85.2% and 91.4%), specificity (81.5% and 94.4%), positive (87.3% and 96.1%) and negative (78.6% and 87.9%) predictive values and accuracy (83.7% and 92.6%). For detecting TPLs, both neck CT and thyroid US have good diagnostic value, although neck CT is more accurate than thyroid US.

  17. Preoperative Chemoradiation With Cetuximab, Irinotecan, and Capecitabine in Patients With Locally Advanced Resectable Rectal Cancer: A Multicenter Phase II Study

    SciTech Connect

    Kim, Sun Young; Hong, Yong Sang; Kim, Dae Yong; Kim, Tae Won; Kim, Jee Hyun; Im, Seok Ah; Lee, Keun Seok; Yun, Tak; Jeong, Seung-Yong; Choi, Hyo Seong; Lim, Seok-Byung; Chang, Hee Jin; Jung, Kyung Hae

    2011-11-01

    Purpose: To evaluate the efficacy and safety of preoperative chemoradiation with cetuximab, irinotecan, and capecitabine in patients with rectal cancer. Methods and Materials: Forty patients with locally advanced, nonmetastatic, and mid- to lower rectal cancer were enrolled. Radiotherapy was delivered at a dose of 50.4 Gy/28 fractions. Concurrent chemotherapy consisted of an initial dose of cetuximab of 400 mg/m{sup 2} 1 week before radiotherapy, and then cetuximab 250 mg/m{sup 2}/week, irinotecan 40 mg/m{sup 2}/week for 5 consecutive weeks and capecitabine 1,650 mg/m{sup 2}/day for 5 days a week (weekdays only) from the first day during radiotherapy. Total mesorectal excision was performed within 6 {+-} 2 weeks. The pathologic responses and survival outcomes were evaluated as study endpoints, and an additional KRAS mutation analysis was performed. Results: In total, 39 patients completed their planned preoperative chemoradiation and underwent R0 resection. The pathologic complete response rate was 23.1% (9/39), and 3 patients (7.7%) showed near total regression of tumor. The 3-year disease-free and overall survival rates were 80.0% and 94.7%, respectively. Grade 3/4 toxicities included leukopenia (4, 10.3%), neutropenia (2, 5.1%), anemia (1, 2.6%), diarrhea (2, 5.1%), fatigue (1, 2.6%), skin rash (1, 2.6%), and ileus (1, 2.6%). KRAS mutations were found in 5 (13.2%) of 38 patients who had available tissue for testing. Clinical outcomes were not significantly correlated with KRAS mutation status. Conclusions: Preoperative chemoradiation with cetuximab, irinotecan, and capecitabine was active and well tolerated. KRAS mutation status was not a predictive factor for pathologic response in this study.

  18. Prognostic value of preoperative inflammatory response biomarkers in patients with sarcomatoid renal cell carcinoma and the establishment of a nomogram

    PubMed Central

    Gu, Liangyou; Ma, Xin; Li, Hongzhao; Chen, Luyao; Xie, Yongpeng; Zhao, Chaofei; Luo, Guoxiong; Zhang, Xu

    2016-01-01

    To examine the prognostic role of inflammatory response biomarkers in sarcomatoid renal cell carcinoma (sRCC). From January 2004 to May 2015, 103 patients with sRCC were enrolled in this study. Preoperative neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were analyzed. Besides well-established clinicopathological prognostic factors, we evaluated the prognostic value of this four markers using Kaplan-Meier method and Cox regression models. Additionally, a nomogram was established to predict the prognosis of sRCC patients. Elevated NLR, dNLR and PLR were significantly associated with worse overall survival (OS), nevertheless, elevated LMR showed an adverse effect on reduced OS. Multivariate analysis revealed that NLR (HR = 4.07, 95% CI = 1.50–11.00, P = 0.006) retained as independent factor. Incorporation of the NLR into a prognostic model including T stage, M stage, tumor necrosis and percentage of sarcomatoid generated a nomogram, which accurately predicted OS for sRCC patients. Preoperative NLR may serve as a potential prognostic biomarker in patients with sRCC and may help with clinical decisions about treatment intervention in clinical practice. The proposed nomogram can be used for the prediction of OS in patients with sRCC. PMID:27035802

  19. Preoperative evaluation and risk factors of lung cancer.

    PubMed

    Gaballo, Annarita; Corbo, Giuseppe M; Valente, Salvatore; Ciappi, Giuliano

    2004-01-01

    Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. If FEV1 and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection. However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.

  20. Experience And Results With Preoperatively Shaped AO Mandibular Reconstruction Plates

    NASA Astrophysics Data System (ADS)

    Reuters, Ulrich; Prein, Joachim; Muller, Werner

    1989-04-01

    As a rule continuous bony defects of the mandible after tumour resection are temporarily bridged with the AO reconstruction plate. To precontour the plate, CT-scans of the mandible at a scale of 1:1 6 mm above and parallel to the inferior margin are needed. Corresponding layers further cranial show the anatomy of the chin. Using a lateral cephalograph, the mandibular angle and the length of the plate in the ascending ramus are measured. Of the 19 preshaped reconstruction plates implanted, 11 did not need any intraoperative adjustment of shape. The other 8 plates needed only slight modifications of contour. Preoperative bending of the reconstruction plate reduces the time taken for the operation, protects the material and the plate is precisely shaped.

  1. Preoperational test report, primary ventilation condenser cooling system

    SciTech Connect

    Clifton, F.T.

    1997-10-29

    This represents the preoperational test report for the Primary Ventilation Condenser Cooling System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system uses a closed chilled water piping loop to provide offgas effluent cooling for tanks AY101, AY102, AZ1O1, AZ102; the offgas is cooled from a nominal 100 F to 40 F. Resulting condensation removes tritiated vapor from the exhaust stack stream. The piping system includes a package outdoor air-cooled water chiller with parallel redundant circulating pumps; the condenser coil is located inside a shielded ventilation equipment cell. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  2. [Hypokalemic effect of salbutamol administered intravenously in the preoperative period].

    PubMed

    Fábregas, N; Taurá, P; Castillo, J; Tomás, A; Planella, V L; Naldá, M A

    1989-01-01

    In 8 healthy patients (ASA I-II) there was analyzed the effect of salbutamol over serum levels of potassium, glucose, insulin, AMPc and GMPc. Also were determined the arterial blood pressure and heart rate. The drug was administered intravenously, as bronchodilator, during the preoperative period. There was a significant decrease in kaliemia (p less than 0.001 immediately after receiving the salbutamol infusion and p less than 0.05 at 60 min). Their plasma potassium levels dropped from 4.03 +/- 25 to 3.45 +/- 0.16 mEq.l-1. The plasma levels of glucose and insulin increased with a significance of p less than 0.001 post salbutamol perfusion. There were no changes in the plasmatic AMPc and GMPc. Heart rate increased from 67 +/- 10.8 to 80.5 +/- 13.7 (p less than 0.01) post perfusion, returning afterwards to their basal values. Arterial blood pressure was unmodified.

  3. Multi-modal Learning-based Pre-operative Targeting in Deep Brain Stimulation Procedures.

    PubMed

    Liu, Yuan; Dawant, Benoit M

    2016-02-01

    Deep brain stimulation, as a primary surgical treatment for various neurological disorders, involves implanting electrodes to stimulate target nuclei within millimeter accuracy. Accurate pre-operative target selection is challenging due to the poor contrast in its surrounding region in MR images. In this paper, we present a learning-based method to automatically and rapidly localize the target using multi-modal images. A learning-based technique is applied first to spatially normalize the images in a common coordinate space. Given a point in this space, we extract a heterogeneous set of features that capture spatial and intensity contextual patterns at different scales in each image modality. Regression forests are used to learn a displacement vector of this point to the target. The target is predicted as a weighted aggregation of votes from various test samples, leading to a robust and accurate solution. We conduct five-fold cross validation using 100 subjects and compare our method to three indirect targeting methods, a state-of-the-art statistical atlas-based approach, and two variations of our method that use only a single modality image. With an overall error of 2.63±1.37mm, our method improves upon the single modality-based variations and statistically significantly outperforms the indirect targeting ones. Our technique matches state-of-the-art registration methods but operates on completely different principles. Both techniques can be used in tandem in processing pipelines operating on large databases or in the clinical flow for automated error detection.

  4. US in preoperative evaluation of parotid gland neoplasms.

    PubMed

    Gerwel, Agata; Kosik, Krzysztof; Jurkiewicz, Dariusz

    2015-01-01

    Salivary gland neoplasms account for only 3% of all tumors of the head and neck area, but as they represent a wide variety of histological types, they are a big diagnostic challenge. The cornerstone of salivary gland neoplasm treatment, both for the benign and malignant lesions, is surgery. The main goal of the therapy is not only to achieve complete surgical tumor resection, but also to preserve adjacent structures (facial nerve, parapharyngeal space structures). Ultrasonography is an examination commonly used in the preoperative diagnosis of the lesions localized within salivary glands. Very often it is the only diagnostic imaging method used in these cases. The aim of the study was to establish diagnostic value of US examination and its parameters for the assessment of parotid gland tumors. A prospective study was performed on a group of 51 patients with parotid gland neoplasms, who over a period of 3 years underwent surgery in Otolaryngology and Laryngological Oncology Department with Craniomaxillofacial Surgery Department of Central Clinical Hospital of Ministry of Defence in Warsaw. All the included patients underwent US examination in the preoperative period. The parameters selected for the assessment were: ill-defined tumor margins, tumor vascularity and the presence of enlarged regional lymph nodes. The results of imaging examination were compared to the final diagnosis based on pathological examination of the surgical specimen. The parameters of the US examination such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the evaluation of parotid gland tumors were established based on the examination results. An analysis was performed and ill-defined parotid tumor margins turned out to be a US parameter with higher diagnostic value for differentiating benign and malignant lesions than increased tumor vascularity. The presence of enlarged regional lymph nodes with blurred echostructure on the US examination

  5. Preoperative gait characterization of patients with ankle arthrosis.

    PubMed

    Khazzam, Michael; Long, Jason T; Marks, Richard M; Harris, Gerald F

    2006-08-01

    The purpose of this study was to evaluate the kinematic changes that occur about the foot and ankle during gait in patients with degenerative joint disease (DJD). By comparing a normal adult population with what was found in the DJD population we determined how the motion of theses groups differed, thereby characterizing how this pathology affects foot and ankle motion. A 15-camera Vicon Motion Analysis System was used in conjunction with weight bearing radiographs to obtain three-dimensional motion of the foot and ankle during ambulation. The study was comprised of 34 patients and 35 ankles diagnosed with DJD (19 men and 15 women) of the ankle and 25 patients with normal ankles (13 men and 12 women). Dynamic foot and ankle motion was analyzed using the four-segment Milwaukee Foot Model (MFM). The data from this model resulted in three-dimensional (3D) kinematic parameters in the sagittal, coronal, and transverse planes as well as spatial-temporal parameters. Patient health status was evaluated using the SF-36 Health Survey and American Orthopaedics Foot and Ankle Society (AOFAS) hindfoot scores. The DJD group showed significant differences (p<0.001) as compared to normals with prolonged stance time, shortened stride length, reduced cadence and a walking speed which was only 66.96% of normal. Overall, kinematic data in the DJD cohort showed significant differences (p<0.001) in all planes of motion for tibial, hindfoot and forefoot motion as compared to normals. The average preoperative AOFAS hindfoot score was 26. DJD of the ankle results in decreased range of motion during gait. This decreased range of motion may be related to several factors including bony deformity, muscle weakness, and attempts to decrease the pain associated with weight bearing. To date there has not been a study which describes the effect of this disease process on motion of the foot and ankle. These findings may prove to be useful in the pre-operative assessment of these patients.

  6. Effects of Preoperative Clarithromycin Administration in Patients with Nasal Polyposis

    PubMed Central

    Perić, A; Baletić, N; Milojević, M; Sotirović, J; Živić, L; Perić, AV; Vojvodić, D

    2014-01-01

    ABSTRACT Objective: In recent years, various investigators have shown considerable interest in the use of macrolide antibiotics for treatment of chronic rhinosinusitis and nasal polyposis. The aim of this study was to evaluate the clinical effects of preoperative long-term, low-dose clarithromycin administration in patients with nasal polyposis. Methods: Eighty nasal polyp patients (42 non-atopic and 38 atopic) were included in this prospective, non-placebo controlled investigation and randomized equally to either the combined clarithromycin-surgical or surgical group. Forty patients received 500 mg of clarithromycin daily for eight weeks, and, after evaluation, they were treated by functional endoscopic sinus surgery (FESS). The other 40 patients were treated only surgically. The nasal symptom scores and endoscopic scores after macrolide treatment/surgical treatment, and after six and 12 months of follow-up were evaluated. Results: After clarithromycin therapy, we found improvement in symptom scores in 25/40, and improvement in endoscopic scores in 19/40 patients. We found no significant difference in nasal symptom score between allergic and non-allergic patients regarding the outcome to macrolide (p = 0.352) or surgical treatment (p = 0.396). When we compared differences between endoscopic scores at the time points of 12 months and six months postoperatively (ESt12 minus ESt6), we found statistically lower differences in the clarithromycin-surgery group than in the surgery group (p = 0.006). Conclusion: Preoperative clarithromycin administration postponed nasal polyp relapse after FESS. Allergies have no influence on the clinical efficacy of clarithromycin therapy and on the efficacy of FESS. PMID:25867579

  7. Planning of vessel grafts for reconstructive surgery in congenital heart diseases

    NASA Astrophysics Data System (ADS)

    Rietdorf, U.; Riesenkampff, E.; Schwarz, T.; Kuehne, T.; Meinzer, H.-P.; Wolf, I.

    2010-02-01

    The Fontan operation is a surgical treatment for patients with severe congenital heart diseases, where a biventricular correction of the heart can't be achieved. In these cases, a uni-ventricular system is established. During the last step of surgery a tunnel segment is placed to connect the inferior caval vein directly with the pulmonary artery, bypassing the right atrium and ventricle. Thus, the existing ventricle works for the body circulation, while the venous blood is passively directed to the pulmonary arteries. Fontan tunnels can be placed intra- and extracardially. The location, length and shape of the tunnel must be planned accurately. Furthermore, if the tunnel is placed extracardially, it must be positioned between other anatomical structures without constraining them. We developed a software system to support planning of the tunnel location, shape, and size, making pre-operative preparation of the tunnel material possible. The system allows for interactive placement and adjustment of the tunnel, affords a three-dimensional visualization of the virtual Fontan tunnel inside the thorax, and provides a quantification of the length, circumferences and diameters of the tunnel segments. The visualization and quantification can be used to plan and prepare the tunnel material for surgery in order to reduce the intra-operative time and to improve the fit of the tunnel patch.

  8. Accurate documentation, correct coding, and compliance: it's your best defense!

    PubMed

    Coles, T S; Babb, E F

    1999-07-01

    This article focuses on the need for physicians to maintain an awareness of regulatory policy and the law impacting the federal government's medical insurance programs, and to internalize and apply this knowledge in their practices. Basic information concerning selected fraud and abuse statutes and the civil monetary penalties and sanctions for noncompliance is discussed. The application of accurate documentation and correct coding principles, as well as the rationale for implementating an effective compliance plan in order to prevent fraud and abuse and/or minimize disciplinary action from government regulatory agencies, are emphasized.

  9. A network meta-analysis on the effects of information technology application on preoperative knowledge of patients.

    PubMed

    Lai, Yi-Horng

    2015-01-01

    The application of information technology in health education plan in Taiwan has existed for a long time. The purpose of this study is to explore the relationship between information technology application in health education and patients' preoperative knowledge by synthesizing existing researches that compare the effectiveness of information technology application and traditional instruction in the health education plan. In spite of claims regarding the potential benefits of using information technology in health education plan, results of previous researches were conflicting. This study is carried out to examine the effectiveness of information technology by using network meta-analysis, which is a statistical analysis of separate but similar studies in order to test the pooled data for statistical significance. Information technology application in health education discussed in this study include interactive technology therapy (person-computer), group interactive technology therapy (person-person), multimedia technology therapy and video therapy. The result has shown that group interactive technology therapy is the most effective, followed by interactive technology therapy. And these four therapies of information technology are all superior to the traditional health education plan (leaflet therapy).

  10. Calibration of radiographs by a reference metal ball affects preoperative selection of implant size.

    PubMed

    Schropp, Lars; Stavropoulos, Andreas; Gotfredsen, Erik; Wenzel, Ann

    2009-12-01

    The aim was to evaluate the impact of a reference ball for calibration of periapical and panoramic radiographs on preoperative selection of implant size for three implant systems. Presurgical digital radiographs (70 panoramic, 43 periapical) from 70 patients scheduled for single-tooth implant treatment, recorded with a metal ball placed in the edentulous area, were evaluated by three observers with the intent to select the appropriate implant size. Four reference marks corresponding to the margins of the metal ball were manually placed on the digital image by means of computer software. Additionally, an implant with proper dimensions for the respective site was outlined by manually placing four reference marks. The diameter of the metal ball and the unadjusted length and width of the implant were calculated. Implant size was adjusted according to a "standard" calibration method (SCM; magnification factor 1.25 in panoramic images and 1.05 in periapical images) and according to a reference ball calibration method (RCM; true magnification). Based on the unadjusted as well as the adjusted implant dimensions, the implant size was selected among those available in a given implant system. For periapical radiographs, when comparing SCM and RCM with unadjusted implant dimensions, implant size changed in 42% and 58%, respectively. When comparing SCM and RCM, implant size changed in 24%. For panoramic radiographs, comparing SCM and RCM changed implant size in 48%. The use of a reference metal ball for calibration of periapical and panoramic radiographs when selecting implant size during treatment planning might be advantageous.

  11. Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer.

    PubMed

    Behrendt, Carolyn E; Tumyan, Lusine; Gonser, Laura; Shaw, Sara L; Vora, Lalit; Paz, I Benjamin; Ellenhorn, Joshua D I; Yim, John H

    2014-08-01

    Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.

  12. Evaluation of Stress Intensity and Anxiety Level in Preoperative Period of Cardiac Patients

    PubMed Central

    Rosiek, Anna; Kornatowski, Tomasz; Rosiek-Kryszewska, Aleksandra; Leksowski, Łukasz; Leksowski, Krzysztof

    2016-01-01

    Introduction. The stress related to patient's stay in a hospital increases when it is necessary to perform a surgery. Therefore, the study of the phenomenon of stress intensity in hospitalized patients has become an important issue for public health. Material and Method. The study was conducted in University Hospital No. 1 in the cardiosurgery clinic. The study involved 58 patients who were admitted as planned to the hospital. The study used a standardized questionnaire measuring intensity of the stress and also deepened interviews with patients about stress and anxiety felt before the surgery. Results. The greater the patient's anxiety resulting from his state of health, the greater the intensity of stress in the preoperative period. This relationship is linear. The results of the study also made it possible to see intrapersonal factors (pain, illness, and suffering) and extrapersonal factors (anesthesia, surgery, and complications after surgery), which are causes of anxiety before surgery. Conclusion. The research showed high (negative) results of anxiety and stress associated with the disease, surgery, and complications after cardiac surgery. Active involvement in hospitalization elements, such as patient education before surgery, psychological support, and medical care organization taking into account patient's preferences, reduces the impact of stressors. PMID:27042655

  13. Specific test and evaluation plan

    SciTech Connect

    Hays, W.H.

    1998-03-20

    The purpose of this Specific Test and Evaluation Plan (STEP) is to provide a detailed written plan for the systematic testing of modifications made to the 241-AX-B Valve Pit by the W-314 Project. The STEP develops the outline for test procedures that verify the system`s performance to the established Project design criteria. The STEP is a lower tier document based on the W-314 Test and Evaluation Plan (TEP). Testing includes Validations and Verifications (e.g., Commercial Grade Item Dedication activities), Factory Acceptance Tests (FATs), installation tests and inspections, Construction Acceptance Tests (CATs), Acceptance Test Procedures (ATPs), Pre-Operational Test Procedures (POTPs), and Operational Test Procedures (OTPs). It should be noted that POTPs are not required for testing of the transfer line addition. The STEP will be utilized in conjunction with the TEP for verification and validation.

  14. Psychological Analysis of Oral Cancer Patients during Pre-operative Period in South Indian Population: A Prospective, Quantitative, Multicentre Study

    PubMed Central

    Kamatchinathan, Prabhusankar; Muthuraman, Varun; Antharaju, Yuvaraj; Kumar, Mahendra; Varadharajan, Usha

    2016-01-01

    Introduction Oral cancer is prevalent worldwide with high incidence of mortality and morbidity. It is associated with poor prognosis and low survival rate. Moreover, patients affected are more likely to develop psychological issues and thus, addressing psychological needs of such patients is crucial. Aim The aim of our study was to assess the quality of life of oral cancer patients in the pre-operative period, thereby providing them with the necessary psychological support. Materials and Methods A total of 206 patients, scheduled to undergo treatment for oral cancer were selected from various cancer centres in South India. After informed consent, 171 patients were finally analysed for their quality of life using Functional Assessment of Cancer Therapy-General (FACT-G) version 4; and Functional Assessment of Cancer Therapy Head and Neck (FACT-H&N), as a Quality of Life (QOL) survey. Result Most of the patients had poor quality of life and were found to be emotionally distressed pre-operatively as they did not have proper emotional support from society. Conclusion From the study it was observed that catering to the psychological needs of oral cancer patients is important and psychological counselling should be a part of a comprehensive treatment plan for such patients. PMID:27891463

  15. Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model.

    PubMed

    Kono, Kenichi; Shintani, Aki; Okada, Hideo; Terada, Tomoaki

    2013-01-01

    Silicone models of cerebral aneurysms are used for evaluation of devices, training, or hemodynamic studies. We report preoperative simulations of endovascular treatment for a case with an unruptured wide-neck aneurysm of the anterior communicating artery using a patient-specific silicone model. Using a rapid prototyping system, we created a silicone model based on the vascular image obtained by three-dimensional rotational angiogram. The aneurysm and vessels formed a cavity in the silicone block model. We performed endovascular simulations using several difference devices and attempted possible methods for coil embolization. We designed treatment strategies based on the simulations and performed balloon-assisted coil embolization of the aneurysm. The simulations were especially useful in navigation of a microcatheter by planning the shape of its tip beforehand. There was one significant difference between the silicone model simulations and actual treatment: the shape of the vessel in the silicone block model was not changed by insertion of a catheter or guidewire. This is the first study to describe preoperative endovascular simulations using a patient-specific silicone model. Our methods of creating a patient-specific model are relatively simple and easy. Although this is a single case, we demonstrate that the simulations are feasible and helpful for designing a treatment strategy and safe manipulation of endovascular devices by experiencing their behavior before actual treatment.

  16. Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection

    PubMed Central

    Huang, Fang; Chen, Qiang; Lai, Qing-quan; Huang, Wen-han; Wu, Hong; Li, Wei-cheng

    2016-01-01

    Abstract The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD). From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy. In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation. MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information. PMID:27684852

  17. Three-dimensional planning in craniomaxillofacial surgery

    PubMed Central

    Rubio-Palau, Josep; Prieto-Gundin, Alejandra; Cazalla, Asteria Albert; Serrano, Miguel Bejarano; Fructuoso, Gemma Garcia; Ferrandis, Francisco Parri; Baró, Alejandro Rivera

    2016-01-01

    Introduction: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. Materials and Methods: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients’ outcomes. Conclusions: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results. PMID:28299272

  18. The Effect of Structured Preadmission Preoperative Teaching on Patient Outcomes After Abdominal Surgery

    DTIC Science & Technology

    1990-01-01

    booklet: Information About Your Admission Day Surgery ............. 86 * B. Preoperative patient education program ....... 96 C. Nomograms for inspiratory...been established in most hospitals so that patient education may be viewed as a cost to the hospital (Cook, 1985; Devine & Cook, 1983). Surgical...Impediments mean that most patients have inadequate preoperative education. Patient education and psychological support are integral components of nursing

  19. Routine preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting.

    PubMed

    Vohra, Hunaid A; Briffa, Norman P

    2005-01-01

    The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.

  20. Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery

    PubMed Central

    Tseng, Yao-Hui; Lee, Yee-Fan; Hsieh, Min-Shu; Chien, Ning; Ko, Wei-Chun; Chen, Jo-Yu; Lee, Jang-Ming; Huang, Pei-Ming; Lin, Mong-Wei; Chen, Jin-Shing

    2016-01-01

    Background Preoperative computed tomography (CT)-guided localization of small lung nodules is important for accurate and efficient video-assisted thoracoscopic surgery (VATS). Resection of multiple small pulmonary nodules in one VATS procedure can aid in patient management. The aim of this study was to evaluate the usefulness of CT-guided Patent Blue V (PBV) dye localization in patients with multiple pulmonary nodules who underwent VATS. Methods This retrospective study was conducted from January 2013 to December 2015. One hundred consecutive patients (59.9±10.5 years of age) with 217 nodules who underwent preoperative CT-guided PBV dye localization for multiple (2 to 4) nodules before VATS were enrolled. Results The mean nodule size was 0.8±0.4 cm, with a mean depth from the pleura or fissure of 0.7±0.7 cm. The mean procedure duration was 50±20 minutes. The mean amount of injected PBV dye was 0.2±0.1 mL per nodule. The overall success rate was 99% by nodule. Failed localization of two nodules in two patients was due to poor dye visualization (n=1) and significant pneumothorax (n=1). Cases of hemorrhage (24%) were mild and asymptomatic, and none of the patients had hemoptysis. None of the cases of pneumothorax (40%) required chest tube placement before VATS. One (1%) patient developed anaphylaxis. The mean post-operative hospital stay was 6.4±4.4 days. Conclusions CT-guided PBV dye localization for multiple small pulmonary nodules before VATS is a safe, feasible, and accurate method with high success rate. This approach makes it easy to perform multiple nodule resections during one VATS operation. PMID:28066667

  1. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas

    SciTech Connect

    Bossi, Alberto . E-mail: alberto.bossi@uz.kuleuven.ac.be; De Wever, Ivo; Van Limbergen, Erik; Vanstraelen, Bianca

    2007-01-01

    Purpose: Preoperative external-beam radiation therapy (preop RT) in the management of Retroperitoneal Liposarcomas (RPLS) typically involves the delivery of radiation to the entire tumor mass: yet this may not be necessary. The purpose of this study is to evaluate a new strategy of preop RT for RPLS in which the target volume is limited to the contact area between the tumoral mass and the posterior abdominal wall. Methods and Materials: Between June 2000 and Jan 2005, 18 patients with the diagnosis of RPLS have been treated following a pilot protocol of pre-op RT, 50 Gy in 25 fractions of 2 Gy/day. The Clinical Target Volume (CTV) has been limited to the posterior abdominal wall, region at higher risk for local relapse. A Three-Dimensional conformal (3D-CRT) and an Intensity Modulated (IMRT) plan were generated and compared; toxicity was reported following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0. Results: All patients completed the planned treatment and the acute toxicity was tolerable: 2 patients experienced Grade 3 and 1 Grade 2 anorexia while 2 patients developed Grade 2 nausea. IMRT allows a better sparing of the ipsilateral and the contralateral kidney. All tumors were successfully resected without major complications. At a median follow-up of 27 months 2 patients developed a local relapse and 1 lung metastasis. Conclusions: Our strategy of preop RT is feasible and well tolerated: the rate of resectability is not compromised by limiting the preop CTV to the posterior abdominal wall and a better critical-structures sparing is obtained with IMRT.

  2. The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

    PubMed Central

    Koorevaar, Rinco C. T.; van ‘t Riet, Esther; Gerritsen, Marleen J. J.; Madden, Kim; Bulstra, Sjoerd K.

    2016-01-01

    Background Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. Methods and Findings A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression

  3. [Organization of an anaesthesia preoperative evaluation clinic - The Anaesthesia/Patient Blood Management Clinic: one Model].

    PubMed

    Schöpper, Christa; Venherm, Stefan; Van Aken, Hugo; Ellermann, Ines; Steinbicker, Andrea

    2016-04-01

    The anesthesia preoperative evaluation has been developed in recent years in a centralized clinic, that can be visited by the majority of patients, in order to evaluate and obtain patient's consent for anesthesia. In the current article, the organization and structure of such a central anesthesia preoperative evaluation clinic in the Department of Anesthesia, Intensive Care and Pain Medicine at the University Hospital of Muenster, is described. Besides the central preoperative evaluation clinic, 3 clinics are localized in separate buildings and preoperative visits have to be completed in special scenarios on the wards, too. A pharmaceutical evaluation for patient's medication and the patient blood management have been integrated into the anesthesia preoperative evaluation clinic. Processes are explained and current numbers of patients are mentioned.

  4. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID

  5. Mill profiler machines soft materials accurately

    NASA Technical Reports Server (NTRS)

    Rauschl, J. A.

    1966-01-01

    Mill profiler machines bevels, slots, and grooves in soft materials, such as styrofoam phenolic-filled cores, to any desired thickness. A single operator can accurately control cutting depths in contour or straight line work.

  6. Electromagnetic navigation bronchoscopy guided injection of methylene blue combined with hookwire for preoperative localization of small pulmonary lesions in thoracoscopic surgery

    PubMed Central

    Sun, Jiayuan; Mao, Xiaowei; Xie, Fangfang

    2015-01-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used in the resection of small pulmonary lesions in the clinical practice. The accurate preoperative localization of small pulmonary lesions is significant to guide the operation. We report a thoracoscopic pulmonary wedge resection with electromagnetic navigation bronchoscopy (ENB) guided injection of methylene blue combined with hookwire to localize the small pulmonary lesion in a 50-year-old woman. We successfully performed VATS followed by the combined localization of these two methods. This localization method has a higher accuracy and fewer complications, which can effectively guide the surgical resection. PMID:26793384

  7. Effect of preoperative mastoid ventilation on tympanoplasty success.

    PubMed

    Metin, Mehmet; Kaptan, Zeynep Kizilkaya; Dogan, Sedat; Yazici, Hasmet; Bayraktar, Cem; Gocmen, Hakan; Samim, Etem Erdal

    2014-01-01

    Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05).

  8. Effect of Preoperative Mastoid Ventilation on Tympanoplasty Success

    PubMed Central

    Metin, Mehmet; Kaptan, Zeynep Kizilkaya; Dogan, Sedat; Yazici, Hasmet; Bayraktar, Cem; Gocmen, Hakan; Samim, Etem Erdal

    2014-01-01

    Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20–35.09% female and 37–64.91% male) with a mean age of 29.69 ± SD (range 12–56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05). PMID:25374605

  9. Preoperative portal vein embolization for hepatocellular carcinoma: Consensus and controversy

    PubMed Central

    Aoki, Taku; Kubota, Keiichi

    2016-01-01

    Thirty years have passed since the first report of portal vein embolization (PVE), and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant (FLR). PVE has been shown to be useful in patients with hepatocellular carcinoma (HCC) and chronic liver disease. However, special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers, and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases. Advances in the embolic material and selection of the treatment approach, and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections. A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure, however, application of this technique in HCC patients requires special caution, as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers. PMID:27028706

  10. Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.

    PubMed

    Bille-Brahe, N E; Engell, H C; Sørensen, M B

    1981-02-01

    This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

  11. Chlorhexidine gluconate versus chloroxylenol for preoperative skin preparation in dogs.

    PubMed

    Stubbs, W P; Bellah, J R; Vermaas-Hekman, D; Purich, B; Kubilis, P S

    1996-01-01

    The efficacy of 3% chloroxylenol (PCMX) or 4% chlorhexidine gluconate (CG) for preoperative skin preparation was assessed in 100 dogs undergoing clean or clean-contaminated surgical procedures. Replication Organism Detection and Counting (RODAC) plates were used to quantify skin bacteria colony forming units (CFU) at the operative site before and after skin preparation and immediately postoperatively. Reduction of CFU after skin preparation and immediately postoperatively was significant for each agent. However, CFU levels were significantly lower in the CG group than in the PCMX group after surgical preparation, regardless of initial CFU numbers. No significant difference in CFU counts was observed between antiseptic groups postoperatively. Within-group comparisons showed PCMX to be significantly less efficacious when the prescrub CFU number was greater than 1,000. Bacterial reduction was similar in the CG group regardless of prescrub CFU levels. The number of negative cultures after skin preparation was significantly greater with CG than with PCMX. Chlorhexidine gluconate also had fewer cultures with heavy bacterial growth (> 5 CFUs) after surgical preparation. There was no significant difference between antiseptics in the number of negative cultures or cultures with more than 5 CFUs immediately after surgery. The number of skin reactions and postoperative wound infections that occurred with each technique were similar. Three percent PCMX, as used in this study, was less effective than 4% CG in its immediate antimicrobial activity, however, this difference was not associated with an increased wound infection rate.

  12. Recce mission planning

    NASA Astrophysics Data System (ADS)

    York, Andrew M.

    2000-11-01

    The ever increasing sophistication of reconnaissance sensors reinforces the importance of timely, accurate, and equally sophisticated mission planning capabilities. Precision targeting and zero-tolerance for collateral damage and civilian casualties, stress the need for accuracy and timeliness. Recent events have highlighted the need for improvement in current planning procedures and systems. Annotating printed maps takes time and does not allow flexibility for rapid changes required in today's conflicts. We must give aircrew the ability to accurately navigate their aircraft to an area of interest, correctly position the sensor to obtain the required sensor coverage, adapt missions as required, and ensure mission success. The growth in automated mission planning system capability and the expansion of those systems to include dedicated and integrated reconnaissance modules, helps to overcome current limitations. Mission planning systems, coupled with extensive integrated visualization capabilities, allow aircrew to not only plan accurately and quickly, but know precisely when they will locate the target and visualize what the sensor will see during its operation. This paper will provide a broad overview of the current capabilities and describe how automated mission planning and visualization systems can improve and enhance the reconnaissance planning process and contribute to mission success. Think about the ultimate objective of the reconnaissance mission as we consider areas that technology can offer improvement. As we briefly review the fundamentals, remember where and how TAC RECCE systems will be used. Try to put yourself in the mindset of those who are on the front lines, working long hours at increasingly demanding tasks, trying to become familiar with new operating areas and equipment, while striving to minimize risk and optimize mission success. Technical advancements that can reduce the TAC RECCE timeline, simplify operations and instill Warfighter

  13. Contrast-enhanced ultrasound improves accurate identification of appendiceal mucinous adenocarcinoma in an old patient

    PubMed Central

    Shang, Jing; Ruan, Li-tao; Dang, Ying; Wang, Yun-yue; Song, Yan; Lian, Jie

    2016-01-01

    Abstract Background: Adenocarcinoma of appendiceal origin is far rarer than other colorectal carcinomas and its preoperative diagnosis is challenging. To our knowledge, utility of contrast-enhanced ultrasound (CEUS) to diagnose it is much less. Method: A 61-year-old man presented with abdominal pain in the right lower quadrant for 20 days. In order to fulfill an accurately preoperative diagnosis, he received laboratory and imaging tests such as carcinoembryonic antigen (CEA), computer tomography (CT), CEUS and endoscope. Diagnosis and Intervention: He was initially suspected of suffering appendicitis, while his white blood cell count was normal and carcinoembryonic antigen (CEA) in serum was remarkably increased. Both routine ultrasound and computer tomography (CT) examinations supported suppurative appendicitis. The overall data, however, failed to excluded neoplastic pathology thoroughly. Therefore, CEUS was carried out and showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The result of the follow-up biopsy guided by endoscope was consistent with appendiceal tumor. The patient received laparoscopic right hemicolectomy. Histopathology confirmed as well differentiated mucinous adenocarcinoma of appendix origin. His postoperative course was uneventful, and he had a regular diet again without any complaint. Result: Serum CEA was remarkably increased (12.00 ng/mL). Both routine ultrasound and CT examinations supported suppurative appendicitis. However, CEUS examination showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The follow-up biopsy guided by endoscope and surgical specimens confirmed as well differentiated mucinous adenocarcinoma of appendix origin. Conclusion: Most mucinous adenocarcinoma mimicking appendicitis results in difficult diagnosis preoperatively. Clinician and radiologist should be

  14. Does Preoperative Weight Change Predict Postoperative Weight Loss After Laparoscopic Sleeve Gastrectomy?

    PubMed

    Sherman, William E; Lane, Aaron E; Mangieri, Christopher W; Choi, Yong U; Faler, Byron J

    2015-09-01

    Background: Some institutions and insurance companies mandate a preoperative weight loss regimen prior to bariatric surgery. Previous studies suggest little to no correlation between preoperative and postoperative weight loss for laparoscopic Roux-en-Y gastric bypass (RNYGB). This study examined the impact of preoperative weight change for patients undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A retrospective analysis was performed on patients undergoing LSG at the authors' institution from 2010 to 2012. Patients were grouped based on preoperative weight gain or loss. The correlation between preoperative BMI change and postoperative BMI change was studied, as well as length of surgery. Results: Of 141 patients with 1-year follow-up, 72 lost, six maintained, and 64 gained weight preoperatively. Percentage of excess BMI loss at 1 year was not statistically different between those who lost weight and those who gained weight. Percent change in BMI from initial visit to surgery does not correlate with change in BMI at 1 year postoperatively or with length of surgery. Conclusions: Preoperative weight loss is not a reliable predictor of postoperative weight loss or shorter operative time after LSG. Potential patients who otherwise meet indications for LSG should not be denied based on inability to lose weight.

  15. Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

    PubMed

    Leung, John S L; Seto, Alfred; Li, George K H

    2017-04-01

    Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

  16. Preoperative hyponatremia as a clinical characteristic in elderly patients with large pituitary tumor.

    PubMed

    Nishizawa, S; Yokoyama, T; Yokota, N; Ohta, S

    2000-05-01

    This study investigated the pathophysiology of preoperative hyponatremia in elderly patients with a large pituitary tumor. The tumor size, initial symptoms, and preoperative pituitary hormonal function were analyzed in 96 patients, consisting of 82 younger than 70 years old (mean age 49.7 years) and 14 older than 70 years old (mean age 72.0 years). There was no difference in tumor size between the two age groups. The initial symptom of all younger patients was visual disturbance. Preoperative hormonal evaluations revealed subclinical panhypopituitarism in four patients (4.9%). Five of the 14 older patients had severe hyponatremia (107-117 mEq/l) based on panhypopituitarism, and four of these five patients showed consciousness disturbance as the initial symptom, initiated by physical and/or psychological stress, or occurrence of intratumoral hemorrhage. Preoperative subclinical panhypopituitarism was found in another patient. The overall occurrence rate of preoperative panhypopituitarism in the older patients was 42.9%. The difference in the frequency of preoperative panhypopituitarism was statistically significant between the two groups. Preoperative severe hyponatremia associated with a large pituitary tumor is characteristic of elderly patients. The number of receptors for adrenocorticotropic hormone in the adrenal cortex decreases during the aging process. Additional physical and/or psychological stress prompts pituitary dysfunction in such patients, causing the manifestation of acute symptoms of adrenal insufficiency based on panhypopituitarism. Primary care using high dose hydrocortisone and electrolyte fluid is critical.

  17. Difficult Myotomy Is Not Determined by Preoperative Therapy and Does Not Impact Outcome

    PubMed Central

    Villadolid, Desiree V.; Al-Saadi, Sam; Rosemurgy, Alexander S.

    2007-01-01

    Objectives: The impact of preoperative endoscopic therapy on the difficulty of laparoscopic Heller myotomy and the impact of the difficulty of the myotomy on long-term outcome has not been determined. This study was undertaken to determine whether preoperative therapy impacts the difficulty of laparoscopic Heller myotomy and whether preoperative therapy or difficulty of myotomy impacts long-term outcomes. Methods: Since 1992, 305 patients, 56% male, median age 49 years, underwent laparoscopic Heller myotomy and were prospectively followed. The difficulty of the laparoscopic Heller myotomy was scored by the operating surgeon for the most recent 170 consecutive patients on a scale of 1 (easiest) to 5 (most difficult). Patients scored their symptoms before and after myotomy using a Likert scale from 0 (never/not bothersome) to 10 (always/very bothersome). Results: Before myotomy, 66% of patients underwent endoscopic therapy: 33% dilation, 11% Botox, and 22% both. Preoperative endoscopic therapy did not correlate with the difficulty of the myotomy (P=NS). Median follow-up was 25 months. Regardless of the difficulty of the myotomy, dysphagia improved with myotomy (P<0.0001). By regression analysis, the frequency and severity of postmyotomy dysphagia correlated with neither preoperative endoscopic therapy nor the difficulty of the myotomy. Conclusions: Laparoscopic Heller myotomy improves the frequency and severity of dysphagia. The difficulty of laparoscopic Heller myotomy is not impacted by preoperative therapy, and neither preoperative therapy nor difficulty of the myotomy impact long-term outcome. PMID:17931516

  18. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    PubMed Central

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  19. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years 1

    PubMed Central

    de Moura, Louise Amália; Dias, Iohanna Maria Guimarães; Pereira, Lilian Varanda

    2016-01-01

    Abstract Objective: to estimate the prevalence and factors associated with preoperative anxiety in children who wait for outpatient surgery. Method: cross-sectional analysis of baseline data of a prospective cohort study that investigates the predictors of postoperative pain in children aged 5-12 years submitted to inguinal and umbilical hernia repair. It was selected 210 children, which were interviewed in the preoperative holding area of a general hospital. Anxiety was evaluated using the modified Yale Preoperative Anxiety Scale (mYPAS). Sociodemographic and clinical variables were analyzed as exposure and anxiety (mYPAS final score>30) as outcome. Logistic regression was used to identify factors associated with preoperative anxiety. Results: forty-two percent (42.0%) of children presented preoperative anxiety (CI95%: 35.7%-48.6%), with mean scores equal to 30.1 (SD=8.4). Factors associated with preoperative anxiety were: age group of 5-6 years (OR=2.28; p=0.007) and socioeconomic status classified as class C (OR=2.39; p=0.016). Conclusion: the evaluation of children who wait for outpatient surgery should be multidimensional and comprise information on age and socioeconomic status, in order to help in the identification and early treatment of preoperative anxiety. PMID:27305179

  20. Resection after preoperative chemotherapy versus synchronous liver resection of colorectal cancer liver metastases

    PubMed Central

    Kim, Chan W.; Lee, Jong L.; Yoon, Yong S.; Park, In J.; Lim, Seok-Byung; Yu, Chang S.; Kim, Tae W.; Kim, Jin C.

    2017-01-01

    Abstract This study aimed to determine the prognostic effects of preoperative chemotherapy for colorectal cancer liver metastasis (CLM). We retrospectively evaluated 2 groups of patients between January 2006 and August 2012. A total of 53 patients who had ≥3 hepatic metastases underwent resection after preoperative chemotherapy (preoperative chemotherapy group), whereas 96 patients who had ≥3 hepatic metastases underwent resection with a curative intent before chemotherapy for CLM (primary resection group). A propensity score (PS) model was used to compare the both groups. The 3-year disease-free survival (DFS) rates were 31.7% and 20.4% in the preoperative chemotherapy and primary resection groups, respectively (log-rank = 0.015). Analyzing 32 PS matched pairs, we found that the DFS rate was significantly higher in the preoperative chemotherapy group than in the primary resection group (3-year DFS rates were 34.2% and 16.8%, respectively [log-rank = 0.019]). Preoperative chemotherapy group patients had better DFSs than primary resection group patients in various multivariate analyses, including crude, multivariable, average treatment effect with inverse probability of treatment weighting model and PS matching. Responses to chemotherapy are as important as achieving complete resection in cases of multiple hepatic metastases. Preoperative chemotherapy may therefore be preferentially considered for patients who experience difficulty undergoing complete resection for multiple hepatic metastases. PMID:28207557

  1. Influence of Preoperative Peripheral Parenteral Nutrition with Micronutrients after Colorectal Cancer Patients

    PubMed Central

    Tang, Hsiu-Chih; Hu, Shu-Hui; Yang, Hui-Lan

    2015-01-01

    Background. The inflammatory reactions are stronger after surgery of malnourished preoperative patients. Many studies have shown vitamin and trace element deficiencies appear to affect the functioning of immune cells. Enteral nutrition is often inadequate for malnourished patients. Therefore, total parenteral nutrition (TPN) is considered an effective method for providing preoperative nutritional support. TPN needs a central vein catheter, and there are more risks associated with TPN. However, peripheral parenteral nutrition (PPN) often does not provide enough energy or nutrients. Purpose. This study investigated the inflammatory response and prognosis for patients receiving a modified form of PPN with added fat emulsion infusion, multiple vitamins (MTV), and trace elements (TE) to assess the feasibility of preoperative nutritional support. Methods. A cross-sectional design was used to compare the influence of PPN with or without adding MTV and TE on malnourished abdominal surgery patients. Results. Both preoperative groups received equal calories and protein, but due to the lack of micronutrients, patients in preoperative Group B exhibited higher inflammation, lower serum albumin levels, and higher anastomotic leak rates and also required prolonged hospital stays. Conclusion. Malnourished patients who receive micronutrient supplementation preoperatively have lower postoperative inflammatory responses and better prognoses. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support. PMID:26000296

  2. Phonoaudiology guidance in the preoperative period in the head and neck tumors

    PubMed Central

    Scheidt, Grasiella Aparecida Nau; Fleig, Raquel; do Nascimento, Iramar Baptistella

    2013-01-01

    Summary Introduction: The habit of smoking and intake of alcoholic drinks can lead to the incidence of malignant tumors in several areas, including the head or neck. Phonoaudiology is an area of oncology that is always seeking to expand its applications in oncological head and neck cases, with intervention in pre- and post-operative periods and in different clinical fields. Aim: To evaluate and describe the impact of phonoaudiology preoperative guidance in patients, specifically smokers and alcohol drinkers, with head and neck cancer. Methods: Series Study. Interviews were conducted by telephone with 40 individuals diagnosed with malignant head and neck tumors. Questionnaires regarding the use of tobacco and alcohol were administered before and after the phonoaudiology preoperative guidance. Results: Among the 40 individuals who received phonoaudiology preoperative guidance, 26 were smokers before the orientation. Of these 26 individuals, 18 (69.24%) abandoned tobacco dependence, 4 (15.38%) did not quit smoking, and 4 (15.38%) quit smoking for a few months before resuming smoking after receiving phonoaudiology preoperative guidance. Regarding alcohol consumption, 31 individuals ingested alcohol before phonoaudiology preoperative guidance. Of these 31 individuals, 17 (54.84%) abandoned alcohol dependence, 8 (25.81%) did not abstain from alcohol consumption, and 6 (19.35%) resumed alcohol consumption after a period of abstinence after receiving phonoaudiology preoperative guidance. Conclusion: Phonoaudiology preoperative orientations are effective in the treatment of head and neck malignant tumors. PMID:25992003

  3. Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries.

    PubMed

    Fernandes, S C; Arriaga, P; Esteves, F

    2014-12-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The participants were randomly assigned to one of the seven independent conditions that were combined into the following three main groups: an experimental group, which received educational materials with information about surgery and hospitalization (a board game, a video or a booklet); a comparison group, which received entertaining material with the same format type; and a control group, which did not receive any material. Children's preoperative worries and parental anxiety were evaluated after the experimental manipulation. Children who received educational materials were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups, although no statistically differences were found between the type of materials within the experimental group, and no significant effect occurred on parental state anxiety. These results do however support the hypothesis that providing preoperative materials with educational information reduce children's preoperative worries.

  4. An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control

    SciTech Connect

    Kim, Bo Kyong; Chen, Yen-Lin E.; Kirsch, David G.; Goldberg, Saveli I.; Kobayashi, Wendy; Kung, Jong Hyun; Wolfgang, John A.; Doppke, Karen

    2010-07-01

    Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design. Methods and Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and {>=}95% of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins). Results: Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5%, 80.0%, 77.5% and 82.8%, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients. Conclusions: These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins {>=}1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.

  5. Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic

    PubMed Central

    Collins, Jamie E.; Ghazinouri, Roya; Alcantara, Luis; Thornhill, Thomas S.; Katz, Jeffrey N.

    2013-01-01

    Objective. In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functional outcomes. We determined whether similar associations exist in a developing country. Methods. Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes—improvement in functional status over 12 months and functional status at 12 months—using analysis of variance with multivariable linear regression. Results. Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys. Conclusion. Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries. PMID:23748412

  6. Preoperative Determinants of Outcomes of Infant Heart Surgery in a Limited-Resource Setting.

    PubMed

    Reddy, N Srinath; Kappanayil, Mahesh; Balachandran, Rakhi; Jenkins, Kathy J; Sudhakar, Abish; Sunil, G S; Raj, R Benedict; Kumar, R Krishna

    2015-01-01

    We studied the effect of preoperative determinants on early outcomes of 1028 consecutive infant heart operations in a limited-resource setting. Comprehensive data on pediatric heart surgery (January 2010-December 2012) were collected prospectively. Outcome measures included in-hospital mortality, prolonged ventilation (>48 hours), and bloodstream infection (BSI) after surgery. Preoperative variables that showed significant individual association with outcome measures were entered into a logistic regression model. Weight at birth was low in 224 infants (21.8%), and failure to thrive was common (mean-weight Z score at surgery was 2.72 ± 1.7). Preoperatively, 525 infants (51%) needed intensive care, 69 infants (6.7%) were ventilated, and 80 infants (7.8%) had BSI. In-hospital mortality (4.1%) was significantly associated with risk adjustment for congenital heart surgery-1 (RACHS-1) risk category (P < 0.001). Neonatal status, preoperative BSI, and requirement of preoperative intensive care and ventilation had significant individual association with adverse outcomes, whereas low birth weight, prematurity, and severe failure to thrive (weight Z score <-3) were not associated with adverse outcomes. On multivariable logistic regression analysis, preoperative sepsis (odds ratio = 2.86; 95% CI: 1.32-6.21; P = 0.008) was associated with mortality. Preoperative intensive care unit stay, ventilation, BSI, and RACHS-1 category were associated with prolonged postoperative ventilation and postoperative sepsis. Neonatal age group was additionally associated with postoperative sepsis. Although severe failure to thrive was common, it did not adversely affect outcomes. In conclusions, preoperative BSI, preoperative intensive care, and mechanical ventilation are strongly associated with adverse outcomes after infant cardiac surgery in this large single-center experience from a developing country. Failure to thrive and low birth weight do not appear to adversely affect surgical

  7. Preoperative androgen deprivation therapy for localized prostate cancer: Delayed biochemical recurrence in high-risk disease

    PubMed Central

    Pal, Sumanta K.; Ruel, Nora; Voglezang, Nicholas; Chang, Mark; Wilson, Timothy G.; Jones, Jeremy O.; Yuh, Bertram

    2016-01-01

    Background The role of preoperative androgen deprivation therapy (ADT) for localized prostate cancer is controversial; prospective assessments have yielded varying results. We sought to define a subset of patients with a higher likelihood of benefit from preoperative ADT. Methods An institutional database including consecutive patients receiving definitive surgery for localized prostate cancer was interrogated. Patients recorded as having received preoperative ADT were matched in a 1:2 fashion to patients who had not received prior ADT. Patients were matched on the basis of clinicopathologic characteristics, use of adjuvant treatment strategies, and duration of PSA follow-up. Time to biochemical recurrence (TTBR) was compared using the Kaplan-Meier method and log-rank test for the overall study population and in subsets defined by D’Amico risk. Results No significant differences in clinicopathologic characteristics were noted between recipients (n=101) and matched non-recipients (n=196) of preoperative ADT. Although not statistically significant, positive surgical margin rates, seminal vesicle invasion and extracapsular extension were less frequent in patients receiving preoperative ADT. Furthermore, a lesser incidence of perioperative complications was noted in this group (7.4% v 18.4%). No significant differences were noted in TTBR between recipients and non-recipients of preoperative ADT in the overall study population. However, amongst patients with high-risk disease, TTBR was significantly longer in those patients who had received preoperative ADT (P=0.004). Conclusions The data presented herein suggest a potential benefit with preoperative ADT in patients with high-risk localized prostate cancer. Consideration should be given to enriching for this subset in preoperative studies of novel endocrine therapies. PMID:24342128

  8. Near-facility environmental monitoring quality assurance project plan

    SciTech Connect

    McKinney, S.M.

    1997-11-24

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and near facility environmental monitoring performed by Waste Management Federal Services, Inc., Northwest Operations and supersedes WHC-EP-0538-2. This plan applies to all sampling and monitoring activities performed by waste management Federal Services, Inc., Northwest Operations in implementing facility environmental monitoring at the Hanford Site.

  9. Maxillary fixed prosthesis design based on the preoperative physical examination.

    PubMed

    Block, Michael S

    2015-05-01

    The purpose of this article is to illustrate the use of physical examination findings that can be used to determine the design characteristics of a full arch restoration in the maxilla. These anatomic findings include 1) the resting and 2) smile line exposures of the central incisor; 3) the vertical position of the edentulous ridge when smiling; 4) the anteroposterior relation of the teeth to the edentulous ridge; 5) the presence of bone posterior to the premolar region; 6) the anterior height of the alveolar bone in relation to the floor of the nose; and 7) the planned inclination of the maxillary teeth. Based on these physical findings, the final prosthetic plan can be established before surgery. Determination of the final restorative plan determines the surgical procedures to be performed.

  10. Paraclinoid carotid artery aneurysms with the dome eroding the anterior clinoid process: preoperative depiction of topography and surgical tactics--two case reports.

    PubMed

    Nagasawa, S; Ogawa, R; Suyama, Y; Ohta, T

    1996-09-01

    A 70-year-old male and a 55-year-old female presented with unruptured aneurysms in the clinoid segment of the carotid artery. Intraoperative rupture during removal of the anterior clinoid process resulted in unintended carotid artery occlusion in the former patient, causing hemispherical infarction and death. However, the aneurysm was successfully clipped due to preoperative recognition of the aneurysmal dome in the clinoid process in the latter. Magnetic resonance angiography and three-dimensional computed tomography angiography source images provide detailed visualization of the topographic anatomy around the paraclinoid aneurysms and are helpful for definite surgical planning.

  11. Preoperative Versus Postoperative Initiation of Warfarin Therapy in Patients Undergoing Total Hip and Knee Arthroplasty.

    PubMed

    Cipriano, Cara; Erdle, Nicholas; Li, Kai; Curtin, Brian

    2017-01-01

    The optimal strategy for postoperative deep venous thrombosis prophylaxis remains controversial in hip and knee arthroplasty. Warfarin causes transient hypercoagulability; however, the optimal timing of treatment remains unclear. We evaluated the effects of preoperative versus postoperative warfarin therapy with a primary endpoint of perioperative change in hemoglobin. Warfarin was dosed according to a standard nomogram. No difference in perioperative hemoglobin change was observed. The preoperative group demonstrated higher INRs. Initiation of warfarin preoperatively was not associated with any difference in perioperative hemoglobin change. Larger studies are needed to determine whether the risk of adverse events is increased with either strategy.

  12. Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial.

    PubMed

    Dionigi, Alberto; Sangiorgi, Diego; Flangini, Roberto

    2014-03-01

    This study investigated whether a clown doctor intervention could reduce preoperative anxiety in children hospitalized for minor surgery and in their parents. A randomized controlled trial was conducted with 77 children and 119 parents: the clown group consisted of 52 children accompanied in the preoperating room by their parents (n = 89) and two clowns while the comparison group consisted of children accompanied by the parents only. The clown intervention significantly reduced the children's preoperative anxiety: children benefited from the clown's presence and showed better adjustment than children in the comparison group. Mothers in Comparison Group showed higher anxiety.

  13. [18F]-fluoro-l-thymidine PET and advanced MRI for preoperative grading of gliomas

    PubMed Central

    Collet, S.; Valable, S.; Constans, J.M.; Lechapt-Zalcman, E.; Roussel, S.; Delcroix, N.; Abbas, A.; Ibazizene, M.; Bernaudin, M.; Barré, L.; Derlon, J.M.; Guillamo, J.S.

    2015-01-01

    Purpose Conventional MRI based on contrast enhancement is often not sufficient in differentiating grade II from grade III and grade III from grade IV diffuse gliomas. We assessed advanced MRI, MR spectroscopy and [18F]-fluoro-l-thymidine ([18F]-FLT) PET as tools to overcome these limitations. Methods In this prospective study, thirty-nine patients with diffuse gliomas of grades II, III or IV underwent conventional MRI, perfusion, diffusion, proton MR spectroscopy (1H-MRS) and [18F]-FLT-PET imaging before surgery. Relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), Cho/Cr, NAA/Cr, Cho/NAA and FLT-SUV were compared between grades. Results Cho/Cr showed significant differences between grade II and grade III gliomas (p = 0.03). To discriminate grade II from grade IV and grade III from grade IV gliomas, the most relevant parameter was the maximum value of [18F]-FLT uptake FLTmax (respectively, p < 0.001 and p < 0.0001). The parameter showing the best correlation with the grade was the mean value of [18F]-FLT uptake FLTmean (R2 = 0.36, p < 0.0001) and FLTmax (R2 = 0.5, p < 0.0001). Conclusion Whereas advanced MRI parameters give indications for the grading of gliomas, the addition of [18F]-FLT-PET could be of interest for the accurate preoperative classification of diffuse gliomas, particularly for identification of doubtful grade III and IV gliomas. PMID:26106569

  14. Preoperative N Staging of Gastric Cancer by Stomach Protocol Computed Tomography

    PubMed Central

    Kim, Se Hoon; Kim, Jeong Jae; Lee, Jeong Sub; Kim, Seung Hyoung; Kim, Bong Soo; Maeng, Young Hee; Hyun, Chang Lim; Kim, Min Jeong

    2013-01-01

    Purpose Clinical stage of gastric cancer is currently assessed by computed tomography. Accurate clinical staging is important for the tailoring of therapy. This study evaluated the accuracy of clinical N staging using stomach protocol computed tomography. Materials and Methods Between March 2004 and November 2012, 171 patients with gastric cancer underwent preoperative stomach protocol computed tomography (Jeju National University Hospital; Jeju, Korea). Their demographic and clinical characteristics were reviewed retrospectively. Two radiologists evaluated cN staging using axial and coronal computed tomography images, and cN stage was matched with pathologic results. The diagnostic accuracy of stomach protocol computed tomography for clinical N staging and clinical characteristics associated with diagnostic accuracy were evaluated. Results The overall accuracy of stomach protocol computed tomography for cN staging was 63.2%. Computed tomography images of slice thickness 3.0 mm had a sensitivity of 60.0%; a specificity of 89.6%; an accuracy of 78.4%; and a positive predictive value of 78.0% in detecting lymph node metastases. Underestimation of cN stage was associated with larger tumor size (P<0.001), undifferentiated type (P=0.003), diffuse type (P=0.020), more advanced pathologic stage (P<0.001), and larger numbers of harvested and metastatic lymph nodes (P<0.001 each). Tumor differentiation was an independent factor affecting underestimation by computed tomography (P=0.045). Conclusions Computed tomography with a size criterion of 8 mm is highly specific but relatively insensitive in detecting nodal metastases. Physicians should keep in mind that computed tomography may not be an appropriate tool to detect nodal metastases for choosing appropriate treatment. PMID:24156034

  15. Registering stereovision surface with preoperative magnetic resonance images for brain shift compensation

    NASA Astrophysics Data System (ADS)

    Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

    2012-02-01

    Intraoperative brain deformation can significantly degrade the accuracy of image guidance using preoperative MR images (pMR). To compensate for brain deformation, biomechanical models have been used to assimilate intraoperative displacement data, compute whole-brain deformation field, and to produce updated MR images (uMR). Stereovision (SV) is an important technique to capture both geometry and texture information of exposed cortical surface at the craniotomy, from which surface displacement data (known as sparse data) can be extracted by registering with pMR to drive the computational model. Approaches that solely utilize geometrical information (e.g., closest point distance (CPD) and iterative closest point (ICP) method) do not seem to capture surface deformation accurately especially when significant lateral shift occurs. In this study, we have developed a texture intensity-based method to register cortical surface reconstructed from stereovision after dural opening with pMR to extract 3D sparse data. First, a texture map is created from pMR using surface geometry before dural opening. Second, a mutual information (MI)-based registration was performed between the texture map and the corresponding stereo image after dural opening to capture the global lateral shift. A block-matching algorithm was then executed to differentiate local displacements in smaller patches. The global and local displacements were finally combined and transformed in 3D following stereopsis. We demonstrate the application of the proposed method with a clinical patient case, and show that the accuracy of the technique is 1-2 mm in terms of model-data misfit with a computation time <10 min.

  16. A novel visual facial anxiety scale for assessing preoperative anxiety

    PubMed Central

    Cao, Xuezhao; Yumul, Roya; Elvir Lazo, Ofelia Loani; Friedman, Jeremy; Durra, Omar; Zhang, Xiao; White, Paul F.

    2017-01-01

    Background There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety. Methods The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0–10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale. Results The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing ‘no’ anxiety, 250 (94.3%) participants chose the face A10 as representing ‘highest’ anxiety and 147 (55.5%) participants chose the face A8 as representing ‘moderate-high’ anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3

  17. Adaptive script based animations for intervention planning.

    PubMed

    Muehler, Konrad; Bade, Ragnar; Preim, Bernhard

    2006-01-01

    We describe scripting facilities to create medical animations for intervention planning based on medical volume data and derived segmentation information. A data independent scripting language has been developed to separate animation scripts from imaging data. The scripting facilities are adaptive and allow to reuse one script to create animations for many different patients. With expressive animations, we support the individual planning process, the preoperative documentation as well as discussions between medical doctors, for example in a tumor board. We also discuss the enhancement of interactive explorations with animations generated on the fly.

  18. Pre-Operative Image-based Segmentation of the Cranial Nerves and Blood Vessels in Microvascular Decompression: Can we Prevent Unnecessary Explorations?

    PubMed Central

    Dolati, P; Golby, A; Eichberg, D; Abolfotoh, M; Dunn, IF; Mukundan, S; Hulou, MM; Al-Mefty, O

    2016-01-01

    Objectives This study was conducted to validate the accuracy of image-based pre-operative segmentation using the gold standard endoscopic and microscopic findings for localization and pre-operative diagnosis of the offensive vessel. Patients and Methods Fourteen TN and 6 HS cases were randomly selected. All patients had 3T MRI, which included thin-sectioned 3D space T2, 3D Time of Flight and MPRAGE Sequences. Imaging sequences were loaded in BrainLab iPlanNet and fused. Individual segmentation of the affected cranial nerves and the compressing vascular structure was performed by a neurosurgeon, and the results were compared with the microscopic and endoscopic findings by two blinded neurosurgeons. For each case, at least three neurovascular landmarks were targeted. Each segmented neurovascular element was validated by manual placement of the navigation probe over each target, and errors of localization were measured in mm. Results All patients underwent retro-sigmoid craniotomy and MVD using both microscope and endoscope. Based on image segmentation, the compressing vessel was identified in all cases except one, which was also negative intraoperatively. Perfect correspondence was found between image-based segmentation and endoscopic and microscopic images and videos (Dice coefficient of 1). Measurement accuracy was 0.45+/-0.21 mm (mean +/-SD). Conclusion Image-based segmentation is a promising method for pre-operative identification and localization of offending blood vessels causing HFS and TN. Using this method may prevent some unnecessary explorations on especially atypical cases with no vascular contacts. However, negative pre-operative image segmentation may not preclude one from exploration in classic cases of TN or HFS. A multicenter study with larger number of cases is recommended. PMID:26476700

  19. Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT.

    PubMed

    Yoo, Sua; Blitzblau, Rachel; Yin, Fang-Fang; Horton, Janet K

    2015-01-08

    The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensity-modulated radiation therapy (IMRTNC), coplanar IMRT (IMRTCO), and volumetric-modulated arc therapy (VMAT). The planning CT scans of 16 patients in the prone position were used in this study, with the single-fraction prescription doses of 15 Gy for the first eight patients and 18 Gy for the remaining eight patients. Six (6) MV photon beams were designed to avoid the heart and contralateral breast. Optimization for IMRT and VMAT was performed to reduce the dose to the skin and normal breast. All plans were normalized such that 100% of the prescribed dose covered greater than 95% of the clinical target volume (CTV) consisting of gross tumor volume (GTV) plus 1.5 cm margin. Mean homogeneity index (HI) was the lowest (1.05 ± 0.02) for 3D CRT and the highest (1.11 ± 0.04) for VMAT. Mean conformity index (CI) was the lowest (1.42 ± 0.32) for IMRTNC and the highest (1.60 ± 0.32) for VMAT. Mean of the maximum point dose to skin was the lowest (73.7 ± 11.5%) for IMRTNC and the highest (86.5 ± 6.68%) for 3D CRT. IMRTCO showed very similar HI, CI, and maximum skin dose to IMRTNC (differences <1%). The estimated mean treatment delivery time, excluding the time spent for patient positioning and imaging, was 7.0 ± 1.0, 8.3 ± 1.1, 9.7 ± 1.0, and 11.0 ± 1.5min for VMAT, IMRTCO, IMRTNC and 3D CRT, respectively. In comparison of all four techniques for preoperative single-fraction partial breast radiotherapy, we can conclude that noncoplanar or coplanar IMRT were optimal in this study as IMRT plans provided homogeneous and conformal target coverage, skin sparing, and relatively short treatment delivery time.

  20. Standardized phase angle indicates nutritional status in hospitalized preoperative patients.

    PubMed

    Cardinal, Thiane R; Wazlawik, Elisabeth; Bastos, João Luiz; Nakazora, Lívia M; Scheunemann, Lisiane

    2010-09-01

    There is currently no criterion standard to assess nutritional status, and different methods have been used in hospitalized patients. The aim of this study was to investigate the agreement and the association between bioelectrical impedance analysis derived by standardized phase angle (SPA) and other methods used for the nutritional assessment of body composition, metabolic status, and functional status in surgical patients. The hypothesis was that the SPA is effective for evaluating nutritional status in surgical patients; therefore, it could be used when the application of other assessment methods is not possible. The sample consisted of 125 patients (20-94 years of age) before elective gastrointestinal or hernia repair. The participants were from the Surgical Clinic 1 at the University Hospital of the Federal University of Santa Catarina, Florianópolis, SC, Brazil. Nutritional status was evaluated during the preoperative period based on the triceps skinfold thickness, mid-arm circumference, body mass index, percent weight loss, nutritional risk screening 2002 (NRS 2002), subjective global assessment (SGA), and SPA. The agreement between the SPA and the other methods was assessed with the k coefficient. The agreement between the SPA and the methods of nutritional assessment that were investigated for diagnosing malnutrition was moderate for NRS 2002 and SGA, weak for percent weight loss, and poor for triceps skinfold thickness, mid-arm circumference, and body mass index. There was a significant association between SPA and both NRS 2002 and SGA (P < .001). Our results suggest that SPA is able to indicate the risk of nutritional deficiency in the patients assessed. However, good agreement between SPA and the methods investigated was not observed.

  1. Differential Network Analysis Applied to Preoperative Breast Cancer Chemotherapy Response

    PubMed Central

    Warsow, Gregor; Struckmann, Stephan; Kerkhoff, Claus; Reimer, Toralf; Engel, Nadja; Fuellen, Georg

    2013-01-01

    In silico approaches are increasingly considered to improve breast cancer treatment. One of these treatments, neoadjuvant TFAC chemotherapy, is used in cases where application of preoperative systemic therapy is indicated. Estimating response to treatment allows or improves clinical decision-making and this, in turn, may be based on a good understanding of the underlying molecular mechanisms. Ever increasing amounts of high throughput data become available for integration into functional networks. In this study, we applied our software tool ExprEssence to identify specific mechanisms relevant for TFAC therapy response, from a gene/protein interaction network. We contrasted the resulting active subnetwork to the subnetworks of two other such methods, OptDis and KeyPathwayMiner. We could show that the ExprEssence subnetwork is more related to the mechanistic functional principles of TFAC therapy than the subnetworks of the other two methods despite the simplicity of ExprEssence. We were able to validate our method by recovering known mechanisms and as an application example of our method, we identified a mechanism that may further explain the synergism between paclitaxel and doxorubicin in TFAC treatment: Paclitaxel may attenuate MELK gene expression, resulting in lower levels of its target MYBL2, already associated with doxorubicin synergism in hepatocellular carcinoma cell lines. We tested our hypothesis in three breast cancer cell lines, confirming it in part. In particular, the predicted effect on MYBL2 could be validated, and a synergistic effect of paclitaxel and doxorubicin could be demonstrated in the breast cancer cell lines SKBR3 and MCF-7. PMID:24349128

  2. Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy

    PubMed Central

    Alshehri, Fahad M.; Akbar, Mahboob H.; Altwairgi, Adel K.; AlThaqufi, Omar J.

    2015-01-01

    Objectives: To assess duplex ultrasound (DUS) parameters, and predicti the outcome of varicocele ligation in male infertility. Methods: This retrospective and follow up study was conducted at Dr. Sulaiman Al Habib Hospital, AlQassim, Saudi Arabia between January 2011 and December 2012. Eighty-two patients were selected, who presented with clinical/subclinical varicocele and male infertility. All these patients had DUS of the scrotum and underwent for low ligation varicocelectomy. These patients were followed for a period of 12-24 months after surgery for the occurrence of paternity. We reviewed pre-operative scrotal DUS of these 82 patients for the testicular size and volume, pampiniform veins caliber and duration of reflux in the dilated veins at rest, and after valsalva maneuver. These DUS parameters were correlated with the postoperative paternity rate. Results: Postoperative paternity was achieved in 18 patients (31.6%) with normal-sized testes, and in 3 patients (12%) with small size testes. The positive paternity rate was higher (38.5%) in patients with clinically detected varicocele, compared with only 16.7% of patients with subclinical varicocele (detected by ultrasound only). In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (70.6%), with shunt-type varicocele (71.4%), and patients with a permanent grade of venous reflux (62.5%). Conclusion: Selection of patients for the successful paternity after varicocele repair depends mainly on DUS parameters, which includes normal size testicles with shunt type of bilateral varicocele and continuous reflux. PMID:26620986

  3. The medical evaluation of the elderly preoperative patient.

    PubMed

    Daly, M P

    1989-06-01

    Improvements in anesthesia and surgical techniques have greatly reduced the perioperative mortality and morbidity of elderly patients. Mortality is more closely correlated with pathology, type of surgery, and duration of anesthesia rather than with age. Particular attention should be directed toward cardiac and pulmonary status, because operative mortality and morbidity is related, for the most part, to cardiovascular and pulmonary complications. Postoperatively, the occurrence of pulmonary emboli and painless myocardial infarctions is more common in this age group. Elderly patients are more often confused postoperatively owing to the residual effect of anesthetics, analgesics, fever, and electrolyte disturbances. The stress of surgery and unfamiliar surroundings are also frequent precipitating causes. Orthostatic blood pressure and pulse readings should be checked before ambulating elderly patients who have been at bed rest for more than 2 to 3 days because of the frequent occurrence of orthostatic hypotension. Pressure sores, incontinence, and aspiration pneumonia may also occur owing to immobility. The elderly patient's functional status and mental status may be enhanced by simple encouragement, early mobilization, and by social interaction. It is not possible to precisely define the risks of proposed procedure, nor can the physician eliminate all risks from a surgical procedure. The risks a particular patient is subjected to depend on the complex interplay of the preoperative medical condition of the patient, the type of surgery proposed, and the skill and expertise of the anesthesiologist and surgeon. We must strive to achieve the goal of bringing our patient to the operating room in the best possible condition in the time available.

  4. Neck Pain, Preoperative Opioids, and Functionality After Cervical Fusion.

    PubMed

    Faour, Mhamad; Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U

    2017-01-01

    The use of opioids among patients with workers' compensation claims is associated with tremendous costs, especially for patients who undergo spinal surgery. This study compared return-to-work rates after single-level cervical fusion for degenerative disk disease between patients who received opioids before surgery and patients who underwent fusion with no previous opioid use. All study subjects qualified for workers' compensation benefits for injuries sustained at work between 1993 and 2011. The study population included 281 subjects who underwent single-level cervical fusion for degenerative disk disease with International Classification of Diseases, Ninth Revision, and Current Procedural Terminology code algorithms. The opioid group included 77 subjects who received opioids preoperatively. The control group included 204 subjects who had surgery with no previous opioid use. The primary outcome was meeting return-to-work criteria within 3 years of follow-up after fusion. Secondary outcome measures after surgery, surgical details, and presurgical characteristics for each cohort also were collected. In 36.4% of the opioid group, return-to-work criteria were met compared with 56.4% of the control group. Patients who took opioids were less likely to meet return-to-work criteria compared with the control group (odds ratio, 0.44; 95% confidence interval, 0.26-0.76; P=.0028). Return-to-work rates within the first year after fusion were 24.7% for the opioid group and 45.6% for the control group (P=.0014). Patients who used opioids were absent from work for 255 more days compared with the control group (P=.0001). The use of opioids for management of diskogenic neck pain, with the possibility of surgical intervention, is a negative predictor of successful return to work after fusion in a workers' compensation population. [Orthopedics. 2017; 40(1):25-32.].

  5. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques

    PubMed Central

    Rozen, Warren Matthew; Spychal, Robert T.; Hunter-Smith, David J.

    2016-01-01

    Background Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking. Methods A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken. Results Since Bouman’s first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing. Conclusions Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising. PMID:27047788

  6. Computed tomography in chronic suppurative otitis media: value in surgical planning.

    PubMed

    Payal, Garg; Pranjal, Kulshreshtha; Gul, Motwani; Mittal, M K; Rai, A K

    2012-09-01

    The present study was conducted prospectively to evaluate how accurately high resolution computed tomography scanning could define the extent and severity of the underlying disease in patients with chronic suppurative ear disease, thus, helping convert a surgical exploration into a planned procedure. Sixty adult consecutive cases of chronic suppurative otitis media underwent a detailed high resolution computed tomography by a single radiologist. The recorded radiological findings in various heads were then compared to the surgical findings during mastoid exploration of these patients by a single otologist and the two statistically compared. The presence and distribution of soft tissue in the middle ear cleft and mastoid could confidently be predicted using this modality. The malleus, body and short process of incus were well visualized, but not the long process of incus and the stapes suprastructure. Lateral semicircular canal fistulae could be demonstrated with an acceptable degree of accuracy. It was possible to detect facial nerve dehiscence and defects in tegmen tympani in significant number of cases although, statistical values were low for these structures. High resolution scanning is a modality which can accurately image the pathological anatomy in unsafe chronic suppurative otitis media. Otologists should use it more often, especially in complicated cases as an adjunct to better preoperative assessment, and thus, the surgical outcome. Its accuracy is likely to improve with larger studies and better experience, wherein its routine use may become justifiable.

  7. Can the conventional sextant prostate biopsy accurately predict unilateral prostate cancer in low-risk, localized, prostate cancer?

    PubMed

    Mayes, Janice M; Mouraviev, Vladimir; Sun, Leon; Tsivian, Matvey; Madden, John F; Polascik, Thomas J

    2011-01-01

    We evaluate the reliability of routine sextant prostate biopsy to detect unilateral lesions. A total of 365 men with complete records including all clinical and pathologic variables who underwent a preoperative sextant biopsy and subsequent radical prostatectomy (RP) for clinically localized prostate cancer at our medical center between January 1996 and December 2006 were identified. When the sextant biopsy detects unilateral disease, according to RP results, the NPV is high (91%) with a low false negative rate (9%). However, the sextant biopsy has a PPV of 28% with a high false positive rate (72%). Therefore, a routine sextant prostate biopsy cannot provide reliable, accurate information about the unilaterality of tumor lesion(s).

  8. Preoperative evaluation of cervical lymph nodes for metastasis in patients with oral squamous cell carcinoma: A comparative study of efficacy of palpation, ultrasonography and computed tomography

    PubMed Central

    Mishra, Niranjan; Rath, Krushna Chandra; Upadhyay, Upendra Nath; Raut, Subhrajit; Baig, Shadab Ali; Birmiwal, Krishna Gopal

    2016-01-01

    Introduction: Oral cancer is a major health threat in a country like India, where patients frequently present with advanced disease with regional dissemination to cervical lymph nodes. The management and prognosis depend on the status of cervical lymph nodes. Thus, it becomes imperative to diagnose and evaluate them preoperatively. Aim: This study aims to compare the efficacy of palpation, ultrasonography (USG) and computed tomography (CT) in the preoperative evaluation of cervical lymph node for metastasis in patients with oral squamous cell carcinoma. Settings: Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. Methodology: A total of thirty patients of either sex of age group 20–70 years, diagnosed with oral cancer were randomly selected for the study and subjected to palpation, USG and computer tomography followed by histopathology for confirmation. The results were evaluate statistically by sensitivity, specificity, positive predictive value, and negative predictive value and accuracy. Results: For level IA palpation, USG and CT were equally sensitive (100%) and specific (100%). Although palpation, USG and CT were equally sensitive (80%) for level IB, the specificity of palpation (70%) accurate than palpation (92.7%), for detection of metastasis in cervical lymph nodes in patients with oral squamous cell carcinoma. CT along with USG should be used for accurate preoperative evaluation of cervical lymph node. PMID:28356691

  9. Accurate pointing of tungsten welding electrodes

    NASA Technical Reports Server (NTRS)

    Ziegelmeier, P.

    1971-01-01

    Thoriated-tungsten is pointed accurately and quickly by using sodium nitrite. Point produced is smooth and no effort is necessary to hold the tungsten rod concentric. The chemically produced point can be used several times longer than ground points. This method reduces time and cost of preparing tungsten electrodes.

  10. 77 FR 15813 - Preoperational Testing of Instrument and Control Air Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-16

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Preoperational Testing of Instrument and Control Air Systems AGENCY: Nuclear Regulatory Commission... testing of the instrument and control air systems (ICAS) in a commercial nuclear power plant....

  11. [Effect of practical use of preoperative immunonutrition with impact on prevention of postoperative pneumonia after esophagectomy].

    PubMed

    Kano, Masayuki; Nabeya, Yoshihiro; Akutsu, Yasunori; Shuto, Kiyohiko; Uesato, Masaya; Miyazawa, Yukimasa; Matsubara, Hisahiro

    2009-11-01

    To clarify the clinical benefits of administering immune-enhancing diet, Impact,we examined retrospectively the effect of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy. In 47 patients without preoperative radiotherapy, no patient who preoperatively administered Impact>or=2,250 mL failed to develop pneumonia. The patients whose postoperative hospital stay was more than 30 days were administered Impactpreoperative administration of less amount of Impact than an estimated maximum dose, depending on patients' condition, may be beneficial to prevent postoperative pneumonia and a long hospital stay after surgery.

  12. [Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period].

    PubMed

    de Sena, Adnairdes Cabral; do Nascimento, Eliane Regina Pereira; Maia, Ana Rosete Camargo Rodrigues

    2013-09-01

    Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

  13. Preoperational Environmental Survey for the Spent Nuclear Fuel (SNF) Project Facilities

    SciTech Connect

    MITCHELL, R.M.

    2000-10-12

    This document represents the report for environmental sampling of soil, vegetation, litter, cryptograms, and small mammals at the Spent Nuclear Fuel Project facilities located in 100 K and 200 East Areas in support of the preoperational environmental survey.

  14. Preoperational Environmental Survey for the Spent Nuclear Fuel (SNF) Project Facilities

    SciTech Connect

    MITCHELL, R.M.

    2000-09-28

    This document represents the report for environmental sampling of soil, vegetation, litter, cryptograms, and small mammals at the Spent Nuclear Fuel Project facilities located in 100 K and 200 East Areas in support of the preoperational environmental survey.

  15. Preoperational Subsurface Conditions at the Idaho Nuclear Technology and Engineering Center Service Waste Disposal Facility

    SciTech Connect

    Ansley, Shannon Leigh

    2002-02-01

    The Idaho Nuclear Technology and Engineering Center (INTEC) Service Wastewater Discharge Facility replaces the existing percolation ponds as a disposal facility for the INTEC Service Waste Stream. A preferred alternative for helping decrease water content in the subsurface near INTEC, closure of the existing ponds is required by the INTEC Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Record of Decision (ROD) for Waste Area Group 3 Operable Unit 3-13 (DOE-ID 1999a). By August 2002, the replacement facility was constructed approximately 2 miles southwest of INTEC, near the Big Lost River channel. Because groundwater beneath the Idaho National Engineering and Environmental Laboratory (INEEL) is protected under Federal and State of Idaho regulations from degradation due to INEEL activities, preoperational data required by U.S. Department of Energy (DOE) Order 5400.1 were collected. These data include preexisting physical, chemical, and biological conditions that could be affected by the discharge; background levels of radioactive and chemical components; pertinent environmental and ecological parameters; and potential pathways for human exposure or environmental impact. This document presents specific data collected in support of DOE Order 5400.1, including: four quarters of groundwater sampling and analysis of chemical and radiological parameters; general facility description; site specific geology, stratigraphy, soils, and hydrology; perched water discussions; and general regulatory requirements. However, in order to avoid duplication of previous information, the reader is directed to other referenced publications for more detailed information. Documents that are not readily available are compiled in this publication as appendices. These documents include well and borehole completion reports, a perched water evaluation letter report, the draft INEEL Wellhead Protection Program Plan, and the Environmental Checklist.

  16. Preoperational Subsurface Conditions at the Idaho Nuclear Technology and Engineering Center Service Wastewater Discharge Facility

    SciTech Connect

    Ansley, Shannon L.

    2002-02-20

    The Idaho Nuclear Technology and Engineering Center (INTEC) Service Wastewater Discharge Facility replaces the existing percolation ponds as a disposal facility for the INTEC Service Waste Stream. A preferred alternative for helping decrease water content in the subsurface near INTEC, closure of the existing ponds is required by the INTEC Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Record of Decision (ROD) for Waste Area Group 3 Operable Unit 3-13 (DOE-ID 1999a). By August 2002, the replacement facility was constructed approximately 2 miles southwest of INTEC, near the Big Lost River channel. Because groundwater beneath the Idaho National Engineering and Environmental Laboratory (INEEL) is protected under Federal and State of Idaho regulations from degradation due to INEEL activities, preoperational data required by U.S. Department of Energy (DOE) Order 5400.1 were collected. These data include preexisting physical, chemical, and biological conditions that could be affected by the discharge; background levels of radioactive and chemical components; pertinent environmental and ecological parameters; and potential pathways for human exposure or environmental impact. This document presents specific data collected in support of DOE Order 5400.1, including: four quarters of groundwater sampling and analysis of chemical and radiological parameters; general facility description; site specific geology, stratigraphy, soils, and hydrology; perched water discussions; and general regulatory requirements. However, in order to avoid duplication of previous information, the reader is directed to other referenced publications for more detailed information. Documents that are not readily available are compiled in this publication as appendices. These documents include well and borehole completion reports, a perched water evaluation letter report, the draft INEEL Wellhead Protection Program Plan, and the Environmental Checklist.

  17. Preoperative Portal Vein Embolization Tailored to Prepare the Liver for Complex Resections: Initial Experience

    SciTech Connect

    Baere, T. de Robinson, J. M.; Deschamps, F.; Rao, P.; Teriitheau, C.; Goere, D.; Elias, D.

    2010-10-15

    The purpose of this study was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) tailored to prepare the liver for complex and extended resections. During the past 5 years, 12 PVEs were performed in noncirrhotic patients with liver metastases from colon cancer (n = 10), choroidal melanoma (n = 1), and leiomyosarcoma (n = 1) to prepare complex anatomical liver resections in patients with small future remnant livers. These liver resections planned to preserve only segment IV in four patients, segments IV, V, and VIII in four patients, segments II, III, VI, and VII in three patients, and segments V and VI in one patient. PVE was performed under general anesthesia with a flow-guided injection of a mixture of cyanoacrylate and Lipiodol using a 5-Fr catheter. All portal branches feeding the liver segments to be resected were successfully embolized with cyanoacrylate except one, which was occluded with coils due to the risk of reflux with cyanoacrylate. After a mean of 32 days, CT volumetry revealed a mean hypertrophy of the unembolized liver of 47 {+-} 25% (range, 21-88%). Liver resections could be performed in 10 patients but were canceled in 2, due to the occurrence of a new hepatic tumor in one and an insufficiently increased volume in the other. Among the 10 patients who underwent the liver resection, 1 died of postoperative sepsis, 3 died 3 to 32 months after surgery, including 1 death unrelated to cancer, and 6 were alive after 6 to 36 months after surgery. In conclusion, in this preliminary report, PVE appears to be feasible and able to induce hypertrophy of the future remnant liver before a complex and extended hepatectomy. Further evaluation is needed in a larger cohort.

  18. Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?

    PubMed Central

    Wright, Barry; Aghahoseini, Assad

    2016-01-01

    Objective To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy. Design Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual. Results Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes. Conclusions Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group. Trial registration number ISRCTN40219584. PMID:27601483

  19. A clinical evaluation of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation.

    PubMed

    Brown, T R; Ehrlich, C E; Stehman, F B; Golichowski, A M; Madura, J A; Eitzen, H E

    1984-04-01

    In a prospective, randomized study, 737 patients who were evaluated had the operative site prepared preoperatively by either a 0.5 per cent chlorhexidine gluconate spray or povidone-iodine scrub. The wound infection rate in these two comparable groups was not statistically different, although slightly favoring the spray technique (6.0 versus 8.1 per cent). The spray technique challenges the conventional preoperative scrub and offers further advantages of increased effectiveness while also offering savings of time and expense.

  20. Clinically Silent Preoperative Brain Injuries Do Not Worsen with Surgery in Newborns with Congenital Heart Disease

    PubMed Central

    Block, AJ; McQuillen, PS; Chau, V; Glass, H; Poskitt, KJ; Barkovich, AJ; Esch, M; Soulikias, W; Azakie, A; Campbell, A; Miller, SP

    2010-01-01

    Objective Preoperative brain injury, particularly stroke and white matter injury (WMI), is common in newborns with congenital heart disease (CHD). The objective of this study was to determine the risk of hemorrhage or extension of preoperative brain injury with cardiac surgery. Methods This dual-center prospective cohort study recruited 92 term newborns: 62 with transposition of the great arteries (TGA), and 30 with single ventricle physiology from two tertiary referral centers. Newborns underwent brain MRI scans before and after cardiac surgery. Results Brain injury was identified in 40 (43%) newborns on the preoperative MRI scan (median five days of life): stroke in 23, WMI in 21, and intraventricular hemorrhage in 7. None of the brain lesions presented clinically with overt signs or seizures. Preoperative brain injury was associated with balloon atrial septostomy (BAS) (P=0.003) and lowest SaO2 (P=0.007); in a multivariable model, only the effect of BAS remained significant when adjusting for lowest SaO2. On postoperative MRI in 78 newborns (median 21 days of life), none of the preoperative lesions showed evidence of extension or hemorrhagic transformation (0/40 [95% CI: 0-7%]). The presence of preoperative brain injury was not a significant risk factor for acquiring new injury on the postoperative MRI (P=0.8). Conclusion Clinically silent brain injuries identified preoperatively in newborns with CHD, including stroke, have a low risk of progression with surgery and cardiopulmonary bypass, and should therefore not delay clinically indicated cardiac surgery. In this multi-center cohort, BAS remains an important risk factor for preoperative brain injury, particularly stroke. PMID:20434174

  1. Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma

    PubMed Central

    He, Xiaobo; Guo, Shengjie; Chen, Dong; Yang, Guangwei; Chen, Xin; Zhang, Yijun; He, Qiuming; Qin, Zike; Liu, Zhuowei; Xue, Yunfei; Zhang, Meng; Liu, Ruiwu; Zhou, Fangjian; Han, Hui; Yao, Kai

    2017-01-01

    Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients. Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis. Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR. Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use. PMID:28243330

  2. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review.

    PubMed

    Johansson, T; Fritsch, G; Flamm, M; Hansbauer, B; Bachofner, N; Mann, E; Bock, M; Sönnichsen, A C

    2013-06-01

    Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient's medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.

  3. Pre-operative rehabilitation evaluation of the dysvascular patient prior to amputation.

    PubMed

    Hakimi, Kevin N

    2009-11-01

    Lower-extremity amputation secondary to dysvascular disease, including diabetes and peripheral vascular disease, is a major health problem in the United States. Due to the increased comorbidities in this patient population, pre-operative rehabilitation evaluation by a multidisciplinary team is crucial to ensure optimal patient outcomes. This article discusses the key factors that may affect functional outcomes in this patient population and outlines important history and physical examination components that should be evaluated pre-operatively.

  4. Is Combat Exposure Predictive of Higher Preoperative Stress in Military Members?

    DTIC Science & Technology

    2015-01-26

    of anxiety, depression , PTSD symptoms, and combat experience(s) were assessed. On the day of surgery, preoperative stress was measured using the...Regression modeling suggested anxiety, depression , PTSD, and combat exposure explained 21% of negative emotions (dysphoria) on the day of surgery, R2...213, adjusted R2 = .180, F (3, 72) = 6.488, p < .001. In addition, trait depression may be the best predictor of increased preoperative stress, B

  5. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

    PubMed Central

    Park, Alyssa M.; Bauman, Tyler M.; Larson, Jeffrey A.; Vetter, Joel M.; Benway, Brian M.; Desai, Alana C.

    2016-01-01

    Purpose The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. Materials and Methods We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. Results Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). Conclusions Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient. PMID:27847915

  6. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  7. The superiority of 256-slice spiral computed tomography angiography for preoperative evaluation of surrounding arteries in patients with gastric cancer

    PubMed Central

    Wu, Deqing; Zhao, Linyong; Liu, Ying; Wang, Junjiang; Hu, Weixian; Feng, Xingyu; Lv, Zejian; Li, Yong; Yao, Xueqing

    2017-01-01

    Objective To evaluate the utilization of 256-slice spiral computed tomography (CT) angiography in preoperative assessment of perigastric vascular anatomy in patients with gastric cancer. Methods In this study, 80 gastric cancer patients were included. The medical procedure of 256-slice spiral CT angiography was performed on each of these patients consecutively. Thereafter, these patients were subjected to surgical treatment in our hospital. The techniques of volume rendering (VR) and maximum intensity projection (MIP) were used to image reconstruction of arteries around the stomach. Results Both VR and MIP were applied to reconstruct the images of perigastric arteries. The results indicated that VR imaging was inferior to MIP in determining the variant small artery anatomy around the greater curvature and fundus. The respective rates of imaging produced by VR and MIP for left gastroepiploic artery, short gastric artery, and posterior gastric artery, were 32.50% versus 100%, 16.25% versus 87.50%, and 3.75% versus 25.00%, respectively. According to Hiatt’s classification, 75 out of 240 cases were abnormal types, among which we found Type II in 30 cases, Type III in 33 cases, Type IV in three cases, Type V in six cases, and Type VI in only three cases. There was no significant difference for total and every single variation type, between our group and Hiatt’s group (P>0.05). Conclusion The 256-slice spiral CT angiography can be regarded as an effective and accurate diagnostic modality for preoperative assessing anatomical arterial variations in gastric cancer; MIP was superior to VR at identifying variations of some small artery, whereas VR was better than MIP at showing anatomical arterial variations due to its three-dimensional effect. PMID:28243128

  8. Effects of deformable registration algorithms on the creation of statistical maps for preoperative targeting in deep brain stimulation procedures

    NASA Astrophysics Data System (ADS)

    Liu, Yuan; D'Haese, Pierre-Francois; Dawant, Benoit M.

    2014-03-01

    Deep brain stimulation, which is used to treat various neurological disorders, involves implanting a permanent electrode into precise targets deep in the brain. Accurate pre-operative localization of the targets on pre-operative MRI sequence is challenging as these are typically located in homogenous regions with poor contrast. Population-based statistical atlases can assist with this process. Such atlases are created by acquiring the location of efficacious regions from numerous subjects and projecting them onto a common reference image volume using some normalization method. In previous work, we presented results concluding that non-rigid registration provided the best result for such normalization. However, this process could be biased by the choice of the reference image and/or registration approach. In this paper, we have qualitatively and quantitatively compared the performance of six recognized deformable registration methods at normalizing such data in poor contrasted regions onto three different reference volumes using a unique set of data from 100 patients. We study various metrics designed to measure the centroid, spread, and shape of the normalized data. This study leads to a total of 1800 deformable registrations and results show that statistical atlases constructed using different deformable registration methods share comparable centroids and spreads with marginal differences in their shape. Among the six methods being studied, Diffeomorphic Demons produces the largest spreads and centroids that are the furthest apart from the others in general. Among the three atlases, one atlas consistently outperforms the other two with smaller spreads for each algorithm. However, none of the differences in the spreads were found to be statistically significant, across different algorithms or across different atlases.

  9. Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity

    PubMed Central

    Tafelski, Sascha; Kerper, Léonie F; Salz, Anna-Lena; Spies, Claudia; Reuter, Eva; Nachtigall, Irit; Schäfer, Michael; Krannich, Alexander; Krampe, Henning

    2016-01-01

    Abstract Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery. Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0–100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis. Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th–75th percentiles: 10–52) versus 21 (10–46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men. This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies. PMID:27399095

  10. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis

    PubMed Central

    Zhang, Jiaqiao; Xu, Chuou; He, Deng; Lu, Yuchao; Hu, Henglong; Qin, Baolong; Wang, Yufeng; Wang, Qing; Li, Cong; Liu, Jihong

    2016-01-01

    Purpose To clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting. Methods A total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups. Results Successful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969). Conclusions fURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not. PMID:27917317

  11. Preoperative zoledronic acid therapy prevent hungry bone syndrome in patients with primary hyperparathyroidism

    PubMed Central

    Mayilvaganan, Sabaretnam; Vijaya Sarathi, H. A.; Shivaprasad, C.

    2017-01-01

    Background: Hungry bone syndrome is a common complication of surgery for primary hyperparathyroidism in India which often leads to prolonged hospitalization. There are varying reports on the use and efficacy of bisphosphonates in the prevention of hungry bone syndrome. Methods: We retrospectively analyzed the effect of preoperative bisphosphonate therapy on rates of hungry bone syndrome in our patients with primary hyperparathyroidism. A total of 19 patients underwent surgery for primary hyperparathyroidism at our institute between January 2013 and June 2015 among whom eight did not receive preoperative bisphosphonates and 11 received intravenous zoledronic acid 4 mg, 24–48 h preoperatively. Results: There was no significant difference between the two groups with respect to age, gender, duration of symptoms, preoperative serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase, and the presence of radiological evidence of hyperparathyroid bone disease also did not differ between the groups. Three out of the eight patients who did not receive preoperative zoledronic acid therapy had hungry bone syndrome but none in the zoledronic acid group. The prevalence of hungry bone syndrome tended to be lower in the zoledronic acid group (P = 0.058). The need for intravenous calcium and duration of postoperative hospital stay were significantly lesser in the zoledronic acid group. Conclusion: Preoperative intravenous zoledronic acid significantly reduces the need for intravenous calcium therapy and duration of postoperative hospital stay and seems a promising option to reduce the rate of hungry bone syndrome in patients with primary hyperparathyroidism. PMID:28217502

  12. Toward long-term and accurate augmented-reality for monocular endoscopic videos.

    PubMed

    Puerto-Souza, Gustavo A; Cadeddu, Jeffrey A; Mariottini, Gian-Luca

    2014-10-01

    By overlaying preoperative radiological 3-D models onto the intraoperative laparoscopic video, augmented-reality (AR) displays promise to increase surgeons' visual awareness of high-risk surgical targets (e.g., the location of a tumor). Existing AR surgical systems lack in robustness and accuracy because of the many challenges in endoscopic imagery, such as frequent changes in illumination, rapid camera motions, prolonged organ occlusions, and tissue deformations. The frequent occurrence of these events can cause the loss of image (anchor) points, and thus, the loss of the AR display after a few frames. In this paper, we present the design of a new AR system that represents a first step toward long term and accurate augmented surgical display for monocular (calibrated and uncalibrated) endoscopic videos. Our system uses correspondence-search methods, and a new weighted sliding-window registration approach, to automatically and accurately recover the overlay by predicting the image locations of a high number of anchor points that were lost after a sudden image change. The effectiveness of the proposed system in maintaining a long term (over 2 min) and accurate (less than 1 mm) augmentation has been documented over a set of real partial-nephrectomy laparascopic videos.

  13. Preoperative risk factors of malnutrition for cardiac surgery patients

    PubMed Central

    Donata, Ringaitienė; Dalia, Gineitytė; Vaidas, Vicka; Tadas, Žvirblis; Jūratė, Šipylaitė; Algimantas, Irnius; Juozas, Ivaškevičius

    2016-01-01

    Background. Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients. Materials and methods. The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models. Results. A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416–6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182–2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995–8.389, p < 0.001) and body mass index (OR: 0.928, CI95%: 0.890–0.968, p < 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951–0.983, p < 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002–1.028, p = 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353–6.757, p = 0.007) and mobility (OR: 2.770, CI95%: 1.067–7.194, p = 0.036). Conclusions. MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility

  14. Preoperative use of pregabalin for acute pain in spine surgery

    PubMed Central

    Jiang, Hai-liang; Huang, Shuang; Song, Jiang; Wang, Xiang; Cao, Zhong-shu

    2017-01-01

    Abstract Background: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery. Methods: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. Results: Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, –4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, –4.51 to –0.81 point) at 24 hours, and 4.33 points (95% confidence interval, –6.38 to –2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (–7.07, 95% CI –9.84, –4.30) and 48 hours (–6.52, 95% CI –7.78, –5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances. Conclusions: Preoperative use of pregabalin was

  15. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  16. Preoperative risk factors in total thyroidectomy of substernal goiter

    PubMed Central

    Bove, Aldo; Di Renzo, Raffaella Maria; D’Urbano, Gauro; Bellobono, Manuela; Addetta, Vincenzo D’; Lapergola, Alfonso; Bongarzoni, Giuseppe

    2016-01-01

    The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the

  17. Preoperative evaluation of renal artery in patients with renal tumor

    PubMed Central

    Zhu, Liangsong; Wu, Guangyu; Wang, Jianfeng; Huang, Jiwei; Kong, Wen; Chen, Yonghui; Xue, Wei; Huang, Yiran; Zhang, Jin

    2016-01-01

    Abstract To investigate the feasibility of the noncontrast-enhanced magnetic resonance angiography (NCE-MRA) to evaluate renal arteries before partial nephrectomy (PN). Retrospective analyzed 479 patients who underwent renal surgery between January 2013 and December 2015 with NCE-MRA or computed tomographic angiography (CTA) renal artery image reconstruction preoperative in our department. The renal artery reconstruction score (RARS) was based on the level of artery visualization in a 4-class criterion, and the R.E.N.A.L nephrometry score (R.E.N.A.L), arterial based complexity (ABC) were also analyzed. Of the 479 patients, the overall-lever RARS was 3.62, and the average in 2 groups was no significant difference (NCE-MRA vs CTA, P = 0.072). The performance of NCE-MRA in PN group was similar with CTA. Further comparison demonstrated that the efficiency of NCE-MRA in moderate- or low-degree tumor according to the R.E.N.A.L and ABC complexity less than 3S was equal to CTA. However, high degree (P < 0.001), 3S (P = 0.027), or 3H (P < 0.001) would affect the imaging of renal artery. Intragroup analysis showed that tumor complexity such as max tumor size (r = −o.351, P < 0.001), R.E.N.A.L (r = −0.439, P < 0.001), and ABC (r = −0.619, P < 0.001) were closely correlated with the NCE-MRA performance. The images of 2 sides of the kidney were compared in single person as well, which was meaningful for NCE-MRA patients only (NCE-MRA, P < 0.001; CTA, P = 0.182). The renal artery reconstruction performed by NCE-MRA is feasible and has a similar achievement in the PN potential recipients, with a lower side effect, and meets the requirements for making surgical decision. It has a broad application prospect in clinical practice; however, it still needs to further improve the ability in more complex tumors. PMID:27759632

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

    PubMed

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

    2013-02-01

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

  19. Feedback about More Accurate versus Less Accurate Trials: Differential Effects on Self-Confidence and Activation

    ERIC Educational Resources Information Center

    Badami, Rokhsareh; VaezMousavi, Mohammad; Wulf, Gabriele; Namazizadeh, Mahdi

    2012-01-01

    One purpose of the present study was to examine whether self-confidence or anxiety would be differentially affected by feedback from more accurate rather than less accurate trials. The second purpose was to determine whether arousal variations (activation) would predict performance. On Day 1, participants performed a golf putting task under one of…

  20. Neurological surgery planning system

    NASA Astrophysics Data System (ADS)

    Jiang, Charlie Z. W.; Zamorano, Lucia J.; Kadi, A. Majeed

    1993-09-01

    The computer-assisted neurological surgery planning system (NSPS), developed by the Neurological Surgery Department, Wayne State University, Detroit, MI, is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions. Software consisting of the most advanced technologies in computer vision, computer graphics, and stereotactic numeric analysis forms the kernel of the system. Our paper discusses the functionalities and background theories used in NSPS.

  1. AMSD Test Plan

    NASA Technical Reports Server (NTRS)

    Stahl, H. Philip; Hadaway, James; Burdine, Robert (Technical Monitor)

    2001-01-01

    NASA MSFC is the lead center on the Advanced Mirror System Demonstrator (AMSD) project and therefore has responsibility for testing each AMSD mirror to certify its compliance with the SOW. To accomplish this task it is necessary to accurately characterize each mirror's Radius of Curvature, Optical Axis Vertex Location, Conic Constant and Surface Figure Error. A key challenge is how to measure these parameters in the presence of gravity sag. This presentation will outline the MSFC/UAH team's proposed AMSD test plan.

  2. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery.

    PubMed

    Nielsen, Lone V; Nielsen, Mette S; Schmidt, Julie B; Pedersen, Sue D; Sjödin, Anders

    2016-01-01

    A preoperative weight loss of 8 % is a prerequisite to undergo bariatric surgery (BS) in Denmark. The aim of the present study was to evaluate the efficacy of a 7- or an 11-week low-energy diet (LCD) for achieving preoperative target weight before BS. A total of thirty obese patients (BMI 46·0 (sd 4·4) kg/m(2)) followed an LCD (Cambridge Weight Plan(®), 4184 kJ/d (1000 kcal/d)) for 7 or 11 weeks as preparation for BS. Anthropometric measurements including body composition (dual-energy X-ray absorptiometry), blood parameters and blood pressure were assessed at weeks 0, 7 and 11. At week 7, the majority of patients (77 %) had reached their target weight, and this was achieved after 5·4 (sem 0·3) weeks. Mean weight loss was 9·3 (sem 0·5) % (P < 0·01) and consisted of 41·6 % fat-free mass (FFM) and 58·4 % fat mass. The weight loss was accompanied by a decrease in systolic and diastolic blood pressure (7·1 (sem 2·3) and 7·3 (sem 1·8) mmHg, respectively, all P < 0·01) as well as an improved metabolic profile (8·2 (sem 1·8) % decrease in fasting glucose (P < 0·01), 28·6 (sem 6·4) % decrease in fasting insulin (P < 0·01), 23·1 (sem 2·2) % decrease in LDL (P < 0·01), and 9·7 (sem 4·7) % decrease in TAG (P < 0·05)). Weight, FFM and fat mass continued to decrease from week 7 to 11 (all P < 0·01), whereas no additional improvements was observed in the metabolic parameters. Severely obese patients can safely achieve preoperative target weight on an LCD within 7 weeks as part of preparation for BS. However, the considerable reduction in FFM in severely obese subjects needs further investigation.

  3. Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases.

    PubMed

    D'Elia, F; Zingarelli, A; Palli, D; Grani, M

    2000-01-01

    The aim of this study was to evaluate the accuracy of dynamic CT in the preoperative staging of gastric cancer. One hundred seven patients affected by gastric cancer diagnosed by endoscopic biopsy were prospectively staged by dynamic CT prior to tumor resection. After an oral intake of 400-600 ml of tap water and an intravenous infusion of a hypotonic agent, 200 ml of non-ionic contrast agent were administered by power injector using a biphasic technique. The CT findings were prospectively analyzed and correlated with the pathological findings at surgery. The accuracy of dynamic CT for tumor detection was 80 and 99% in early and advanced gastric cancer, respectively, with overall detection rate of 96% (103 of 107). Three early (pT1) and one advanced (pT2) cancers were undetected. Tumor stage as determined by dynamic CT agreed with pathological findings in 83 of 107 patients with an overall accuracy of 78%. The accuracy of CT in detecting increasing degrees of depth of tumor invasion when compared with pathological TNM staging was 20% (3 of 15) and 87% (80 of 92) in early and advanced cancer, respectively. The sensitivity, specificity, and accuracy of CT in the preoperative staging (pT3-pT4 vs pT1-pT2) was 93, 90, and 91.6%, respectively. The sensitivity, specificity, and accuracy of CT in assessing metastasis to regional lymph nodes was 97.2, 65.7, and 87%, respectively. Computed tomography correctly staged liver metastases in 105 of 107 patients with an overall sensitivity of 87.5% and specificity of 99 %. The sensitivity of peritoneal involvement was 30% when ascites or peritoneal nodules were absent. Our findings show that dynamic CTcan play a role in the preoperative definition of gastric cancer stage. The results can be used to optimize the therapeutic strategy for each individual patient prior to surgery, thus avoiding unnecessary intervention and allowing careful planning of extended surgery in eligible patients.

  4. Accurate Guitar Tuning by Cochlear Implant Musicians

    PubMed Central

    Lu, Thomas; Huang, Juan; Zeng, Fan-Gang

    2014-01-01

    Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task. PMID:24651081

  5. New model accurately predicts reformate composition

    SciTech Connect

    Ancheyta-Juarez, J.; Aguilar-Rodriguez, E. )

    1994-01-31

    Although naphtha reforming is a well-known process, the evolution of catalyst formulation, as well as new trends in gasoline specifications, have led to rapid evolution of the process, including: reactor design, regeneration mode, and operating conditions. Mathematical modeling of the reforming process is an increasingly important tool. It is fundamental to the proper design of new reactors and revamp of existing ones. Modeling can be used to optimize operating conditions, analyze the effects of process variables, and enhance unit performance. Instituto Mexicano del Petroleo has developed a model of the catalytic reforming process that accurately predicts reformate composition at the higher-severity conditions at which new reformers are being designed. The new AA model is more accurate than previous proposals because it takes into account the effects of temperature and pressure on the rate constants of each chemical reaction.

  6. Accurate colorimetric feedback for RGB LED clusters

    NASA Astrophysics Data System (ADS)

    Man, Kwong; Ashdown, Ian

    2006-08-01

    We present an empirical model of LED emission spectra that is applicable to both InGaN and AlInGaP high-flux LEDs, and which accurately predicts their relative spectral power distributions over a wide range of LED junction temperatures. We further demonstrate with laboratory measurements that changes in LED spectral power distribution with temperature can be accurately predicted with first- or second-order equations. This provides the basis for a real-time colorimetric feedback system for RGB LED clusters that can maintain the chromaticity of white light at constant intensity to within +/-0.003 Δuv over a range of 45 degrees Celsius, and to within 0.01 Δuv when dimmed over an intensity range of 10:1.

  7. Accurate guitar tuning by cochlear implant musicians.

    PubMed

    Lu, Thomas; Huang, Juan; Zeng, Fan-Gang

    2014-01-01

    Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼ 30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task.

  8. An Accurate, Simplified Model Intrabeam Scattering

    SciTech Connect

    Bane, Karl LF

    2002-05-23

    Beginning with the general Bjorken-Mtingwa solution for intrabeam scattering (IBS) we derive an accurate, greatly simplified model of IBS, valid for high energy beams in normal storage ring lattices. In addition, we show that, under the same conditions, a modified version of Piwinski's IBS formulation (where {eta}{sub x,y}{sup 2}/{beta}{sub x,y} has been replaced by {Eta}{sub x,y}) asymptotically approaches the result of Bjorken-Mtingwa.

  9. An accurate registration technique for distorted images

    NASA Technical Reports Server (NTRS)

    Delapena, Michele; Shaw, Richard A.; Linde, Peter; Dravins, Dainis

    1990-01-01

    Accurate registration of International Ultraviolet Explorer (IUE) images is crucial because the variability of the geometrical distortions that are introduced by the SEC-Vidicon cameras ensures that raw science images are never perfectly aligned with the Intensity Transfer Functions (ITFs) (i.e., graded floodlamp exposures that are used to linearize and normalize the camera response). A technique for precisely registering IUE images which uses a cross correlation of the fixed pattern that exists in all raw IUE images is described.

  10. Phase II Study of Preoperative Concurrent Chemoradiation Therapy With S-1 in Patients With T4 Oral Squamous Cell Carcinoma

    SciTech Connect

    Nomura, Tomoko; Murakami, Ryuji; Toya, Ryo; Teshima, Keiko; Nakahara, Aya; Hirai, Toshinori; Hiraki, Akimitsu; Nakayama, Hideki; Yoshitake, Yoshihiro; Ota, Kazutoshi; Obayashi, Takehisa; Yamashita, Yasuyuki; Oya, Natsuo; Shinohara, Masanori

    2010-04-15

    Purpose: To determine the feasibility and efficacy of preoperative concurrent chemoradiation therapy (CCRT) with S-1, an oral fluoropyrimidine derivative, in patients with T4 oral squamous cell carcinoma (SCC). Methods and Materials: Only patients with histologically proven T4 oral SCC were included. Radiotherapy (total dose, 30 Gy) was delivered in 2-Gy daily fractions over a period of 3 weeks. Concurrently, S-1 (80 mg/m{sup 2}/day) was administered orally twice daily for 14 consecutive days. Results: We enrolled 46 patients. All underwent radiotherapy as planned; however, oral S-1 was discontinued in 3 patients who manifested acute toxicity. Grade 3 toxicities were mucositis (20%), anorexia (9%), and neutropenia (4%). We encountered no Grade 4 adverse events or serious postoperative morbidity requiring surgical intervention. After CCRT, 32 of the 46 patients underwent radical resection; in 17 (53%) of the operated patients, the pathologic response was complete. During follow-up ranging from 7 to 58 months (median, 22 months), tumor control failed in 5 (16%) of the 32 operated patients; there were 3 local and 2 regional failures. Of the 14 non-operated patients, 8 (57%) manifested local (n = 7) or regional failure (n = 1). The 3-year overall survival rate for all 46 patients was 69%; it was significantly higher for operated than for non-operated patients (82% vs. 48%; p = 0.0288). Conclusion: Preoperative CCRT with S-1 is feasible and effective in patients with T4 oral SCC. Even in inoperable cases, CCRT with S-1 provides adequate tumor control.

  11. Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered

    SciTech Connect

    Nijkamp, Jasper; Kusters, Miranda; Beets-Tan, Regina G.H.; Martijn, Hendrik; Beets, Geerard L.; Velde, Cornelis J.H. van de; Marijnen, Corrie A.M.

    2011-05-01

    Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients. Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT). Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3 interspace, over 60% reduction in absolute small bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added. Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and late toxicity can be expected.

  12. High Frequency QRS ECG Accurately Detects Cardiomyopathy

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Arenare, Brian; Poulin, Gregory; Moser, Daniel R.; Delgado, Reynolds

    2005-01-01

    High frequency (HF, 150-250 Hz) analysis over the entire QRS interval of the ECG is more sensitive than conventional ECG for detecting myocardial ischemia. However, the accuracy of HF QRS ECG for detecting cardiomyopathy is unknown. We obtained simultaneous resting conventional and HF QRS 12-lead ECGs in 66 patients with cardiomyopathy (EF = 23.2 plus or minus 6.l%, mean plus or minus SD) and in 66 age- and gender-matched healthy controls using PC-based ECG software recently developed at NASA. The single most accurate ECG parameter for detecting cardiomyopathy was an HF QRS morphological score that takes into consideration the total number and severity of reduced amplitude zones (RAZs) present plus the clustering of RAZs together in contiguous leads. This RAZ score had an area under the receiver operator curve (ROC) of 0.91, and was 88% sensitive, 82% specific and 85% accurate for identifying cardiomyopathy at optimum score cut-off of 140 points. Although conventional ECG parameters such as the QRS and QTc intervals were also significantly longer in patients than controls (P less than 0.001, BBBs excluded), these conventional parameters were less accurate (area under the ROC = 0.77 and 0.77, respectively) than HF QRS morphological parameters for identifying underlying cardiomyopathy. The total amplitude of the HF QRS complexes, as measured by summed root mean square voltages (RMSVs), also differed between patients and controls (33.8 plus or minus 11.5 vs. 41.5 plus or minus 13.6 mV, respectively, P less than 0.003), but this parameter was even less accurate in distinguishing the two groups (area under ROC = 0.67) than the HF QRS morphologic and conventional ECG parameters. Diagnostic accuracy was optimal (86%) when the RAZ score from the HF QRS ECG and the QTc interval from the conventional ECG were used simultaneously with cut-offs of greater than or equal to 40 points and greater than or equal to 445 ms, respectively. In conclusion 12-lead HF QRS ECG employing

  13. Elevated preoperative plasma D-dimer levels and the incidence of venous thromboembolism in Japanese females with gynecological cancer.

    PubMed

    Kodama, Junichi; Seki, Noriko; Fukushima, Chikako; Kusumoto, Tomoyuki; Nakamura, Keiichiro; Hongo, Atsushi; Hiramatsu, Yuji

    2013-01-01

    The purpose of the present study was to determine the incidence of increased levels of D-dimer and associated factors in preoperative patients with gynecological cancer. Furthermore, we determined the incidence and risk factors associated with preoperative venous thromboembolism (VTE). Overall, 456 patients with invasive gynecological cancer scheduled to undergo surgery were recruited. Preoperative plasma D-dimer levels were measured and patients whose plasma D-dimer concentration exceeded the pre-set cut-off value underwent computed tomography scanning. The incidence of elevated D-dimer and VTE was identified as significantly higher in patients with ovarian cancer. Multivariate analysis revealed that advanced age, low hemoglobin levels and elevated C-reactive protein (CRP) levels were independent factors for preoperative elevations in plasma D-dimer levels. Advanced age was an independent risk factor for preoperative VTE. Massive ascites and the presence of co-morbidities were independent risk factors for preoperative VTE in ovarian cancer. Advanced age and stage were independent risk factors for preoperative VTE in endometrial cancer. Advanced age was an independent risk factor for preoperative VTE in cervical cancer. Plasma D-dimer levels and the incidence of preoperative VTE were higher in patients with ovarian cancer compared with those with other gynecological cancers. Advanced age, low hemoglobin levels and elevated CRP levels were significant factors associated with elevated plasma D-dimer levels and age was an independent risk factor for preoperative VTE in gynecological cancer.

  14. Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients

    PubMed Central

    Lee, Jong-Hyuk; Jung, Han-Kil; Lee, Gang-geun; Kim, Han-Young; Park, Sun-Gyoo

    2013-01-01

    Background Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used. Methods A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room. Results In all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 ± 11.8 vs 41.0 ± 7.0, S group 59.2 ± 17.6 vs 36.4 ± 7.3, SM group 58.3 ± 17.5 vs 26.0 ± 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01). Conclusions The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety. PMID:24427456

  15. An audit of preoperative fasting compliance at a major tertiary referral hospital in Singapore

    PubMed Central

    Lim, Hsien Jer; Lee, Hanjing; Ti, Lian Kah

    2014-01-01

    INTRODUCTION To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients’ knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting. METHODS Patients scheduled for ‘day surgery’ or ‘same day admission surgery’ under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting. RESULTS A total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status. CONCLUSION Despite the patients’ poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance. PMID:24452973

  16. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    SciTech Connect

    Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian; Deville, Curtiland; Guadagnolo, B. Ashleigh; O'Sullivan, Brian; Petersen, Ivy A.; Le Pechoux, Cecile; Abrams, Ross A.; DeLaney, Thomas F.

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  17. Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

    PubMed Central

    Louw, Adriaan; Butler, David S.; Diener, Ina; Puentedura, Emilio J.

    2012-01-01

    Background We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Results Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings. PMID:25694882

  18. Accurate upwind methods for the Euler equations

    NASA Technical Reports Server (NTRS)

    Huynh, Hung T.

    1993-01-01

    A new class of piecewise linear methods for the numerical solution of the one-dimensional Euler equations of gas dynamics is presented. These methods are uniformly second-order accurate, and can be considered as extensions of Godunov's scheme. With an appropriate definition of monotonicity preservation for the case of linear convection, it can be shown that they preserve monotonicity. Similar to Van Leer's MUSCL scheme, they consist of two key steps: a reconstruction step followed by an upwind step. For the reconstruction step, a monotonicity constraint that preserves uniform second-order accuracy is introduced. Computational efficiency is enhanced by devising a criterion that detects the 'smooth' part of the data where the constraint is redundant. The concept and coding of the constraint are simplified by the use of the median function. A slope steepening technique, which has no effect at smooth regions and can resolve a contact discontinuity in four cells, is described. As for the upwind step, existing and new methods are applied in a manner slightly different from those in the literature. These methods are derived by approximating the Euler equations via linearization and diagonalization. At a 'smooth' interface, Harten, Lax, and Van Leer's one intermediate state model is employed. A modification for this model that can resolve contact discontinuities is presented. Near a discontinuity, either this modified model or a more accurate one, namely, Roe's flux-difference splitting. is used. The current presentation of Roe's method, via the conceptually simple flux-vector splitting, not only establishes a connection between the two splittings, but also leads to an admissibility correction with no conditional statement, and an efficient approximation to Osher's approximate Riemann solver. These reconstruction and upwind steps result in schemes that are uniformly second-order accurate and economical at smooth regions, and yield high resolution at discontinuities.

  19. Accurate measurement of unsteady state fluid temperature

    NASA Astrophysics Data System (ADS)

    Jaremkiewicz, Magdalena

    2017-03-01

    In this paper, two accurate methods for determining the transient fluid temperature were presented. Measurements were conducted for boiling water since its temperature is known. At the beginning the thermometers are at the ambient temperature and next they are immediately immersed into saturated water. The measurements were carried out with two thermometers of different construction but with the same housing outer diameter equal to 15 mm. One of them is a K-type industrial thermometer widely available commercially. The temperature indicated by the thermometer was corrected considering the thermometers as the first or second order inertia devices. The new design of a thermometer was proposed and also used to measure the temperature of boiling water. Its characteristic feature is a cylinder-shaped housing with the sheath thermocouple located in its center. The temperature of the fluid was determined based on measurements taken in the axis of the solid cylindrical element (housing) using the inverse space marching method. Measurements of the transient temperature of the air flowing through the wind tunnel using the same thermometers were also carried out. The proposed measurement technique provides more accurate results compared with measurements using industrial thermometers in conjunction with simple temperature correction using the inertial thermometer model of the first or second order. By comparing the results, it was demonstrated that the new thermometer allows obtaining the fluid temperature much faster and with higher accuracy in comparison to the industrial thermometer. Accurate measurements of the fast changing fluid temperature are possible due to the low inertia thermometer and fast space marching method applied for solving the inverse heat conduction problem.

  20. The first accurate description of an aurora

    NASA Astrophysics Data System (ADS)

    Schröder, Wilfried

    2006-12-01

    As technology has advanced, the scientific study of auroral phenomena has increased by leaps and bounds. A look back at the earliest descriptions of aurorae offers an interesting look into how medieval scholars viewed the subjects that we study.Although there are earlier fragmentary references in the literature, the first accurate description of the aurora borealis appears to be that published by the German Catholic scholar Konrad von Megenberg (1309-1374) in his book Das Buch der Natur (The Book of Nature). The book was written between 1349 and 1350.

  1. Determining accurate distances to nearby galaxies

    NASA Astrophysics Data System (ADS)

    Bonanos, Alceste Zoe

    2005-11-01

    Determining accurate distances to nearby or distant galaxies is a very simple conceptually, yet complicated in practice, task. Presently, distances to nearby galaxies are only known to an accuracy of 10-15%. The current anchor galaxy of the extragalactic distance scale is the Large Magellanic Cloud, which has large (10-15%) systematic uncertainties associated with it, because of its morphology, its non-uniform reddening and the unknown metallicity dependence of the Cepheid period-luminosity relation. This work aims to determine accurate distances to some nearby galaxies, and subsequently help reduce the error in the extragalactic distance scale and the Hubble constant H 0 . In particular, this work presents the first distance determination of the DIRECT Project to M33 with detached eclipsing binaries. DIRECT aims to obtain a new anchor galaxy for the extragalactic distance scale by measuring direct, accurate (to 5%) distances to two Local Group galaxies, M31 and M33, with detached eclipsing binaries. It involves a massive variability survey of these galaxies and subsequent photometric and spectroscopic follow-up of the detached binaries discovered. In this work, I also present a catalog of variable stars discovered in one of the DIRECT fields, M31Y, which includes 41 eclipsing binaries. Additionally, we derive the distance to the Draco Dwarf Spheroidal galaxy, with ~100 RR Lyrae found in our first CCD variability study of this galaxy. A "hybrid" method of discovering Cepheids with ground-based telescopes is described next. It involves applying the image subtraction technique on the images obtained from ground-based telescopes and then following them up with the Hubble Space Telescope to derive Cepheid period-luminosity distances. By re-analyzing ESO Very Large Telescope data on M83 (NGC 5236), we demonstrate that this method is much more powerful for detecting variability, especially in crowded fields. I finally present photometry for the Wolf-Rayet binary WR 20a

  2. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery.

    PubMed

    Mavili, Mehmet Emin; Canter, Halil Ibrahim; Saglam-Aydinatay, Banu; Kamaci, Soner; Kocadereli, Ilken

    2007-07-01

    Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were evaluated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative modelsand in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in

  3. Impact of preoperative chronic renal failure on liver transplantation: a population-based cohort study

    PubMed Central

    Chung, Peter Chi-Ho; Chen, Hsiu-Pin; Lin, Jr-Rung; Liu, Fu-Chao; Yu, Huang-Ping

    2016-01-01

    Purpose The purpose of this study was to assess whether preoperative chronic renal failure (CRF) affects the rates of postoperative complications and survival after liver transplantation. Methods This population-based retrospective cohort study included 2,931 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. Patients were divided into two groups, based on the presence or absence of preoperative CRF. Results The overall estimated survival rate of liver transplantation recipients (LTRs) with preoperative CRF was significantly lower than that of patients without preoperative CRF (P=0.0085). There was no significant difference between the groups in terms of duration of intensive care unit stay, total hospital stay, bacteremia, postoperative bleeding, and pneumonia during hospitalization. Long-term adverse effects, including cerebrovascular disease and coronary heart disease, were not different between patients with versus without CRF. Conclusion These findings suggest that LTRs with preoperative CRF have a higher rate of mortality. PMID:28008264

  4. Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement

    PubMed Central

    Czyżewska, Anna; Walesiak, Katarzyna; Krawczak, Karolina; Cabaj, Dominika; Górecki, Andrzej

    2014-01-01

    Introduction The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not. Material and methods Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery. Results Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05). Conclusions Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery. PMID:25395951

  5. Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

    SciTech Connect

    Reed, Valerie K.; Krishnan, Sunil; Mansfield, Paul F.; Bhosale, Priya R.; Kim, Michelle; Das, Prajnan; Janjan, Nora A.; Delclos, Marc E.; Lowy, Andrew M.; Feig, Barry W.; Pisters, Peter W.T.; Ajani, Jaffer A.; Crane, Christopher H.

    2008-07-01

    Purpose: To retrospectively determine the incidence and patterns (in-field, marginal, or out-of-field) of locoregional gastric cancer recurrence in patients who received preoperative chemoradiotherapy and to determine the outcome in these patients. Methods and Materials: Between 1994 and 2004, 149 patients with gastric carcinoma were treated according to institutional protocols with preoperative chemoradiotherapy. Ultimately, 105 patients had an R0 resection. Of these 105 patients, 65 received preoperative chemotherapy followed by chemoradiotherapy and 40 received preoperative chemoradiotherapy. Most (96%) of these patients received 5-fluorouracil-based chemotherapy during radiotherapy, and the median radiation dose was 45 Gy. We retrospectively identified and classified the patterns of locoregional recurrence. Results: The 3-year actuarial incidence of locoregional recurrence was 13%, with locoregional disease recurring as any part of the failure pattern in 14 patients. Most (64%) of the evaluable locoregional recurrences were in-field. Of the 4 patients with a marginal recurrence, 2 had had inadequate coverage of the regional nodal volumes on their oblique fields. The pathologic complete response rate was 23%. A pathologic complete response was the only statistically significant predictor of locoregional control. Conclusion: Patients with gastric cancer who received preoperative chemoradiotherapy had low rates of locoregional recurrence. This strategy merits prospective multi-institutional and randomized evaluation.

  6. Preoperative Expectations and Postoperative Outcomes of Visual Functioning among Cataract Patients in Urban Southern China

    PubMed Central

    Qu, Bo; Gao, Wuyou; Zuo, Yajing; Peng, Wenyan; Jin, Ling; Yu, Minbin; Lamoureux, Ecosse

    2017-01-01

    Purpose To investigate the relationship between preoperative expectations and actual postoperative outcomes of visual function (VF) among patients undergoing first eye cataract surgery. Methods A longitudinal study of 182 patients from hospitals in urban Southern China were surveyed prior to surgery and 3 month after cataract surgery regarding their preoperative, expected postoperative and actual postoperative VF for each of the items on the Catquest-9SF and their satisfaction with cataract surgery. In addition, detailed clinical data were collected preoperatively and postoperatively. Results The majority of cataract patients in urban Southern China had high expectations for VF outcomes after cataract surgery and in most cases postoperative outcomes achieved the expected level of improvement. The mean (standard deviation, SD) preoperative Catquest-9SF score was 15.7 (5.86) and the mean (SD) expected postoperative score was 26.3 (2.93). The discrepancy between actual and expected improvement was significantly correlated with patients’ health literacy, presence of systemic and ocular comorbidity, preoperative visual acuity of the surgery eye, LOCS III nuclear opalescence and cortical cataract grading. Conclusion Cataract patients in urban Southern China had high expectations for surgery outcomes. Patients with low level of health literacy and the presence of systemic and ocular comorbidity may need a comprehensive counseling to decrease the discrepancy regarding expected and actual outcomes. PMID:28068402

  7. Music listening for anxiety relief in children in the preoperative period: a randomized clinical trial 1

    PubMed Central

    Franzoi, Mariana André Honorato; Goulart, Cristina Bretas; Lara, Elizabete Oliveira; Martins, Gisele

    2016-01-01

    ABSTRACT Objective: to investigate the effects of music listening, for 15 minutes, on the preoperative anxiety levels in children undergoing elective surgery in comparison with conventional pediatric surgical care. Method: randomized controlled clinical trial pilot study with 52 children in the preoperative period, aged 3 to 12 years, undergoing elective surgery and randomly allocated in the experimental group (n = 26) and control group (n = 26). Anxiety was assessed in both groups by the application of the modified Yale Preoperative Anxiety Scale and measurement of the physiological variables, upon arrival and 15 minutes after the first measurement. Results: there was a statistically significant difference in preoperative anxiety between the two groups only in relation to the physiological variable, since the respiratory rate of preschool children in the experimental group reduced in the second measurement compared to the control group (p = 0.0453). The experimental group showed a statistically significant reduction in anxiety levels after 15 minutes of music listening (p = 0.0441), specifically with regard to the behavioral domains of activity, vocalization, emotional expression and apparent awakening state. Conclusion: music listening emerges as a potential nursing intervention for relief of preoperative anxiety in children undergoing surgical procedures. RBR-7mcr59. PMID:27992027

  8. Management of Rectal Cancer: Short- vs. Long-Course Preoperative Radiation

    SciTech Connect

    Mohiuddin, Mohammed Marks, John; Marks, Gerald

    2008-11-01

    There is considerable debate on the optimum approach to neoadjuvant therapy in rectal cancer. This review of major published studies of short-course preoperative radiation and the more conventional approach of long-course neoadjuvant chemoradiation was undertaken in an effort to understand the potential advantages and disadvantages of each of these approaches. Studies were evaluated with regard to patient selection, clinical outcomes, and toxicities. Short-course preoperative radiation has shown a clear advantage over surgery alone in reducing local recurrence rates and improving survival of patients with rectal cancer. However, studies using short-course preoperative treatment have included a significant number of early (30%; Stage I/II) and more proximal cancers yet appear to have higher positive margin rates, higher abdominoperineal resection rates, and lower aggregate survival than patients treated with long-course neoadjuvant chemoradiation. Although long-course preoperative chemoradiation is associated with higher rates of reversible acute toxicity, there appears to be more significant and a higher rate of late gastrointestinal toxicity observed in short-course preoperative radiation studies. Patient convenience and lower cost of treatment, however, can be a significant advantage in using a short-course treatment schedule. Selective utilization of either of these approaches should be based on extent of disease and goals of treatment. Patients with distal cancers or more advanced disease (T3/T4) appear to have better outcomes with neoadjuvant chemoradiation, especially where downstaging of disease is critical for more complete surgical resection and sphincter preservation.

  9. Right ventricular failure after left ventricular assist device insertion: preoperative risk factors.

    PubMed

    Santambrogio, Luisa; Bianchi, Tiziana; Fuardo, Marinella; Gazzoli, Fabrizio; Veronesi, Roberto; Braschi, Antonio; Maurelli, Marco

    2006-08-01

    Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart Corp., Ottawa, ON, Canada). We compared the data from the patients who developed right ventricular failure and the patients who did not. Right ventricular failure occurred in 16% of the patients. There was no significant difference between the groups in demographic characteristics. We identified as preoperative risk factors the pre-operative low mean pulmonary artery and the impairment of hepatic and renal function on laboratory data. Our results confirm in part the findings of the few previous studies. This information may be useful for the patient selection for isolated left ventricular assist device implantation, but other studies are necessary before establishing criteria for patient selection for univentricular support universally accepted.

  10. Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis

    PubMed Central

    Park, Hyeong Min; Cho, Chol Kyoon; Koh, Yang Seok; Kim, Hee Joon; Park, Eun Kyu

    2016-01-01

    Backgrounds/Aims Despite hepatolithiasis being a risk factor for biliary neoplasm including cholangiocarcinoma, the incidence of underlying biliary neoplasm is unknown in patients with preoperative benign hepatolithiasis. The aim of this study was to evaluate the incidence of underlying biliary neoplasm in patients who underwent major hepatectomy for preoperative benign hepatolithiasis. Methods Between March 2005 and December 2015, 73 patients who underwent major hepatectomy for preoperative benign hepatolithiasis were enrolled in this study. The incidence and pathological differentiation of concomitant biliary neoplasm were retrospectively determined by review of medical records. Postoperative complications after major hepatectomy were evaluated. Results Concomitant biliary neoplasm was pathologically confirmed in 20 patients (27.4%). Biliary intraepithelial neoplasia (BIN) was detected in 12 patients (16.4%), and 1 patient (1.4%) had intraductal papillary mucinous neoplasm (IPMN), as the premalignant lesion. Cholangiocarcinoma was pathologically confirmed in 7 patients (9.6%). Preoperative imaging of the 73 patients revealed biliary stricture at the first branch of bile duct in 31 patients (42.5%), and at the second branch of bile duct in 39 patients (53.4%). Postoperative complications developed in 14 patients (19.1%). Almost all patients recovered from complications, including intra-abdominal abscess (9.6%), bile leakage (4.1%), pleural effusion (2.7%), and wound infection (1.4%). Only 1 patient (1.4%) died from aspiration pneumonia. Conclusions The incidence of underlying biliary neoplasm was not negligible in the patients with hepatolithiasis, despite meticulous preoperative evaluations. PMID:28261696

  11. Effect of Anaesthesia Method on Preoperative Anxiety Level in Elective Caesarean Section Surgeries

    PubMed Central

    Akildiz, Mahmut; Aksoy, Yakup; Kaydu, Ayhan; Kaçar, Cem Kıvılcım; Şahin, Ömer Fatih; Yıldırım, Zeynep Baysal

    2017-01-01

    Objective In this study, the effect of the anaesthesia method on preoperative anxiety in parturients scheduled to undergo elective caesarean surgery was investigated. Methods After Dicle University Ethics Committee approval, 100 American Society of Anesthesiologists (ASA) II parturients, aged between 18 and 45 years, were included in this study from 2011 to 2012 at the Dicle University Faculty of Medicine, Department of Anaesthesiology. The parturients were divided into two groups, with 50 patients in each group: general anaesthesia (GA) and spinal anaesthesia (SA). Patients were evaluated during the preoperative visit. Demographic data and STAI TX-1 form to measure preoperative anxiety were recorded. Results There were no significant differences between the two groups in maternal age, gestational age, level of education and number of children (p>0.05). The average anxiety score was significantly higher in the SA group than in the GA group (p<0.05). Conclusion In conclusion, spinal anaesthesia is associated with a higher preoperative anxiety level than general anaesthesia in obstetric patients. Therefore, it is necessary to take prevention against preoperative anxiety for the patients undergoing caesarean section surgeries under spinal anaesthesia. PMID:28377838

  12. Minimum graft size calculated from preoperative recipient status in living donor liver transplantation.

    PubMed

    Marubashi, Shigeru; Nagano, Hiroaki; Eguchi, Hidetoshi; Wada, Hiroshi; Asaoka, Tadafumi; Tomimaru, Yoshito; Tomokuni, Akira; Umeshita, Koji; Doki, Yuichiro; Mori, Masaki

    2016-05-01

    Small-for-size graft syndrome is an inevitable complication in living donor liver transplantation (LDLT). We hypothesized that graft weight (GW) measured after graft procurement is one of the variables predicting postoperative graft function. A total of 138 consecutive recipients of adult-to-adult LDLT between March 1999 and October 2014 were included in this study. We investigated the factors associated with small-for-size-associated graft loss (SAGL) to determine the GW required for each patient. Both preoperatively assessed and postoperatively obtained risk factors for SAGL were analyzed in univariate and multivariate logistic regression analysis. Twelve (8.8%) of the transplant recipients had SAGL. In multivariate logistic regression analyses using preoperatively assessed variables, the preoperative Model for End-Stage Liver Disease (MELD) score (P < 0.001) and actual GW/recipient standard liver volume (SLV) ratio (P = 0.008) were independent predictors of SAGL. The recommended graft volume by preoperative computed tomography volumetry was calculated as SLV × (1.616 × MELD + 0.344)/100/0.85 (mL) [MELD ≥ 18.2], or SLV × 0.35 (mL) [MELD < 18.2]. The required allograft volume in LDLT can be determined by the preoperative MELD score of the recipient, and patients with higher MELD scores require larger grafts or deceased donor whole liver transplant to avoid SAGL. Liver Transplantation 22 599-606 2016 AASLD.

  13. Interictal Epileptiform Discharge Effects on Neuropsychological Assessment and Epilepsy Surgical Planning

    PubMed Central

    Drane, Daniel L.; Ojemann, Jeffrey G.; Kim, Michelle S.; Gross, Robert E.; Miller, John W.; Faught, R. Edward; Loring, David W.

    2016-01-01

    Both animal and human research suggests interictal epileptiform discharges (IEDs) may affect cognition, although the significance of such findings remains controversial. We review a wide range of literature with bearing on this topic, and present relevant epilepsy surgery cases, which suggest the effects of IEDs may be substantial and informative for surgical planning. In the first case, we present an epilepsy patient with left anterior temporal lobe (TL) seizure onset who experienced frequent IEDs during preoperative neuropsychological assessment. Cognitive results strongly lateralized to the left TL. Because the patient failed performance validity tests and appeared amnestic for verbal materials inconsistent with his work history, selected neuropsychological tests were repeated 6 weeks later. Scores improved one to two standard deviations over the initial evaluation, and because of this improvement, were only mildly suggestive of left TL impairment. The second case involves another patient with documented left TL epilepsy who experienced epileptiform activity while undergoing neurocognitive testing and simultaneous ambulatory EEG recording. This patient’s verbal memory performance was impaired during the period that IEDs were present but near normal when such activity was absent. Overall, although the presence of IEDs may be helpful in confirming laterality of seizure onset, frequent IEDs might disrupt focal cognitive functions, and distort accurate measurement of neuropsychological ability, interfering with accurate characterization of surgical risks and benefits. Such transient effects on daily performance may also contribute to significant functional compromise. We include a discussion of the manner in which IED effects during presurgical assessment can hinder individual patient presurgical planning as well as distort outcome research (e.g., IEDs occurring during presurgical assessment may lead to an underestimation of postoperative neuropsychological

  14. Accurate taxonomic assignment of short pyrosequencing reads.

    PubMed

    Clemente, José C; Jansson, Jesper; Valiente, Gabriel

    2010-01-01

    Ambiguities in the taxonomy dependent assignment of pyrosequencing reads are usually resolved by mapping each read to the lowest common ancestor in a reference taxonomy of all those sequences that match the read. This conservative approach has the drawback of mapping a read to a possibly large clade that may also contain many sequences not matching the read. A more accurate taxonomic assignment of short reads can be made by mapping each read to the node in the reference taxonomy that provides the best precision and recall. We show that given a suffix array for the sequences in the reference taxonomy, a short read can be mapped to the node of the reference taxonomy with the best combined value of precision and recall in time linear in the size of the taxonomy subtree rooted at the lowest common ancestor of the matching sequences. An accurate taxonomic assignment of short reads can thus be made with about the same efficiency as when mapping each read to the lowest common ancestor of all matching sequences in a reference taxonomy. We demonstrate the effectiveness of our approach on several metagenomic datasets of marine and gut microbiota.

  15. Accurate shear measurement with faint sources

    SciTech Connect

    Zhang, Jun; Foucaud, Sebastien; Luo, Wentao E-mail: walt@shao.ac.cn

    2015-01-01

    For cosmic shear to become an accurate cosmological probe, systematic errors in the shear measurement method must be unambiguously identified and corrected for. Previous work of this series has demonstrated that cosmic shears can be measured accurately in Fourier space in the presence of background noise and finite pixel size, without assumptions on the morphologies of galaxy and PSF. The remaining major source of error is source Poisson noise, due to the finiteness of source photon number. This problem is particularly important for faint galaxies in space-based weak lensing measurements, and for ground-based images of short exposure times. In this work, we propose a simple and rigorous way of removing the shear bias from the source Poisson noise. Our noise treatment can be generalized for images made of multiple exposures through MultiDrizzle. This is demonstrated with the SDSS and COSMOS/ACS data. With a large ensemble of mock galaxy images of unrestricted morphologies, we show that our shear measurement method can achieve sub-percent level accuracy even for images of signal-to-noise ratio less than 5 in general, making it the most promising technique for cosmic shear measurement in the ongoing and upcoming large scale galaxy surveys.

  16. Accurate pose estimation for forensic identification

    NASA Astrophysics Data System (ADS)

    Merckx, Gert; Hermans, Jeroen; Vandermeulen, Dirk

    2010-04-01

    In forensic authentication, one aims to identify the perpetrator among a series of suspects or distractors. A fundamental problem in any recognition system that aims for identification of subjects in a natural scene is the lack of constrains on viewing and imaging conditions. In forensic applications, identification proves even more challenging, since most surveillance footage is of abysmal quality. In this context, robust methods for pose estimation are paramount. In this paper we will therefore present a new pose estimation strategy for very low quality footage. Our approach uses 3D-2D registration of a textured 3D face model with the surveillance image to obtain accurate far field pose alignment. Starting from an inaccurate initial estimate, the technique uses novel similarity measures based on the monogenic signal to guide a pose optimization process. We will illustrate the descriptive strength of the introduced similarity measures by using them directly as a recognition metric. Through validation, using both real and synthetic surveillance footage, our pose estimation method is shown to be accurate, and robust to lighting changes and image degradation.

  17. Sparse and accurate high resolution SAR imaging

    NASA Astrophysics Data System (ADS)

    Vu, Duc; Zhao, Kexin; Rowe, William; Li, Jian

    2012-05-01

    We investigate the usage of an adaptive method, the Iterative Adaptive Approach (IAA), in combination with a maximum a posteriori (MAP) estimate to reconstruct high resolution SAR images that are both sparse and accurate. IAA is a nonparametric weighted least squares algorithm that is robust and user parameter-free. IAA has been shown to reconstruct SAR images with excellent side lobes suppression and high resolution enhancement. We first reconstruct the SAR images using IAA, and then we enforce sparsity by using MAP with a sparsity inducing prior. By coupling these two methods, we can produce a sparse and accurate high resolution image that are conducive for feature extractions and target classification applications. In addition, we show how IAA can be made computationally efficient without sacrificing accuracies, a desirable property for SAR applications where the size of the problems is quite large. We demonstrate the success of our approach using the Air Force Research Lab's "Gotcha Volumetric SAR Data Set Version 1.0" challenge dataset. Via the widely used FFT, individual vehicles contained in the scene are barely recognizable due to the poor resolution and high side lobe nature of FFT. However with our approach clear edges, boundaries, and textures of the vehicles are obtained.

  18. Accurate basis set truncation for wavefunction embedding

    NASA Astrophysics Data System (ADS)

    Barnes, Taylor A.; Goodpaster, Jason D.; Manby, Frederick R.; Miller, Thomas F.

    2013-07-01

    Density functional theory (DFT) provides a formally exact framework for performing embedded subsystem electronic structure calculations, including DFT-in-DFT and wavefunction theory-in-DFT descriptions. In the interest of efficiency, it is desirable to truncate the atomic orbital basis set in which the subsystem calculation is performed, thus avoiding high-order scaling with respect to the size of the MO virtual space. In this study, we extend a recently introduced projection-based embedding method [F. R. Manby, M. Stella, J. D. Goodpaster, and T. F. Miller III, J. Chem. Theory Comput. 8, 2564 (2012)], 10.1021/ct300544e to allow for the systematic and accurate truncation of the embedded subsystem basis set. The approach is applied to both covalently and non-covalently bound test cases, including water clusters and polypeptide chains, and it is demonstrated that errors associated with basis set truncation are controllable to well within chemical accuracy. Furthermore, we show that this approach allows for switching between accurate projection-based embedding and DFT embedding with approximate kinetic energy (KE) functionals; in this sense, the approach provides a means of systematically improving upon the use of approximate KE functionals in DFT embedding.

  19. TWRS phase I privatization site environmental baseline and characterization plan

    SciTech Connect

    Shade, J.W.

    1997-09-01

    This document provides a plan to characterize and develop an environmental baseline for the TWRS Phase I Privatization Site before construction begins. A site evaluation study selected the former Grout Disposal Area of the Grout Treatment Facility in the 200 East Area as the TWRS Phase I Demonstration Site. The site is generally clean and has not been used for previous activities other than the GTF. A DQO process was used to develop a Sampling and Analysis Plan that would allow comparison of site conditions during operations and after Phase I ends to the presently existing conditions and provide data for the development of a preoperational monitoring plan.

  20. Fire Plans

    ERIC Educational Resources Information Center

    Power, June

    2011-01-01

    Many libraries have disaster recovery plans, but not all have prevention and action plans to prepare for an emergency in advance. This article presents the author's review of the prevention and action plans of several libraries: (1) Evergreen State College; (2) Interlochen Public Library; (3) University of Maryland, Baltimore-Marshall Law Library;…

  1. Planning Handbook.

    ERIC Educational Resources Information Center

    Paddock, Susan C.; Mercure, Nancy

    This handbook was designed to assist advisory councils, program staff and administrators, and community members in planning community education programs and in managing those programs effectively. Chapter I defines and describes planning: what it is, why it is used, and how to engage in the process. The critical role of planning leaders is…

  2. Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty.

    PubMed

    Barbay, Kathryn

    2009-01-01

    Preoperative exercise/rehabilitation is currently being considered to improve outcomes for orthopaedic surgery. This article presents an evidence-based practice review of the current research literature from 1998 to 2008 to determine whether preoperative exercise alone will be beneficial to patients preparing for total knee or hip arthroplasty. Only 3 studies met the inclusion criteria of preoperative exercise as the sole intervention. Each of these studies indicated that preoperative exercise had some postoperative benefit to total knee or hip arthroplasty patients. In general, the results are inconclusive due to the lack of strong research evidence, and only a pragmatic recommendation for preoperative exercise prior to total hip or knee arthroplasty is supported. More research is needed in the area of preoperative exercise for persons preparing for total hip or knee arthroplasty.

  3. Preoperative Nutritional Assessment in Elderly Cancer Patients Undergoing Elective Surgery: MNA or PG-SGA?

    PubMed

    Dubhashi, S P; Kayal, Akshat

    2015-12-01

    This study aims to evaluate and compare the use of patient-generated subjective global assessment (PG-SGA) and mini nutritional assessment (MNA) as a preoperative nutritional assessment tool in elderly cancer patients. This was a prospective study carried out on 47 patients, 45 years and above suffering from cancer and admitted to Padmashree Dr. D.Y. Patil Medical College and Hospital, Pune. The patients were evaluated with PG-SGA and MNA tools at the time of admission and baseline data were collected. All patients had undergone surgeries as per indications. Postoperatively, the surgical outcomes and adverse events were noted and statistically evaluated. The average age of the study sample was 61.46 years and 29 patients were females. The patients classified by PG-SGA were ten in group A and 37 in group B and C. The patients classified by MNA were five in no risk group and 42 in group with patients at risk and malnourished. When evaluated with PG-SGA in group B and C, wound infections and requirement of change of antibiotic were seen in 86.4 % patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 14.2 days and their average duration of stay was 29 days. On the other hand, the evaluation of patients with MNA, at risk and malnourished patients, wound infections, and requirement of change of antibiotic were seen in 81 % of patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 13.8 days and their average duration of stay was 27 days. The results were statistically significant. The mini nutritional assessment is more exhaustive in identifying patients at risk and is useful in screening populations to identify frail elderly persons allowing us to intervene earlier, thereby improving the patient prognosis. The patient-generated subjective global assessment is a more comprehensive tool for elderly cancer

  4. A survey among Brazilian thoracic surgeons about the use of preoperative 2D and 3D images

    PubMed Central

    Cipriano, Federico Enrique Garcia; Arcêncio, Livia; Dessotte, Lycio Umeda; Rodrigues, Alfredo José; Vicente, Walter Villela de Andrade

    2016-01-01

    Background Describe the characteristics of how the thoracic surgeon uses the 2D/3D medical imaging to perform surgical planning, clinical practice and teaching in thoracic surgery and check the initial choice and the final choice of the Brazilian Thoracic surgeon as the 2D and 3D models pictures before and after acquiring theoretical knowledge on the generation, manipulation and interactive 3D views. Methods A descriptive research type Survey cross to data provided by the Brazilian Thoracic Surgeons (members of the Brazilian Society of Thoracic Surgery) who responded to the online questionnaire via the internet on their computers or personal devices. Results Of the 395 invitations visualized distributed by email, 107 surgeons completed the survey. There was no statically difference when comparing the 2D vs. 3D models pictures for the following purposes: diagnosis, assessment of the extent of disease, preoperative surgical planning, and communication among physicians, resident training, and undergraduate medical education. Regarding the type of tomographic image display routinely used in clinical practice (2D or 3D or 2D–3D model image) and the one preferred by the surgeon at the end of the questionnaire. Answers surgeons for exclusive use of 2D images: initial choice =50.47% and preferably end =14.02%. Responses surgeons to use 3D models in combination with 2D images: initial choice =48.60% and preferably end =85.05%. There was a significant change in the final selection of 3D models used together with the 2D images (P<0.0001). Conclusions There is a lack of knowledge of the 3D imaging, as well as the use and interactive manipulation in dedicated 3D applications, with consequent lack of uniformity in the surgical planning based on CT images. These findings certainly confirm in changing the preference of thoracic surgeons of 2D views of technologies for 3D images. PMID:27621874

  5. A nomogram composed of clinicopathologic features and preoperative serum tumor markers to predict lymph node metastasis in early gastric cancer patients

    PubMed Central

    Li, Xue; Zhu, Chen-Jing; Wang, Yi-Gao; Chen, Xiao-Long; Zhang, Wei-Han; Chen, Xin-Zu; Yang, Kun; Liu, Kai; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun

    2016-01-01

    Predicting lymph node metastasis (LNM) accurately is of great importance to formulate optimal treatment strategies preoperatively for patients with early gastric cancer (EGC). This study aimed to explore risk factors that predict the presence of LNM in EGC. A total of 697 patients underwent gastrectomy enrolled in this study, were divided into training and validation set, and the relationship between LNM and other clinicopathologic features, preoperative serum combined tumor markers (CEA, CA19-9, CA125) were evaluated. Risk factors for LNM were identified using logistic regression analysis, and a nomogram was created by R program to predict the possibility of LNM in training set, while receiver operating characteristic (ROC) analysis was applied to assess the predictive value of the nomogram model in validation set. Consequently, LNM was significantly associated with tumor size, macroscopic type, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker. In multivariate logistic regression analysis, factors including of tumor size, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker were demonstrated to be independent risk factors for LNM. Moreover, a predictive nomogram with these independent factors for LNM in EGC patients was constructed, and ROC curve demonstrated a good discrimination ability with the AUC of 0.847 (95% CI: 0.789-0.923), which was significantly larger than those produced in previous studies. Therefore, including of these tumor markers which could be convenient and feasible to obtain from the serum preoperatively, the nomogram could effectively predict the incidence of LNM for EGC patients. PMID:27449100

  6. Resection planning for robotic acoustic neuroma surgery

    NASA Astrophysics Data System (ADS)

    McBrayer, Kepra L.; Wanna, George B.; Dawant, Benoit M.; Balachandran, Ramya; Labadie, Robert F.; Noble, Jack H.

    2016-03-01

    Acoustic neuroma surgery is a procedure in which a benign mass is removed from the Internal Auditory Canal (IAC). Currently this surgical procedure requires manual drilling of the temporal bone followed by exposure and removal of the acoustic neuroma. This procedure is physically and mentally taxing to the surgeon. Our group is working to develop an Acoustic Neuroma Surgery Robot (ANSR) to perform the initial drilling procedure. Planning the ANSR's drilling region using pre-operative CT requires expertise and around 35 minutes' time. We propose an approach for automatically producing a resection plan for the ANSR that would avoid damage to sensitive ear structures and require minimal editing by the surgeon. We first compute an atlas-based segmentation of the mastoid section of the temporal bone, refine it based on the position of anatomical landmarks, and apply a safety margin to the result to produce the automatic resection plan. In experiments with CTs from 9 subjects, our automated process resulted in a resection plan that was verified to be safe in every case. Approximately 2 minutes were required in each case for the surgeon to verify and edit the plan to permit functional access to the IAC. We measured a mean Dice coefficient of 0.99 and surface error of 0.08 mm between the final and automatically proposed plans. These preliminary results indicate that our approach is a viable method for resection planning for the ANSR and drastically reduces the surgeon's planning effort.

  7. Endovascular Preoperative Embolization of Orbital Hemangiopericytoma With n-Butyl Cyanoacrylate Glue

    PubMed Central

    Wallace, Kaitlyn M.; Alaraj, Ali; Aakalu, Vinay K.; Aletich, Victor; Setabutr, Pete

    2014-01-01

    Hemangiopericytoma is an uncommon neoplasm that may present in myriad locations, including the lower extremities, pelvic area, and the head and neck area, including the orbit.1 Orbital hemangiopericytoma is often described as synonymous with orbital solitary fibrous tumor, giant cell angiofibroma, and fibrous histiocytoma, as they all belong to a spectrum of collagen-rich fibroblastic tumors that are often CD34-positive and have overlapping histopathologic features.2 Many cases of orbital hemangiopericytoma have been reported in the literature along with various surgical approaches, long-term outcomes, and techniques to manage recurrence; however, few have discussed preoperative embolization.1,3-5 Intraoperative hemorrhage is a concern in both the congenital and the adult form of these cases6,7 and may be an indication for preoperative embolization. A unique case of preoperative embolization was presented with n-butyl cyanoacrylate for surgical resection of a large orbital hemangiopericytoma in a 58-year-old woman. PMID:24317100

  8. Preoperative preparation of patients with cardiomyopathies in non-cardiac surgery.

    PubMed

    Bradić, Zeljko; Ivanović, Branislava; Marković, Dejan; Simić, Dusica; Janković, Radmilo; Kalezić, Nevena

    2011-01-01

    Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative period. Also, patients with hypertrophic and arrhythmogenic right ventricular cardiomyopathy are prone to arrhythmias in the perioperative period. Preoperative evaluation includes history, physical examination, ECG, chest radiography, complete blood count, electrolytes, creatinine, glomerular filtration rate, glucose, liver enzymes, urin analysis, BNP and echocardiographic evaluation of left ventricular function. Drug therapy should be optimized and continued preoperatively. Surgery should be delayed (unless urgent) in patients with decompensated or untreated cardiomyopathy. Preoperative evaluation requires integrated multidisciplinary approach of anesthesiologists, cardiologist and surgeons.

  9. Preoperative computerized dynamic posturography as a prognostic indicator of balance function in patients with acoustic neuroma.

    PubMed

    Bergson, Eric; Sataloff, Robert T

    2005-03-01

    We conducted a study to determine the prognostic reliability of preoperative computerized dynamic posturography (CDP) in patients undergoing surgical excision of an acoustic neuroma. Our goal was to determine the correlation between objective preoperative assessments of balance function and subjective postoperative patient self-assessments. To that end, we retrospectively reviewed the records of 21 adults who had undergone preoperative CDP, and we subsequently obtained their subjective assessments of balance function by follow-up telephone surveys at least 1 year postoperatively. We conclude that although CDP has proven to be useful in many aspects of balance evaluation, it did not appear to be a valuable predictor of subjective postoperative balance function in these patients.

  10. Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly.

    PubMed

    Iwase, K; Higaki, J; Mikata, S; Tanaka, Y; Yoshikawa, M; Hori, S; Osuga, K; Kosugi, S; Tamaki, T; Kamiike, W

    1999-06-01

    Laparoscopically assisted splenectomy with an 8- to 10-cm left upper paramedian laparotomy was performed following preoperative splenic artery embolization using painless contour emboli (super absorbent polymer microsphere) with early successful results in two men (46 and 37 years old) with myelofibrosis accompanied by massive splenomegaly. Dissection around the lower part of the spleen and the hilum initially was performed intracorporeally with the usual laparoscopic view under 12 mm Hg pneumoperitoneum. The alternating changes of viewpoints between the direct view through an 8- to 10-cm incision and the usual laparoscopic view with or without application of a retraction method were effective for safe hilar devascularization. Preoperative splenic artery embolization at the distal site was effective for safe dissection around the enlarged spleen. The patients did not complain of pain before operation. Preoperative painless embolization and laparoscopically assisted splenectomy with small laparotomy promotes the feasibility and safety of minimally invasive splenectomy for myelofibrosis with massive splenomegaly.

  11. A Preoperative Medical History and Physical Should Not Be a Requirement for All Cataract Patients.

    PubMed

    Schein, Oliver D; Pronovost, Peter J

    2017-03-20

    Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery. We propose that the minority of patients who might benefit from a preoperative medical history and physical can be identified prospectively. Regulatory agencies should not constrain medical practice in a way that adds enormous cost and patient burden in the absence of value.

  12. Preoperative factors affecting the outcome of unruptured posterior circulation aneurysm surgery.

    PubMed

    Eftekhar, Behzad; Morgan, Michael Kerin

    2011-01-01

    We retrospectively investigated preoperative variables contributing to adverse surgical outcome for repair of unruptured posterior circulation aneurysms on data collected prospectively between October 1989 and March 2010. Putative risk factors including age, sex, smoking status, positive family history, modified Rankin Score prior to the surgery, size of the aneurysm, specific site (basilar caput and trunk, vertebral artery and posterior inferior cerebellar artery), midline location, presence of calcium, thrombus or irregularity in the aneurysm on preoperative imaging, associated arteriovenous malformation and preoperative coiling were investigated using regression analyses. In a total of 121 operations, surgical mortality and morbidity was 16.3%. For patients with aneurysms less than 9mm this rate was 3.2%. Among the investigated variables we found that size, calcification of the aneurysm and age were each predictors of surgical outcome of unruptured posterior circulation aneurysms.

  13. Influence of preoperative parenteral alimentation on postoperative growth in adolescent Crohn's disease.

    PubMed

    Lake, A M; Kim, S; Mathis, R K; Walker, W A

    1985-04-01

    The postoperative growth rates achieved in eight early pubertal adolescent males with Crohn's disease undergoing surgery for obstructive complications is reported as a function of the use of 1 month's preoperative central venous alimentation. All patients had ileal strictures with ileocolitis, bone ages less than 13, Tanner stages 1 or 2, and growth velocities below the 3rd percentile for age. During a 3-year follow-up, those receiving preoperative venous alimentation demonstrated greater oral caloric intake (significant for 1 year) and greater postoperative growth velocity (significant for 2 years) in comparison to those patients who did not receive preoperative venous alimentation. There was no significant difference between the two groups of patients in postoperative weight gain, sexual development, and 3-year disease control.

  14. Apparatus for accurately measuring high temperatures

    DOEpatents

    Smith, D.D.

    The present invention is a thermometer used for measuring furnace temperatures in the range of about 1800/sup 0/ to 2700/sup 0/C. The thermometer comprises a broadband multicolor thermal radiation sensor positioned to be in optical alignment with the end of a blackbody sight tube extending into the furnace. A valve-shutter arrangement is positioned between the radiation sensor and the sight tube and a chamber for containing a charge of high pressure gas is positioned between the valve-shutter arrangement and the radiation sensor. A momentary opening of the valve shutter arrangement allows a pulse of the high gas to purge the sight tube of air-borne thermal radiation contaminants which permits the radiation sensor to accurately measure the thermal radiation emanating from the end of the sight tube.

  15. Apparatus for accurately measuring high temperatures

    DOEpatents

    Smith, Douglas D.

    1985-01-01

    The present invention is a thermometer used for measuring furnace temperaes in the range of about 1800.degree. to 2700.degree. C. The thermometer comprises a broadband multicolor thermal radiation sensor positioned to be in optical alignment with the end of a blackbody sight tube extending into the furnace. A valve-shutter arrangement is positioned between the radiation sensor and the sight tube and a chamber for containing a charge of high pressure gas is positioned between the valve-shutter arrangement and the radiation sensor. A momentary opening of the valve shutter arrangement allows a pulse of the high gas to purge the sight tube of air-borne thermal radiation contaminants which permits the radiation sensor to accurately measure the thermal radiation emanating from the end of the sight tube.

  16. LSM: perceptually accurate line segment merging

    NASA Astrophysics Data System (ADS)

    Hamid, Naila; Khan, Nazar

    2016-11-01

    Existing line segment detectors tend to break up perceptually distinct line segments into multiple segments. We propose an algorithm for merging such broken segments to recover the original perceptually accurate line segments. The algorithm proceeds by grouping line segments on the basis of angular and spatial proximity. Then those line segment pairs within each group that satisfy unique, adaptive mergeability criteria are successively merged to form a single line segment. This process is repeated until no more line segments can be merged. We also propose a method for quantitative comparison of line segment detection algorithms. Results on the York Urban dataset show that our merged line segments are closer to human-marked ground-truth line segments compared to state-of-the-art line segment detection algorithms.

  17. Highly accurate articulated coordinate measuring machine

    DOEpatents

    Bieg, Lothar F.; Jokiel, Jr., Bernhard; Ensz, Mark T.; Watson, Robert D.

    2003-12-30

    Disclosed is a highly accurate articulated coordinate measuring machine, comprising a revolute joint, comprising a circular encoder wheel, having an axis of rotation; a plurality of marks disposed around at least a portion of the circumference of the encoder wheel; bearing means for supporting the encoder wheel, while permitting free rotation of the encoder wheel about the wheel's axis of rotation; and a sensor, rigidly attached to the bearing means, for detecting the motion of at least some of the marks as the encoder wheel rotates; a probe arm, having a proximal end rigidly attached to the encoder wheel, and having a distal end with a probe tip attached thereto; and coordinate processing means, operatively connected to the sensor, for converting the output of the sensor into a set of cylindrical coordinates representing the position of the probe tip relative to a reference cylindrical coordinate system.

  18. Practical aspects of spatially high accurate methods

    NASA Technical Reports Server (NTRS)

    Godfrey, Andrew G.; Mitchell, Curtis R.; Walters, Robert W.

    1992-01-01

    The computational qualities of high order spatially accurate methods for the finite volume solution of the Euler equations are presented. Two dimensional essentially non-oscillatory (ENO), k-exact, and 'dimension by dimension' ENO reconstruction operators are discussed and compared in terms of reconstruction and solution accuracy, computational cost and oscillatory behavior in supersonic flows with shocks. Inherent steady state convergence difficulties are demonstrated for adaptive stencil algorithms. An exact solution to the heat equation is used to determine reconstruction error, and the computational intensity is reflected in operation counts. Standard MUSCL differencing is included for comparison. Numerical experiments presented include the Ringleb flow for numerical accuracy and a shock reflection problem. A vortex-shock interaction demonstrates the ability of the ENO scheme to excel in simulating unsteady high-frequency flow physics.

  19. Toward Accurate and Quantitative Comparative Metagenomics

    PubMed Central

    Nayfach, Stephen; Pollard, Katherine S.

    2016-01-01

    Shotgun metagenomics and computational analysis are used to compare the taxonomic and functional profiles of microbial communities. Leveraging this approach to understand roles of microbes in human biology and other environments requires quantitative data summaries whose values are comparable across samples and studies. Comparability is currently hampered by the use of abundance statistics that do not estimate a meaningful parameter of the microbial community and biases introduced by experimental protocols and data-cleaning approaches. Addressing these challenges, along with improving study design, data access, metadata standardization, and analysis tools, will enable accurate comparative metagenomics. We envision a future in which microbiome studies are replicable and new metagenomes are easily and rapidly integrated with existing data. Only then can the potential of metagenomics for predictive ecological modeling, well-powered association studies, and effective microbiome medicine be fully realized. PMID:27565341

  20. Obtaining accurate translations from expressed sequence tags.

    PubMed

    Wasmuth, James; Blaxter, Mark

    2009-01-01

    The genomes of an increasing number of species are being investigated through the generation of expressed sequence tags (ESTs). However, ESTs are prone to sequencing errors and typically define incomplete transcripts, making downstream annotation difficult. Annotation would be greatly improved with robust polypeptide translations. Many current solutions for EST translation require a large number of full-length gene sequences for training purposes, a resource that is not available for the majority of EST projects. As part of our ongoing EST programs investigating these "neglected" genomes, we have developed a polypeptide prediction pipeline, prot4EST. It incorporates freely available software to produce final translations that are more accurate than those derived from any single method. We describe how this integrated approach goes a long way to overcoming the deficit in training data.

  1. Micron Accurate Absolute Ranging System: Range Extension

    NASA Technical Reports Server (NTRS)

    Smalley, Larry L.; Smith, Kely L.

    1999-01-01

    The purpose of this research is to investigate Fresnel diffraction as a means of obtaining absolute distance measurements with micron or greater accuracy. It is believed that such a system would prove useful to the Next Generation Space Telescope (NGST) as a non-intrusive, non-contact measuring system for use with secondary concentrator station-keeping systems. The present research attempts to validate past experiments and develop ways to apply the phenomena of Fresnel diffraction to micron accurate measurement. This report discusses past research on the phenomena, and the basis of the use Fresnel diffraction distance metrology. The apparatus used in the recent investigations, experimental procedures used, preliminary results are discussed in detail. Continued research and equipment requirements on the extension of the effective range of the Fresnel diffraction systems is also described.

  2. Accurate radio positions with the Tidbinbilla interferometer

    NASA Technical Reports Server (NTRS)

    Batty, M. J.; Gulkis, S.; Jauncey, D. L.; Rayner, P. T.

    1979-01-01

    The Tidbinbilla interferometer (Batty et al., 1977) is designed specifically to provide accurate radio position measurements of compact radio sources in the Southern Hemisphere with high sensitivity. The interferometer uses the 26-m and 64-m antennas of the Deep Space Network at Tidbinbilla, near Canberra. The two antennas are separated by 200 m on a north-south baseline. By utilizing the existing antennas and the low-noise traveling-wave masers at 2.29 GHz, it has been possible to produce a high-sensitivity instrument with a minimum of capital expenditure. The north-south baseline ensures that a good range of UV coverage is obtained, so that sources lying in the declination range between about -80 and +30 deg may be observed with nearly orthogonal projected baselines of no less than about 1000 lambda. The instrument also provides high-accuracy flux density measurements for compact radio sources.

  3. Magnetic ranging tool accurately guides replacement well

    SciTech Connect

    Lane, J.B.; Wesson, J.P. )

    1992-12-21

    This paper reports on magnetic ranging surveys and directional drilling technology which accurately guided a replacement well bore to intersect a leaking gas storage well with casing damage. The second well bore was then used to pump cement into the original leaking casing shoe. The repair well bore kicked off from the surface hole, bypassed casing damage in the middle of the well, and intersected the damaged well near the casing shoe. The repair well was subsequently completed in the gas storage zone near the original well bore, salvaging the valuable bottom hole location in the reservoir. This method would prevent the loss of storage gas, and it would prevent a potential underground blowout that could permanently damage the integrity of the storage field.

  4. Preoperative biliary drainage in Perihilar Cholangiocarcinoma: Identifying patients who require percutaneous drainage after failed endoscopic drainage

    PubMed Central

    Wiggers, Jimme K; Koerkamp, Bas Groot; Coelen, Robert J; Rauws, Erik A; Schattner, Mark A; Nio, C Yung; Brown, Karen T; Gonen, Mithat; van Dieren, Susan; van Lienden, Krijn P; Allen, Peter J; Besselink, Marc GH; Busch, Olivier RC; D’Angelica, Michael I; DeMatteo, Robert P; Gouma, Dirk J; Kingham, T Peter; Jarnagin, William R; van Gulik, Thomas M

    2016-01-01

    Background and study aims Preoperative biliary drainage is often initiated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with potentially resectable perihilar cholangiocarcinoma (PHC), but additional percutaneous transhepatic catheter (PTC) drainage is frequently required. This study aimed to develop and validate a prediction model to identify patients with a high risk of inadequate ERCP drainage. Patients and Methods Patients with potentially resectable PHC and preoperative (attempted) ERCP drainage were included from two specialty center cohorts between 2001 and 2013. Indications for additional PTC drainage were failure to place an endoscopic stent, failure to relieve jaundice, cholangitis, or insufficient drainage of the future liver remnant. A prediction model was derived from the European cohort and externally validated in the USA cohort. Results 108 of 288 patients (38%) required additional preoperative PTC after inadequate ERCP drainage. Independent risk factors for additional PTC were proximal biliary obstruction on preoperative imaging (Bismuth 3 or 4) and pre-drainage total bilirubin level. The prediction model identified three subgroups: patients with a low risk of 7%, a moderate risk of 40%, and a high risk of 62%. The high-risk group consisted of patients with a total bilirubin level above 150 μmol/L and Bismuth 3a or 4 tumours, who typically require preoperative drainage of the angulated left bile ducts. The prediction model had good discrimination (AUC 0.74) and adequate calibration in the external validation cohort. Conclusions Selected patients with potentially resectable PHC have a high risk (62%) of inadequate preoperative ERCP drainage requiring additional PTC. These patients might do better with initial PTC instead of ERCP. PMID:26382308

  5. Perioperative Complications of Total En Bloc Spondylectomy: Adverse Effects of Preoperative Irradiation

    PubMed Central

    Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Hayashi, Hiroyuki; Ishii, Takayoshi; Igarashi, Takashi; Fang, Xiang; Tsuchiya, Hiroyuki

    2014-01-01

    Background Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. We examined the perioperative complications associated with TES in patients receiving preoperative irradiation. Methods Seventy-seven patients underwent TES between May 2010 and April 2013. We performed a retrospective review of prospectively collected data for 50 patients with metastatic tumors of the thoracic spine, excluding patients with primary spinal tumors, lumbar spinal metastasis, and combined anterior and posterior approach TES. Patients were divided into 2 groups: those with preoperative irradiation (RT-TES group, 18 patients) and those without preoperative irradiation (TES group, 32 patients). The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits. Results Significant differences in patient characteristics were not observed between the RT-TES and TES groups. Perioperative TES complications occurred in 20/50 patients (40.0%). The complication rate in the RT-TES group was 77.8% (14 out of 18), threefold higher than the 18.8% (6 out of 32) in the TES group (P<0.01). The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01). Conclusion The perioperative complication rate associated with TES for spinal metastasis was significantly higher among patients receiving preoperative irradiation than among those not receiving preoperative irradiation. PMID:24893004

  6. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies.

    PubMed

    Benzo, Roberto; Wigle, Dennis; Novotny, Paul; Wetzstein, Marnie; Nichols, Francis; Shen, Robert K; Cassivi, Steve; Deschamps, Claude

    2011-12-01

    Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no randomized study has been published to date. We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a randomized single blinded design. Outcomes were length of hospital stay and postoperative complications. The first study tested 4 weeks of guideline-based PR vs. usual care: that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery. Nine patients were randomized and no differences were found between arms. The second study tested ten preoperative PR sessions using a customized protocol with nonstandard components (exercise prescription based on self efficacy, inspiratory muscle training, and the practice of slow breathing) (n=10) vs. usual care (n=9). The PR arm had shorter length of hospital stay by 3 days (p=0.058), fewer prolonged chest tubes (11% vs. 63%, p=0.03) and fewer days needing a chest tube (8.8 vs. 4.3 days p=0.04) compared to the controlled arm. A ten-session preoperative PR intervention may improve post operative lung reexpansion evidenced by shorter chest tube times and decrease the length of hospital stay, a crude estimator of post operative morbidity and costs. Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection. 4 weeks of conventional preoperative PR seems non feasible.

  7. Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter

    SciTech Connect

    Gavioli, Margherita Losi, Lorena; Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica; Falchi, Anna Maria; Bertoni, Filippo; Natalini, Gianni

    2007-10-01

    Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible.

  8. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism

    PubMed Central

    Lee, Jae Bok; Kim, Woo Young

    2015-01-01

    Purpose The role of preoperative localization studies is controversial in surgery of secondary hyperparathyroidism (sHPT). The aim of study was to evaluate the accuracy of preoperative ultrasonography (USG), CT, and 99mTc sestamibi scintigraphy (MIBI) in localizing enlarged parathyroid glands and to find the impact of correct localization in successful parathyroidectomy. Methods We compared operative findings with the preoperative localization of ultrasonography, computerized tomography and sestamibi scintigraphy in 109 patients with sHPT and identified well-visualized locations of abnormal parathyroid glands by evaluating the sensitivity of each imaging study with regard to typical locations of glands. We investigated the effect of preoperative imaging localization on the surgical outcomes by measuring the intraoperative parathyroid hormone (ioPTH) decrement for positive or negative imaging localization. Results USG (91.5%) had the highest sensitivity and MIBI (56.1%) had the lowest among 3 modalities. The sensitivity of combined USG and CT (95.0%) was the highest among combined 2 modalities. The combination of all 3 modalities (95.4%) had the highest sensitivity among the combinations of modalities. The reduction of ioPTH in patients with positive imaging localization (86.6%) was greater than negative imaging localization (84.2%), with no significant difference (P = 0.586). The recurrence or persistence of sHPT was not correlated with preoperative imaging localization (19 patients in negative, 16 in positive; P = 0.14). Conclusion Preoperative imaging localization contributed to surgical success but not to surgical outcomes. The combination of ioPTH measurement with imaging localization might be valuable for better surgical results in sHPT. PMID:26665124

  9. Evaluation of Preoperative and Intraoperative RBC Transfusion Practices at Maputo Central Hospital, Mozambique

    PubMed Central

    Burke, Zachary; Chen, James; Conceicao, Celson; Hoffman, Risa; Miller, Lee; Taela, Atanasio; DeUgarte, Daniel

    2013-01-01

    BACKGROUND The purpose of this study was to evaluate preoperative and intraoperative blood transfusion practices in Hospital Central (Maputo, Mozambique) and estimate the number of potentially avoidable transfusions. STUDY DESIGN AND METHODS A retrospective cohort study was performed. Age, comorbidities, hemoglobin, the potential for blood loss, and units of packed red blood cell (RBC) transfusions were recorded. Preoperative transfusions were evaluated to determine whether they met criteria established by the Mozambican Ministry of Health as well as proposed guidelines based on more restrictive protocols. Avoidable blood transfusions were defined as those preoperative transfusions that were not indicated based on these guidelines. Multivariate logistic regression was used to identify factors that predicted transfusion. RESULTS Two-hundred and five patients (age range: 0.1 - 86 years) underwent surgery in the main operating room during the two-week study period. Overall, thirty-five (17%) patients received sixty-eight transfusions. Of these, thirty-six transfusions were given preoperatively and thirty-two were given intraoperatively. Thirty-six percent of preoperative transfusions were avoidable according to national guidelines. Ninety-two percent were avoidable using more restrictive guidelines. The primary predictors of preoperative blood transfusion were lower hemoglobin (odd's ratio 0.390 / 1 g/dl; p<0.0001) and the potential for blood loss (odd's ratio 3.73; p=0.0410). CONCLUSIONS Adherence to existing hemoglobin thresholds recommended by national blood transfusion guidelines could significantly reduce the number of transfusions and the association risk of transfusion-transmissible infections. Adoption of more restrictive guidelines is recommended to further improve blood transfusion utilization and further reduce the transmission risk of HIV and hepatitis. PMID:23692441

  10. The high cost of accurate knowledge.

    PubMed

    Sutcliffe, Kathleen M; Weber, Klaus

    2003-05-01

    Many business thinkers believe it's the role of senior managers to scan the external environment to monitor contingencies and constraints, and to use that precise knowledge to modify the company's strategy and design. As these thinkers see it, managers need accurate and abundant information to carry out that role. According to that logic, it makes sense to invest heavily in systems for collecting and organizing competitive information. Another school of pundits contends that, since today's complex information often isn't precise anyway, it's not worth going overboard with such investments. In other words, it's not the accuracy and abundance of information that should matter most to top executives--rather, it's how that information is interpreted. After all, the role of senior managers isn't just to make decisions; it's to set direction and motivate others in the face of ambiguities and conflicting demands. Top executives must interpret information and communicate those interpretations--they must manage meaning more than they must manage information. So which of these competing views is the right one? Research conducted by academics Sutcliffe and Weber found that how accurate senior executives are about their competitive environments is indeed less important for strategy and corresponding organizational changes than the way in which they interpret information about their environments. Investments in shaping those interpretations, therefore, may create a more durable competitive advantage than investments in obtaining and organizing more information. And what kinds of interpretations are most closely linked with high performance? Their research suggests that high performers respond positively to opportunities, yet they aren't overconfident in their abilities to take advantage of those opportunities.

  11. Intraocular lens power estimation by accurate ray tracing for eyes underwent previous refractive surgeries

    NASA Astrophysics Data System (ADS)

    Yang, Que; Wang, Shanshan; Wang, Kai; Zhang, Chunyu; Zhang, Lu; Meng, Qingyu; Zhu, Qiudong

    2015-08-01

    For normal eyes without history of any ocular surgery, traditional equations for calculating intraocular lens (IOL) power, such as SRK-T, Holladay, Higis, SRK-II, et al., all were relativley accurate. However, for eyes underwent refractive surgeries, such as LASIK, or eyes diagnosed as keratoconus, these equations may cause significant postoperative refractive error, which may cause poor satisfaction after cataract surgery. Although some methods have been carried out to solve this problem, such as Hagis-L equation[1], or using preoperative data (data before LASIK) to estimate K value[2], no precise equations were available for these eyes. Here, we introduced a novel intraocular lens power estimation method by accurate ray tracing with optical design software ZEMAX. Instead of using traditional regression formula, we adopted the exact measured corneal elevation distribution, central corneal thickness, anterior chamber depth, axial length, and estimated effective lens plane as the input parameters. The calculation of intraocular lens power for a patient with keratoconus and another LASIK postoperative patient met very well with their visual capacity after cataract surgery.

  12. Preoperative albumin level is a marker of alveolar echinococcosis recurrence after hepatectomy

    PubMed Central

    Joliat, Gaëtan-Romain; Labgaa, Ismail; Demartines, Nicolas; Halkic, Nermin

    2017-01-01

    AIM To identify a preoperative blood marker predictive of alveolar echinococcosis (AE) recurrence after hepatectomy. METHODS All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital (CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume (MCV), red blood cell distribution width (RDW), thrombocytes, C-reactive protein (CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic (ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrence-free survival curves were calculated using the Kaplan-Meier method. RESULTS The cohort included 68 adult patients (37 females) with median age of 61 years [interquartile range (IQR): 46-71]. Eight of the patients (12%) presented a recurrence over a median follow-up time of 76 mo (IQR: 34-128). Median time to recurrence was 10 mo (IQR: 6-11). Median preoperative leukocyte, MCV, RDW, thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L (IQR: 41-45) for non-recurrent cases and 36 g/L (IQR: 33-42) for recurrent cases (P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840 (95%CI: 0.642-1, P = 0.002). The cut-off albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence (HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively). CONCLUSION Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up. PMID:28223729

  13. Computed tomography evaluation of the adrenal gland in the preoperative assessment of bronchogenic carcinoma

    SciTech Connect

    Sandler, M.A.; Pearlberg, J.L.; Madrazo, B.L.; Gitschlag, K.F.; Gross, S.C.

    1982-12-01

    One hundred ten patients with proved bronchogenic carcinoma who were undergoing computed tomography (CT) of the thorax also underwent CT of the adrenals to determine the value of routine preoperative assessement of this gland. Sixteen adrenal masses were found in 11 patients. In five patients the adrenals were the only site of metastasis. CT of the adrenals should be performed routinely when the thorax is examined pre-operatively in patients with non-oat-cell bronchogenic carcinoma to improve patient selection for thoractomy.

  14. Complications associated with preoperative radiation therapy and Iodine-125 brachytherapy for localized prostatic carcinoma

    SciTech Connect

    Flanigan, R.C.; Patterson, J.; Mendiondo, O.A.; Gee, W.F.; Lucas, B.A.; McRoberts, J.W.

    1983-08-01

    Twenty-five consecutive patients with localized adenocarcinoma of the prostate treated with 1,050 rad preoperative radiation therapy and Iodine-125 seed brachytherapy are reviewed. Significant long-term postoperative complications included radiation cystitis (12%), radiation proctitis (4%), genital and leg edema (12%), stress incontinence (8%), total incontinence (4%), and impotence (26%). Complications occurred in 75 per cent of patients who received additional postoperative radiation. Improved staging with CT scan, lymphangiography, and Chiba needle biopsy of any possibly abnormal lymph nodes provided excellent preoperative staging with only 1 patient (6%) upstaged at surgery to Stage D1.

  15. Stage I carcinoma of the endometrium: a 5-year experience utilizing preoperative cesium

    SciTech Connect

    Belinson, J.L.; Spirou, B.; McClure, M.; Badger, G.; Pretorius, R.G.; Roland, T.A.

    1985-03-01

    A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.

  16. 3D soft tissue predictions with a tetrahedral mass tensor model for a maxillofacial planning system: a quantitative validation study

    NASA Astrophysics Data System (ADS)

    Mollemans, W.; Schutyser, F.; Nadjmi, N.; Maes, F.; Suetens, P.

    2006-03-01

    In this paper we present an extensive quantitative validation on 3D facial soft tissue simulation for maxillofacial surgery planning. The study group contained 10 patients. In previous work we presented a new Mass Tensor Model to simulate the new facial appearance after maxillofacial surgery in a fast way. 10 patients were preoperatively CT-scanned and the surgical intervention was planned. 4 months after surgery, a post-operative control CT was acquired. In this study, the simulated facial outlook is compared with post-operative image data. After defining corresponding points between the predicted and actual post-operative facial skin surface, using a variant of the non-rigid TPS-RPM algorithm, distances between these correspondences are quantified and visualized in 3D. As shown, the average median distance measures only 0.60 mm and the average 90% percentile stays below 1.5 mm. We can conclude that our model clearly provides an accurate prediction of the real post-operative outcome and is therefore suitable for use in clinical practice.

  17. Approaching system equilibrium with accurate or not accurate feedback information in a two-route system

    NASA Astrophysics Data System (ADS)

    Zhao, Xiao-mei; Xie, Dong-fan; Li, Qi

    2015-02-01

    With the development of intelligent transport system, advanced information feedback strategies have been developed to reduce traffic congestion and enhance the capacity. However, previous strategies provide accurate information to travelers and our simulation results show that accurate information brings negative effects, especially in delay case. Because travelers prefer to the best condition route with accurate information, and delayed information cannot reflect current traffic condition but past. Then travelers make wrong routing decisions, causing the decrease of the capacity and the increase of oscillations and the system deviating from the equilibrium. To avoid the negative effect, bounded rationality is taken into account by introducing a boundedly rational threshold BR. When difference between two routes is less than the BR, routes have equal probability to be chosen. The bounded rationality is helpful to improve the efficiency in terms of capacity, oscillation and the gap deviating from the system equilibrium.

  18. Preoperative Ultrasound Guided Fine Needle Aspiration Cytology of Ovarian Lesions- Is It a Rapid and Effective Diagnostic Modality?

    PubMed Central

    Datta, Saikat; Chaudhuri, Snehamay; Paul, Prabir Chandra; Khandakar, Binny; Mandal, Sonali

    2016-01-01

    Introduction The deep seated ovarian lesions unapproachable by unguided aspiration cytology were easily done under ultrasound guidance. It gave a before hand cytological diagnosis of the lesion to the surgeon determining the modality of treatment for the patient. Aim To find the diagnostic accuracy of the method of ultrasound guided cytological assessment of ovarian lesion. Materials and Methods The study was conducted as a prospective observational study over a period of one year, in hospital setting, where ultrasound guided fine needle aspiration had been used to aspirate ovarian lesions, giving a rapid cytological diagnosis. In 43 sample cases, aspiration of fluid done from ovarian lesions were followed by cyto-centrifugation and staining by May-Grunwald-Giemsa (MGG) and Papanicolaou (Pap) stain providing a cytological opinion regarding benign/malignant nature of the lesion and further categorization. Later the cytological diagnosis was compared with final histopathological diagnosis, taking it as a gold standard. Results The overall sensitivity, specificity, and diagnostic accuracy of ultrasound guided aspiration and cytological analysis were high, 96%, 76.92% and 89.47% respectively as calculated by comparing the cytological diagnosis with histological diagnosis, taking it as gold standard. Conclusion This method has evolved as a highly sensitive, rapid, simple and effective modality for screening and as well as accurate preoperative diagnosis of ovarian lesions. PMID:27134878

  19. How accurately can 21cm tomography constrain cosmology?

    NASA Astrophysics Data System (ADS)

    Mao, Yi; Tegmark, Max; McQuinn, Matthew; Zaldarriaga, Matias; Zahn, Oliver

    2008-07-01

    There is growing interest in using 3-dimensional neutral hydrogen mapping with the redshifted 21 cm line as a cosmological probe. However, its utility depends on many assumptions. To aid experimental planning and design, we quantify how the precision with which cosmological parameters can be measured depends on a broad range of assumptions, focusing on the 21 cm signal from 6accurate yet robust method for measuring cosmological parameters that exploits the fact that the ionization power spectra are rather smooth functions that can be accurately fit by 7 phenomenological parameters. We find that for future experiments, marginalizing over these nuisance parameters may provide constraints almost as tight on the cosmology as if 21 cm tomography measured the matter power spectrum directly. A future square kilometer array optimized for 21 cm tomography could improve the sensitivity to spatial curvature and neutrino masses by up to 2 orders of magnitude, to ΔΩk≈0.0002 and Δmν≈0.007eV, and give a 4σ detection of the spectral index running predicted by the simplest inflation models.

  20. Preoperative Short-Course Concurrent Chemoradiation Therapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer: A Phase 2 Multicenter Study (KROG 10-01)

    SciTech Connect

    Yeo, Seung-Gu; Oh, Jae Hwan; Kim, Dae Yong; Baek, Ji Yeon; Kim, Sun Young; Park, Ji Won; Kim, Min Ju; Chang, Hee Jin; Kim, Tae Hyun; Lee, Jong Hoon; Jang, Hong Seok; Kim, Jun-Gi; Lee, Myung Ah; Nam, Taek-Keun

    2013-05-01

    Purpose: A prospective phase 2 multicenter trial was performed to investigate the efficacy and safety of preoperative short-course concurrent chemoradiation therapy (CRT) followed by delayed surgery for patients with locally advanced rectal cancer. Methods and Materials: Seventy-three patients with cT3-4 rectal cancer were enrolled. Radiation therapy of 25 Gy in 5 fractions was delivered over 5 consecutive days using helical tomotherapy. Concurrent chemotherapy was administered on the same 5 days with intravenous bolus injection of 5-fluorouracil (400 mg/m{sup 2}/day) and leucovorin (20 mg/m{sup 2}/day). After 4 to 8 weeks, total mesorectal excision was performed. The primary endpoint was the pathologic downstaging (ypStage 0-I) rate, and secondary endpoints included tumor regression grade, tumor volume reduction rate, and toxicity. Results: Seventy-one patients completed the planned preoperative CRT and surgery. Downstaging occurred in 20 (28.2%) patients, including 1 (1.4%) with a pathologic complete response. Favorable tumor regression (grade 4-3) was observed in 4 (5.6%) patients, and the mean tumor volume reduction rate was 62.5 ± 21.3%. Severe (grade ≥3) treatment toxicities were reported in 27 (38%) patients from CRT until 3 months after surgery. Conclusions: Preoperative short-course concurrent CRT followed by delayed surgery for patients with locally advanced rectal cancer demonstrated poor pathologic responses compared with conventional long-course CRT, and it yielded considerable toxicities despite the use of an advanced radiation therapy technique.

  1. Preoperative Chemotherapy in Patients With Intermediate-Risk Rectal Adenocarcinoma Selected by High-Resolution Magnetic Resonance Imaging: The GEMCAD 0801 Phase II Multicenter Trial

    PubMed Central

    Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V.; Santos, Jesus; Pericay, Carles

    2014-01-01

    Background. The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. Methods. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). Results. On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%–89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9–33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%–85%), and the 2-year local relapse rate was 2% (95% CI: 0%–11%). Conclusion. In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. PMID:25209376

  2. Preoperative factors affecting length of stay after elective ACDF with and without corpectomy: a multivariate analysis of an academic center cohort

    PubMed Central

    Basques, Bryce A.; Bohl, Daniel D.; Golinvaux, Nicholas S.; Gruskay, Jordan A.; Grauer, Jonathan N.

    2014-01-01

    Study Design Retrospective cohort study of 183 patients who underwent elective anterior cervical discectomy and fusion (ACDF) at a single institution over a two-year period. Objective To determine which preoperative factors were independently associated with a prolonged hospital length of stay (LOS) following ACDF. Summary of Background Data ACDF has become the most common treatment modality for addressing cervical spine pathology. Extended LOS following ACDF is associated with increased costs and complications. There is a lack of conclusive data for factors affecting LOS after ACDF. This study aims to create a multivariate model to determine the association of various patient and operative characteristics with LOS after ACDF. Methods Patients who underwent elective ACDF at a single academic institution between January 2011 and February 2013 were identified using billing records. Their charts were reviewed to collect variables available preoperatively such as patient demographics, comorbidities, and surgery planned. Patients were categorized as normal or extended LOS, with extended LOS defined as LOS > 75th percentile. A multivariate logistic regression was used to determine which factors were independently associated with extended LOS. Results A total of 183 ACDF patients were identified. The average LOS for this cohort was 2.0 ± 2.5 days (Mean ± Standard Deviation). Extended LOS was defined as ≥ 3 days. Multivariate analysis revealed that preoperative factors independently associated with extended LOS were history of non-spinal malignancy (Odds Ratio [OR] = 4.9), history of pulmonary disease (OR = 4.0), and procedures that included corpectomy (OR = 4.5). Conclusion Patients with a history of non-spinal malignancy or pulmonary disease, as well as patients who underwent corpectomy, were more likely to have an extended LOS (ORs 4.0–4.9). Of significant note, other factors that one might expect to be associated with extended LOS did not independently predict

  3. Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

    SciTech Connect

    Landman, Joanne; Kulawansa, Sagarika; McCarthy, Michael; Troedson, Russell; Phillips, Michael; Tinning, Jill; Taylor, Donna

    2015-03-15

    Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL. Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins. Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases. ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

  4. The Value of High-Resolution MRI Technique in Patients with Rectal Carcinoma: Pre-Operative Assessment of Mesorectal Fascia Involvement, Circumferential Resection Margin and Local Staging

    PubMed Central

    Algebally, Ahmed Mohamed; Mohey, Nesreen; Szmigielski, Wojciech; Yousef, Reda Ramadan Hussein; Kohla, Samah

    2015-01-01

    Summary Background The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. Material/Methods The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. Results The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Conclusions Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery. PMID:25806096